1
|
Brindisino F, Sciscione S, Andriesse A, Cioeta M, Struyf F, Feller D. Frozen shoulder: subjects' needs and perspectives and clinicians' beliefs and management strategies: do they align? A cross-sectional study. BMC Musculoskelet Disord 2024; 25:745. [PMID: 39289654 PMCID: PMC11406753 DOI: 10.1186/s12891-024-07803-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVE Physiotherapists (PTs) play a crucial role in managing individuals with Frozen Shoulder (FS), frequently being the first healthcare professionals involved in the treatment of this condition. AIM This study aimed to compare the beliefs, expectations, and perspectives of individuals with FS with the knowledge, skills, and strategies of PTs, highlighting similarities and differences. METHOD This study adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). From May 1st to August 1st, 2023, a two-part survey was conducted involving PTs and individuals diagnosed with FS. The survey focused on comparing key areas such as clinical assessment, patient education, treatment expectations, and the psychological aspects of the patient-clinician relationship. RESULTS A total of 501 PTs and 110 subjects with FS participated in the survey. Most PTs showed proficiency in FS pathoanatomical conditions and were also attentive to psychological aspects (88.4%), describing the pathology evolution in three or two stages (68.2%). They also highlighted the importance of patient education (89.6%) and recognized the potential benefits of a multiprofessional collaboration in managing FS (82.2%). Reassurance was reported as a priority by 32.3% of PTs. Subjects with FS expressed a preference for PTs who are both expert and empathetic (73.6%). Regarding their understanding of FS, 29.09% of subjects reported receiving a three-phase explanation, while 26.36% felt inadequately informed. Nearly half of the subjects (49.09%) anticipated being managed independently by a PT, with 93.64% prioritizing the improvement of their range of motion. CONCLUSION This study revealed a general agreement between subjects with FS and PTs regarding aspects of the therapeutic relationship, patient education, pathology management, compliance and motivation strategies, and pain management preferences. However, significant differences emerged concerning the perception of physiotherapy effectiveness, primary treatment goals, subjects' priorities, and the importance of psychological assessment.
Collapse
Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | | | - Arianna Andriesse
- Medical Translation Private Practice c/o Andriesse Medical Translator, Lecce, Italy
| | | | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Daniel Feller
- Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy
- Centre of Higher Education for Health Sciences of Trento, Trento, Italy
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Sirignano M, Nyland J, Krupp R. Subacromial balloon spacer massive rotator cuff tear treatment systematic review and meta-analysis: Patient selection and physical therapy may be keys to outcome success. Knee Surg Sports Traumatol Arthrosc 2024; 32:2346-2357. [PMID: 38922784 DOI: 10.1002/ksa.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Subacromial balloon spacer implantation (SBSI) efficacy for massive rotator cuff tear treatment was evaluated based on perceived shoulder function, active shoulder mobility, pain, complications and research study methodological quality. The purpose was to better discern the efficacy of this device from both surgical and rehabilitative perspectives to improve patient outcomes. METHODS PubMed, EMBASE and Cochrane Library databases were searched (1 January 2010 to 1 June 2024) using 'balloon spacer', 'subacromial spacer', 'subacromial balloon spacer', 'shoulder spacer' and 'inspace' terms. Pre-surgery (baseline), 12-month (12-m) and 24-month (24-m) post-SBSI mean changes were compared using one-way ANOVA and Scheffe post hoc tests, and comparative study effect sizes were calculated (p ≤ 0.05). RESULTS This review consists of 27 studies with 894 patients (67.8 ± 5 years of age) and 29.4 ± 17-month follow-up. Modified Coleman Methodology Scores (MCMS) revealed fair overall quality (mean = 61.4 ± 11). Constant-Murley scores improved from 34.8 ± 6 (baseline), to 64.2 ± 9 (12-m) and 67.9 ± 8 (24-m) (12-m, 24-m > baseline, p < 0.001). ASES scores improved from 35.1 ± 14 (baseline), to 