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ABOUYANNIS M, ESMAIL H, HAMALUBA M, NGAMA M, MWANGUDZAH H, MUMBA N, YERI BK, MWALUKORE S, ALPHAN HJ, AGGARWAL D, ALCOBA G, CAMMACK N, CHIPPAUX JP, COLDIRON ME, GUTIÉRREZ JM, HABIB AG, HARRISON RA, ISBISTER GK, LAVONAS EJ, MARTINS D, RIBEIRO I, WATSON JA, WILLIAMS DJ, CASEWELL NR, WALKER SA, LALLOO DG. [A global core outcome measurement set for snakebite clinical trials]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2023; 3:mtsi.v3i3.2023.421. [PMID: 38094484 PMCID: PMC10714599 DOI: 10.48327/mtsi.v3i3.2023.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/25/2023] [Indexed: 12/18/2023]
Abstract
Background Snakebite clinical trials have often used heterogeneous outcome measures and there is an urgent need for standardisation. Method A globally representative group of key stakeholders came together to reach consensus on a globally relevant set of core outcome measurements. Outcome domains and outcome measurement instruments were identified through searching the literature and a systematic review of snakebite clinical trials. Outcome domains were shortlisted by use of a questionnaire and consensus was reached among stakeholders and the patient group through facilitated discussions and voting. Results Five universal core outcome measures should be included in all future snakebite clinical trials: mortality, WHO disability assessment scale, patient-specific functional scale, acute allergic reaction by Brown criteria, and serum sickness by formal criteria. Additional syndrome-specific core outcome measures should be used depending on the biting species. Conclusion This core outcome measurement set provides global standardisation, supports the priorities of patients and clinicians, enables meta-analysis, and is appropriate for use in low-income and middle-income settings.
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Affiliation(s)
- Michael ABOUYANNIS
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, Royaume-Uni
- Kenya Medical Research Institute (KEMRI) - Wellcome Research Programme, Kilifi, Kenya
| | - Hanif ESMAIL
- Medical Research Council Clinical Trials Unit at UCL, University College London, Londres, Royaume-Uni
- Institute for Global Health, University College London, Londres, Royaume-Uni
| | - Mainga HAMALUBA
- Kenya Medical Research Institute (KEMRI) - Wellcome Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford, Royaume-Uni
| | - Mwanajuma NGAMA
- Kenya Medical Research Institute (KEMRI) - Wellcome Research Programme, Kilifi, Kenya
| | - Hope MWANGUDZAH
- Kenya Medical Research Institute (KEMRI) - Wellcome Research Programme, Kilifi, Kenya
| | - Noni MUMBA
- Kenya Medical Research Institute (KEMRI) - Wellcome Research Programme, Kilifi, Kenya
| | - Betty K. YERI
- Kenya Medical Research Institute (KEMRI) - Wellcome Research Programme, Kilifi, Kenya
| | - Salim MWALUKORE
- Kenya Medical Research Institute (KEMRI) - Wellcome Research Programme, Kilifi, Kenya
| | - Hassan J. ALPHAN
- Kenya Medical Research Institute (KEMRI) - Wellcome Research Programme, Kilifi, Kenya
| | - Dinesh AGGARWAL
- Department of Medicine, University of Cambridge, Royaume-Uni
| | - Gabriel ALCOBA
- Service de médecine, Médecins Sans Frontières, Genève, Suisse
- Service de médecine tropicale et humanitaire, Hôpitaux universitaires de Genève, Genève, Suisse
| | | | - Jean-Philippe CHIPPAUX
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Unité « Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique » (MERIT), Paris, France
| | | | - José M. GUTIÉRREZ
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Abdulrazaq G. HABIB
- Bayero University Department of Infectious and Tropical Diseases, Kano, Nigéria
| | - Robert A. HARRISON
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, Royaume-Uni
| | - Geoffrey K. ISBISTER
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australie
| | - Eric J. LAVONAS
- Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, Colorado; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, États-Unis
| | | | | | - James A. WATSON
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford, Royaume-Uni
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thaïlande
| | - David J. WILLIAMS
- Regulation and Prequalification Department, Access to Medicines and Health Products Division, Organisation mondiale de la Santé, Genève, Suisse Auteur correspondant :
| | - Nicholas R. CASEWELL
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, Royaume-Uni
| | - Sarah A. WALKER
- Medical Research Council Clinical Trials Unit at UCL, University College London, Londres, Royaume-Uni