83.3 ± 7 (12-m) and 81.8 ± 5 (24-m)(12-m, 24-m > baseline, p < 0.001). VAS pain scores improved from 6.6 ± 1 (baseline), to 2.6 ± 1 (12-m) and 2.0 ± 1 (24-m) (12-m, 24-m < baseline, p < 0.001). Flexion increased from 108.5 ± 25° (baseline), to 128.5 ± 30° (12-m) and 151.2 ± 14° (24-m) (24-m > 12-m, baseline, p = 0.01). Abduction increased from 97.7 ± 24° (baseline) to 116.3 ± 23° (12-m) and 142.3 ± 15° (24-m) (24-m > 12-m, baseline, p = 0.02). External rotation (ER) in adduction changed from 33.1 ± 7° (baseline) to 32.5 ± 4° (12-m) and 53.9 ± 9° (24-m)(24-m > 12-m, baseline, p = 0.01). ER at 90° abduction increased from 56.3 ± 3° (baseline) to 83.5 ± 5° (12-m) and 77.1 ± 4° (24-m) (24-m, 12-m > baseline, p = 0.01). Comparison studies, however, displayed insignificant results with small effect sizes. CONCLUSION Despite overall fair MCMS scores, at 24-m post-SBSI, shoulder function improved and pain decreased. More rigorous comparative studies, however, revealed insignificant findings. Patients with the potential to re-establish the essential glenohumeral joint force couple that depresses the humeral head on the glenoid fossa and who comply with physical therapy may be more likely to achieve success following SBSI. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Michael Sirignano
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - John Nyland
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
- Norton Orthopaedic Institute, Louisville, Kentucky, USA
| | - Ryan Krupp
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
- Norton Orthopaedic Institute, Louisville, Kentucky, USA
| |
Collapse
|
3
|
Li J, Xiao C, Li T, Duan Y, Jiang Y, Shi L, Hong X, Geng W, Hu J, Wang Y, Dai B, Cao J, Wei J. Treatment expectations of patients and clinicians: a cross-sectional study. Front Psychiatry 2024; 15:1447405. [PMID: 39238937 PMCID: PMC11374636 DOI: 10.3389/fpsyt.2024.1447405] [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: 06/11/2024] [Accepted: 07/30/2024] [Indexed: 09/07/2024] Open
Abstract
Importance Understanding treatment expectations of patients and their clinicians is of great importance in improving personalized medical services and enhancing patient safety systems. Objective To investigate treatment expectations of patients and their clinicians and compare differences between both, by using a pair of validated structured assessment tools covering three key aspects/dimensions of clinical interests. Design setting and participants This single-center cross-sectional study was conducted at Peking Union Medical College Hospital in China. The study enrolled patients aged 16 years and older receiving inpatient care and their clinicians. Patient recruitment was conducted from March 2023 to November 2023. Assessments In addition to demographic and clinical characteristics, this study employed two validated structured assessment tools to evaluate treatment expectations among patients and their clinicians: the Hospitalized Patients' Expectations for Treatment Scale-Patient version (HOPE-P) and its counterpart, the Hospitalized Patients' Expectations for Treatment Scale-Clinician version (HOPE-C). Results A total of 233 patients (mean [SD] age, 52.3 [15.1] years; 108 [46.4%] female) along with their clinicians, who numbered 75 in total were enrolled in this study. The distribution of total scores for HOPE-P and HOPE-C displayed similar patterns, with most scores concentrated in the higher range (above 50% of the full score). The mean HOPE-P total score was higher than that of HOPE-C (mean [SD] score, 38.78 [4.86] vs 37.49 [4.32]; t = 3.12, P = 0.002). In Dimension 2, the HOPE-P score was higher than HOPE-C (23.67 [3.20] vs 21.72 [3.03]; t = 6.98, P < 0.001). However, in Dimensions 1 and 3, HOPE-P scored lower than HOPE-C (13.37 [2.44] vs 13.84 [1.73]; t = -2.384, P < 0.018; 1.74 [1.14] vs 1.94 [1.00]; t = -2.00, P = 0.047). Certain demographic and clinical characteristics led to variations in patients' treatment expectations, including marital status, monthly family income, and smoking history. Conclusions and relevance This cross-sectional study revealed significant differences between patients' and doctors' treatment expectations. Notably, it highlighted the need for clinicians to focus on rationalizing patients' expectations concerning treatment outcomes. Trial Registration Chinese Clinical Trial Registry Identifier ChiCTR2300075262.