| | - David G. LALLOO
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, Royaume-Uni
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Abouyannis M, Esmail H, Hamaluba M, Ngama M, Mwangudzah H, Mumba N, Yeri BK, Mwalukore S, Alphan HJ, Aggarwal D, Alcoba G, Cammack N, Chippaux JP, Coldiron ME, Gutiérrez JM, Habib AG, Harrison RA, Isbister GK, Lavonas EJ, Martins D, Ribeiro I, Watson JA, Williams DJ, Casewell NR, Walker SA, Lalloo DG. A global core outcome measurement set for snakebite clinical trials. Lancet Glob Health 2023; 11:e296-e300. [PMID: 36669810 DOI: 10.1016/s2214-109x(22)00479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/09/2022] [Accepted: 10/31/2022] [Indexed: 01/20/2023]
Abstract
Snakebite clinical trials have often used heterogeneous outcome measures and there is an urgent need for standardisation. A globally representative group of key stakeholders came together to reach consensus on a globally relevant set of core outcome measurements. Outcome domains and outcome measurement instruments were identified through searching the literature and a systematic review of snakebite clinical trials. Outcome domains were shortlisted by use of a questionnaire and consensus was reached among stakeholders and the patient group through facilitated discussions and voting. Five universal core outcome measures should be included in all future snakebite clinical trials-mortality, WHO disability assessment scale, patient-specific functional scale, acute allergic reaction by Brown criteria, and serum sickness by formal criteria. Additional syndrome-specific core outcome measures should be used depending on the biting species. This core outcome measurement set provides global standardisation, supports the priorities of patients and clinicians, enables meta-analysis, and is appropriate for use in low-income and middle-income settings.
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Affiliation(s)
- Michael Abouyannis
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, UK; KEMRI-Wellcome Research Programme, Kilifi, Kenya.
| | - Hanif Esmail
- MRC Clinical Trials Unit at UCL, London, UK; Institute for Global Health, University College London, London, UK
| | - Mainga Hamaluba
- KEMRI-Wellcome Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford, UK
| | | | | | - Noni Mumba
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
| | - Betty K Yeri
- KEMRI-Wellcome Research Programme, Kilifi, Kenya
| | | | | | | | - Gabriel Alcoba
- Medical Department, Médecins Sans Frontières/Doctors Without Borders, Geneva, Switzerland; Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jean-Philippe Chippaux
- University of Paris Cité, French National Reseach Institute For Sustainable Development, Monther and child in the tropics: pathogens, health system, and epidemiological transformation unit, Paris, France
| | | | - José M Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Abdulrazaq G Habib
- Bayero University Department of Infectious and Tropical Diseases, Kano, Nigeria
| | - Robert A Harrison
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, NSW, Australia
| | - Eric J Lavonas
- Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, Colorado, USA and Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Isabela Ribeiro
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - James A Watson
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford, UK; Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - David J Williams
- Regulation and Prequalification Department, Access to Medicines and Health Products Division, World Health Organization, Geneva, Switzerland
| | - Nicholas R Casewell
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - David G Lalloo
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, UK
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Carter RW, Gerardo CJ, Samuel SP, Kumar S, Kotehal SD, Mukherjee PP, Shirazi FM, Akpunonu PD, Bammigatti C, Bhalla A, Manikath N, Platts-Mills TF, Lewin MR. The BRAVO Clinical Study Protocol: Oral Varespladib for Inhibition of Secretory Phospholipase A2 in the Treatment of Snakebite Envenoming. Toxins (Basel) 2022; 15:22. [PMID: 36668842 PMCID: PMC9862656 DOI: 10.3390/toxins15010022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Snakebite is an urgent, unmet global medical need causing significant morbidity and mortality worldwide. Varespladib is a potent inhibitor of venom secretory phospholipase A2 (sPLA2) that can be administered orally via its prodrug, varespladib-methyl. Extensive preclinical data