Collapse
Affiliation(s)
- Jiarui Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chunfeng Xiao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tao Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yanping Duan
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yinan Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lili Shi
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xia Hong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenqi Geng
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaojiao Hu
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yufei Wang
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bindong Dai
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
4
|
Mancuso CA, Duculan R, Cammisa FP, Sama AA, Hughes AP, Lebl DR, Girardi FP. Associations between surgeons' preoperative expectations of lumbar surgery and patient-reported 2-year outcomes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08368-6. [PMID: 38910167 DOI: 10.1007/s00586-024-08368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/15/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE Surgeons' preoperative expectations of lumbar surgery may be associated with patient-reported postoperative outcomes. METHODS Preoperatively spine surgeons completed a validated Expectations Survey for each patient estimating amount of improvement expected (range 0-100). Preoperative variables were clinical characteristics, spine-specific disability (ODI), and general health (RAND-12). Two years postoperatively patients again completed these measures and global assessments of satisfaction. Surgeons' expectations were compared to preoperative variables and to clinically important pre- to postoperative changes (MCID) in ODI, RAND-12, and pain and to satisfaction using hierarchical models. RESULTS Mean expectations survey score for 402 patients was a 57 (IQR 44-68) reflecting moderate expectations. Lower scores were associated with preoperative older age, abnormal gait, sensation loss, vacuum phenomena, foraminal stenosis, prior surgery, and current surgery to more vertebrae (all p ≤ .05). Lower scores were associated postoperatively with not attaining MCID for the ODI (p = .02), RAND-12 (p = .01), and leg pain (p = .01). There were no associations between surgeons' scores and satisfaction (p = .06-.27). 55 patients (14%) reported unfavorable global outcomes and were more likely to have had fracture/infection/repeat surgery (OR 3.2, CI 1.6-6.7, p = .002). CONCLUSION Surgeons' preoperative expectations were associated with patient-reported postoperative improvement in symptoms and function, but not with satisfaction. These findings are consistent with clinical practice in that surgeons expect some but not complete improvement from surgery and do not anticipate that any particular patient will have markedly unfavorable satisfaction ratings. In addition to preoperative discussions about expectations, patients and surgeons should acknowledge different types of outcomes and address them jointly in postoperative discussions.
Collapse
Affiliation(s)
- Carol A Mancuso
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.
- Weill Cornell Medical College, New York, NY, USA.
| | - Roland Duculan
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Frank P Cammisa
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Andrew A Sama
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Alexander P Hughes
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Darren R Lebl
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Federico P Girardi
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| |
Collapse
|
5
|
Karpinski K, Plachel F, Gerhardt C, Saier T, Tauber M, Auffarth A, Paksoy A, Akgün D, Moroder P. Comparison of Patients' and Surgeons' Expectations before Shoulder Arthroplasty. J Clin Med 2024; 13:3489. [PMID: 38930018 PMCID: PMC11204657 DOI: 10.3390/jcm13123489] [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: 03/26/2024] [Revised: 05/20/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Patients suffering from osteoarthritis particularly complain about pain during day and night as well as loss of function. This consequently leads to impaired quality of life and therefore psychological stress. The surgical therapy of choice is joint replacement. Regarding the outcome after operation, expectations might differ between the patient and the surgeon. This can lead to dissatisfaction on both sides. This study aimed to document patients' expectations of a planned shoulder joint replacement. The results were compared with assessments made by shoulder surgeons. Methods: In total, 50 patients scheduled for operative shoulder joint replacement were included in this study, as well as 10 shoulder surgeons. Patients were requested to fill out questionnaires preoperatively to provide sociodemographic data, PROMS (Patient-Reported Outcome Measures) with regard to the pathology and their expectations about surgery in terms of pain relief, gain of range of motion, strength as well as the impact on activities of daily and professional life and sports. In addition, surgeons were asked what they thought their patients expect. Results: The most important goal to achieve for patients was to relieve daytime pain, followed by improvement of self-care and the ability to reach above shoulder level. The most important factors for patients to achieve after operation were 'pain relief' in first place, 'movement' in second and 'strength' in third. This also applied to shoulder surgeons, who ranked 'pain relief' first, followed by 'movement' and 'strength'. When patients where asked what is most important when it comes to choosing their surgeon, 68% voted for 'surgical skills', 28% for 'age/experience', followed by 'empathy', 'sympathy' and 'appearance'. For surgeons, 'age/experience' obtained rank one, 'surgical skills' was ranked second, followed by 'sympathy', 'empathy' and 'appearance'. Surgeons significantly underrated the factor 'empathy' in favor of 'sympathy'. Conclusions: This study shows that patients' expectations for shoulder joint replacement and surgeons' assessments do not differ significantly. Relief from pain and better shoulder movement were crucial for patients to achieve after operation, which was in line with surgeons' expectations. The most important factor for choosing the surgeon was 'surgical skills' for patients, while surgeons thought they would care more about 'age and experience'. This underlines that patients' expectations should be taken into account within the preoperative medical interview. This might allow an optimization of compliance of the patients and lead to a better satisfaction on both sides.
Collapse
Affiliation(s)
- Katrin Karpinski
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
| | - Fabian Plachel
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
| | | | - Tim Saier
- BG Unfallklinik Murnau, 82418 Murnau am Staffelsee, Germany
| | | | - Alexander Auffarth
- Universitätsklinik für Orthopädie und Traumatologie, Universitätsklinikum Salzburg, A-5020 Salzburg, Austria;
| | - Alp Paksoy
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
| | - Doruk Akgün
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
| | - Philipp Moroder
- Centrum für Muskuloskeletale Chirurgie, Klinik für Schulter- und Ellenbogenchirurgie, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany (A.P.); (P.M.)
| |
Collapse
|
6
|
Warren E, Hurley ET, Park CN, Crook BS, Lorentz S, Levin JM, Anakwenze O, MacDonald PB, Klifto CS. Evaluation of information from artificial intelligence on rotator cuff repair surgery. JSES Int 2024; 8:53-57. [PMID: 38312282 PMCID: PMC10837709 DOI: 10.1016/j.jseint.2023.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Purpose The purpose of this study was to analyze the quality and readability of information regarding rotator cuff repair surgery available using an online AI software. Methods An open AI model (ChatGPT) was used to answer 24 commonly asked questions from patients on rotator cuff repair. Questions were stratified into one of three categories based on the Rothwell classification system: fact, policy, or value. The answers for each category were evaluated for reliability, quality and readability using The Journal of the American Medical Association Benchmark criteria, DISCERN score, Flesch-Kincaid Reading Ease Score and Grade Level. Results The Journal of the American Medical Association Benchmark criteria score for all three categories was 0, which is the lowest score indicating no reliable resources cited. The DISCERN score was 51 for fact, 53 for policy, and 55 for value questions, all of which are considered good scores. Across question categories, the reliability portion of the DISCERN score was low, due to a lack of resources. The Flesch-Kincaid Reading Ease Score (and Flesch-Kincaid Grade Level) was 48.3 (10.3) for the fact class, 42.0 (10.9) for the policy class, and 38.4 (11.6) for the value class. Conclusion The quality of information provided by the open AI chat system was generally high across all question types but had significant shortcomings in reliability due to the absence of source material citations. The DISCERN scores of the AI generated responses matched or exceeded previously published results of studies evaluating the quality of online information about rotator cuff repairs. The responses were U.S. 10th grade or higher reading level which is above the AMA and NIH recommendation of 6th grade reading level for patient materials. The AI software commonly referred the user to seek advice from orthopedic surgeons to improve their chances of a successful outcome.