support clinical evaluation of varespladib as a treatment for snakebite envenoming (SBE). The protocol reported here was designed to evaluate varespladib-methyl for SBE from any snake species in multiple geographies. METHODS AND ANALYSIS BRAVO (Broad-spectrum Rapid Antidote: Varespladib Oral for snakebite) is a multicenter, randomized, double-blind, placebo-controlled, phase 2 study to evaluate the safety, tolerability, and efficacy of oral varespladib-methyl plus standard of care (SoC) vs. SoC plus placebo in patients presenting with acute SBE by any venomous snake species. Male and female patients 5 years of age and older who meet eligibility criteria will be randomly assigned 1:1 to varespladib-methyl or placebo. The primary outcome is the Snakebite Severity Score (SSS) that has been modified for international use. This composite outcome is based on the sum of the pulmonary, cardiovascular, nervous, hematologic, and renal systems components of the updated SSS. ETHICS AND DISSEMINATION This protocol was submitted to regulatory authorities in India and the US. A Clinical Trial No Objection Certificate from the India Central Drugs Standard Control Organisation, Drug Controller General-India, and a Notice to Proceed from the US Food and Drug Administration have been obtained. The study protocol was approved by properly constituted, valid institutional review boards or ethics committees at each study site. This study is being conducted in compliance with the April 1996 ICH Guidance for Industry GCP E6, the Integrated Addendum to ICH E6 (R2) of November 2016, and the applicable regulations of the country in which the study is conducted. The trial is registered on Clinical trials.gov, NCT#04996264 and Clinical Trials Registry-India, 2021/07/045079 000062.
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Affiliation(s)
| | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University, Durham, NC 27708, USA
| | | | - Surendra Kumar
- Department of Medicine, Sardar Patel Medical College, PBM Hospital, Bikaner 334001, India
| | - Suneetha D. Kotehal
- Department of Medicine, Mysore Medical College and Research Institute, Mysore 570001, India
| | - Partha P. Mukherjee
- Department of General Medicine, Calcutta National Medical College, Kolkata 700014, India
| | - Farshad M. Shirazi
- Arizona Poison & Drug Information Center, College of Pharmacy and University of Arizona College of Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Peter D. Akpunonu
- Department of Emergency Medicine and Medical Toxicology, University of Kentucky College of Medicine, Lexington, KY 40506, USA
| | - Chanaveerappa Bammigatti
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Neeraj Manikath
- Department of Emergency Medicine, Government Medical College, Kozhikode 673008, India
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Chimeno-Hernández A, Alberola-Zorrilla P, Sánchez-Zuriaga D. Validation of the patients-specific functional scale in patients with haemophilia. Haemophilia 2022; 28:1016-1021. [PMID: 35921236 DOI: 10.1111/hae.14640] [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: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A complete functional assessment is essential to measure health status and treatment effects in patients with haemophilia. The Patient-Specific Functional Scale (PSFS) is a reliable, valid, simple and quick scale that measures physical function in patients with musculoskeletal disorders. However, the reliability and validity of the PSFS have not been evaluated in patients with haemophilia. AIM The aim of this study was to validate the Patient-Specific Functional Scale in patients with haemophilia. METHODS Twenty-eight patients with haemophilia participated in the study. They completed the PSFS and the Haemophilia Activity List (HAL) scales by telephone during an initial session, and then repeated the assessment in a follow-up session 1 week apart. Reliability was analysed by the internal correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC). The concurrent validity of the PSFS was determined by correlating the initial score of the PSFS scale to the initial score of the HAL scale. Correlations were calculated by means of scatter plots and Pearson product-moment r correlation coefficient. RESULTS ICC and SEM values showed excellent reliability for the PSFS scale, with a SDC of 1. A significant moderate correlation was found between the results of the PSFS and the HAL (r = .57, P < .001). CONCLUSION The PSFS is a reliable and valid scale to measure the functionality of people with haemophilia.