Collapse
Affiliation(s)
- Eric Warren
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Eoghan T. Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Caroline N. Park
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Bryan S. Crook
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Samuel Lorentz
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Jay M. Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Peter B. MacDonald
- Section of Orthopaedic Surgery & The Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | | |
Collapse
|
7
|
Razmjou H, Christakis M, Nam D, Drosdowech D, Sheth U, Wainwright A, Richards R. Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process. J Shoulder Elb Arthroplast 2023; 7:24715492231167104. [PMID: 37008201 PMCID: PMC10064165 DOI: 10.1177/24715492231167104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined. Materials and Methods This was an observational study. The demographics, overall health, patient-specific risk profile, expectations, and health-related quality of life were documented. Visual analog scale and the American Shoulder & Elbow Surgeon (ASES) measured pain and functional disability, respectively. Clinical and imaging examination documented clinical findings and extent of degenerative arthritis and cuff tear arthropathy. Appropriateness for arthroplasty surgery was documented by a 5-item Likert response survey and the final decision was documented as ready, not-ready, and would like to further discuss. Results Eighty patients, 38 women (47.5%), mean age: 72(8) participated in the study. The appropriateness decision aid showed excellent discriminate validity (area under the receiver operating characteristic curve value of 0.93) in differentiating between patients who were “ready” and those who were “not-ready” to have surgery. Gender ( P = 0.037), overall health ( P = .024), strength in external rotation ( P = .002), pain severity ( P = .001), ASES score ( P < .0001), and expectations ( P = .024) were contributing factors to the decision to have surgery. Imaging findings did not play a significant role in the final decision to have surgery. Conclusions A 5-item tool showed excellent validity in differentiating patients who were ready to have surgery versus those who were not. Patient's gender, expectations, strength, and self-reported outcomes were important factors in reaching the final decision.
Collapse
Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Helen Razmjou, Holland Orthopedic and Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario, Canada M4Y 1H1.
| | - Monique Christakis
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Diane Nam
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Darren Drosdowech
- Roth | McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Western University, London, Canada
| | - Ujash Sheth
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amy Wainwright
- Department of Rehabilitation, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robin Richards
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Biglari F, Sabaghzadeh A, Ebrahimpour A, Sadighi M, Khabiri SS, Kafiabadi MJ. Wide-awake local anesthesia for open rotator cuff repair: A case report. Int J Surg Case Rep 2022; 97:107494. [PMID: 35961150 PMCID: PMC9382426 DOI: 10.1016/j.ijscr.2022.107494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Improper treatment of rotator cuff tear might result in progression of tear and deterioration of patient function. The rotator cuff tear can be managed conservatively in most cases however surgical treatment is inevitable in persistent patients. PRESENTATION OF CASE A 45-year-old woman presented to our clinic with shoulder pain and restricted range of motion following a fall from a height three months before the current presentation. Due to the lack of favorable response to conservative treatment and the fact that rotator cuff rupture was traumatic, she became a candidate for rotator cuff repair surgery. Due to financial issues and the patient's refusal of undergoing general anesthesia we considered the WALANT technique. Prior to surgery, we explained the whole procedure to the patient, referring to its pros and cons. CLINICAL DISCUSSION The WALANT procedure is a relatively recent technique that has become widespread in orthopedic surgery in the past decade. The advantages of the WALANT technique are that it is simple, feasible, and safe and that the analgesic is adequate during the operation and for the first few hours afterward (5). Concerns with this method include patient discomfort and pain during surgery, which can be managed by educating the patient and minute-by-minute explanation during the procedure. CONCLUSION We advocate open rotator cuff repair with the WALANT approach as an effective, cost-saving, safe, simple, and quick alternative to general and regional anesthesia for certain patients or with limited anesthetic resources. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Farsad Biglari
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sabaghzadeh
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adel Ebrahimpour
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sadighi
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Saeed Khabiri
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Jafari Kafiabadi
- Department of Orthopedic Surgery, Clinical Research Development Unit of Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|