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Affiliation(s)
- Ana Chimeno-Hernández
- Department of Physiotherapy, Universitat de València, València, Spain.,Association of Haemophilia of the Valencian Community (ASHECOVA), València, Spain
| | - Pilar Alberola-Zorrilla
- Association of Haemophilia of the Valencian Community (ASHECOVA), València, Spain.,Department of Anatomy and Human Embryology, Universitat de València, València, Spain
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Bhaumik S, Beri D, Tyagi J, Clarke M, Sharma SK, Williamson PR, Jagnoor J. Outcomes in intervention research on snakebite envenomation: a systematic review. F1000Res 2022; 11:628. [PMID: 36300033 PMCID: PMC9579743 DOI: 10.12688/f1000research.122116.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION A core outcome set (COS) is a minimal list of consensus outcomes that should be used in all intervention research in a specific domain. COS enhance the ability to undertake meaningful comparisons and to understand the benefits or harms of different treatments. A first step in developing a COS is to identify outcomes that have been used previously. We did this global systematic review to provide the foundation for development of a region-specific COS for snakebite envenomation. Methods: We searched 15 electronic databases, eight trial registries, and reference lists of included studies to identify reports of relevant trials, protocols, registry records and systematic reviews. We extracted verbatim data on outcomes, their definitions, measures, and time-points. Outcomes were classified as per an existing outcome taxonomy, and we identified unique outcomes based on similarities in the definition and measurement of the verbatim outcomes. RESULTS We included 107 records for 97 studies which met our inclusion criteria. These reported 538 outcomes, with a wide variety of outcome measures, definitions, and time points for measurement. We consolidated these into 88 unique outcomes, which we classified into core areas of mortality (1, 1.14 %), life impact (6, 6.82%), resource use (15, 17.05%), adverse events (7, 7.95%), physiological/clinical (51, 57.95%), and composite (8, 9.09%) outcomes. The types of outcomes varied by the type of intervention, and by geographic region. Only 15 of the 97 trials (17.04%) listed Patient Related Outcome Measures (PROMS). CONCLUSION Trials evaluating interventions for snakebite demonstrate heterogeneity on outcomes and often omit important information related to outcome measurement (definitions, instruments, and time points). Developing high quality, region-specific COS for snakebite could inform the design of future trials and improve outcome reporting. Measurement of PROMS, resource use and life impact outcomes in trials on snakebite remains a gap.
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Affiliation(s)
- Soumyadeep Bhaumik
- Injury Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales,, Sydney, New South Wales, 2042, Australia,Injury Division, The George Institute for Global Health, New Delhi, Delhi, 110025, India,Meta-research and Evidence Synthesis Unit, George Institute for Global Health, New Delhi, Delhi, 110025, India,
| | - Deepti Beri
- Injury Division, The George Institute for Global Health, New Delhi, Delhi, 110025, India
| | - Jyoti Tyagi
- Meta-research and Evidence Synthesis Unit, George Institute for Global Health, New Delhi, Delhi, 110025, India
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Sanjib Kumar Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Paula R Williamson
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales,, Sydney, New South Wales, 2042, Australia,Injury Division, The George Institute for Global Health, New Delhi, Delhi, 110025, India
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Measurement Properties of the Patient-Specific Functional Scale and Its Current Uses: An Updated Systematic Review of 57 Studies Using COSMIN Guidelines. J Orthop Sports Phys Ther 2022; 52:262-275. [PMID: 35128944 DOI: 10.2519/jospt.2022.10727] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically review measurement properties, including acceptability, feasibility, and interpretability, and current uses of the Patient-Specific Functional Scale (PSFS). DESIGN Systematic review of a patient-reported outcome measure using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines. LITERATURE SEARCH We searched 11 databases from January 2010 to July 2020 for articles on measurement properties or use of PSFS. STUDY SELECTION CRITERIA Published primary articles without language restrictions. DATA SYNTHESIS Two independent reviewers screened all records, extracted data, and performed risk of bias assessments using COSMIN guidelines. We qualitatively synthesized findings for each measurement property in musculoskeletal and nonmusculoskeletal conditions, and 2 reviewers independently performed Grading of Recommendations Assessment, Development and Evaluation assessments. This study was preregistered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/42UZT). RESULTS Of the 985 articles screened, we included 57 articles on measurement properties and 255 articles on the use of PSFS. The PSFS had sufficient test-retest reliability in musculoskeletal (22 studies, 845 participants, low-to-moderate certainty) and nonmusculoskeletal conditions (6 studies, 197 participants, very low certainty), insufficient construct validity as a measure of physical function (21 studies, 2 945 participants, low-to-moderate certainty), and sufficient responsiveness (32 studies, 13 770 participants, moderate-to-high certainty). The standard error of measurement ranged from 0.35 to 1.5. The PSFS was used in 87 unique health conditions, some without prior evidence of validity. CONCLUSION The PSFS is an easy-to-use, reliable, and responsive scale in numerous musculoskeletal conditions, but the construct validity of PSFS remains uncertain. Further study of the measurement properties of the PSFS in nonmusculoskeletal conditions is necessary before clinical use. J Orthop Sports Phys Ther 2022;52(5):262-275. Epub: 05 Feb 2022. doi:10.2519/jospt.2022.10727.
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Contextualizing the Impact of Snakebite Envenoming on Patients: A Qualitative Content Analysis of Patient-Specific Functional Scale Activities Using the International Classification of Functioning, Disability and Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189608. [PMID: 34574532 PMCID: PMC8469450 DOI: 10.3390/ijerph18189608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
To categorize the Patient-specific Functional Scale (PSFS) activities in snakebite envenoming (SBE) using the International Classification of Function (ICF) model in order to describe the impact of SBE on patients’ activities and daily lives and to develop a theoretical SBE model of functioning, we performed a post-hoc analysis of two multi-center, prospective studies, conducted at 14 clinical sites in the United States with consecutive SBE patients presenting to the emergency department. Qualitative content analysis and natural language processing were used to categorize activities reported in the PSFS using the ICF model. Our sample included 93 patients. The mean age was 43.0 (SD 17.9) years, most had lower extremity injuries (59%). A total of 99 unique activities representing eight domains came within the Activity and Participation component of the ICF model, with the majority in the Mobility and General Tasks and Demands domains. The main concerns of SBE patients are the ability to perform daily activities and to engage within their social environment. Applying the ICF model to SBE can facilitate the creation of a patient-centered treatment approach, moving beyond body-structural impairments towards a function-based treatment approach and facilitate early integration of rehabilitation services.
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Björk M, Bergström M, Sverker A, Brodin N. Measures of Participation in Persons With Musculoskeletal Conditions. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:486-498. [PMID: 33091247 DOI: 10.1002/acr.24226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Affiliation(s)
- M Björk
- Linköping University, Linköping, Sweden
| | - M Bergström
- Linköping University, Norrköping Campus, Norrköping, Sweden
| | - A Sverker
- Linköping University, Linköping, Sweden
| | - N Brodin
- Karolinska Institutet, Huddinge, Sweden, and Danderyd Hospital, Stockholm, Sweden
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