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Lee HJ, Xu S, Liow MHL, Pang HN, Tay DKJ, Yeo SJ, Lo NN, Chen JY. Unicompartmental knee arthroplasty in obese patients, poorer survivorship at 15 years. J Orthop 2024; 53:156-162. [PMID: 38601892 PMCID: PMC11002850 DOI: 10.1016/j.jor.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The preclusion of obese patients from unicompartmental knee arthroplasty (UKA) has increasingly been challenged. This study aimed to evaluate the impact of Body Mass Index (BMI) on UKA at 15-year follow-up. Materials and methods 169 unilateral UKA patients from 2003 to 2007 were followed-up prospectively for at least 15 years. 70 patients were left for analysis after accounting for patient demise, revision surgery and loss to follow-up. 48 of these patients (69%) were in the Control group (BMI <30 kg/m2) and 22 (31%) were in the Obese group (BMI ≥30 kg/m2). Patients were assessed before and after operation using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), and Physical (PCS) and Mental (MCS) component of the Short Form 12. Survivorship analysis was also performed. Results Obese patients went through UKA at an earlier age than the non-obese patients (54.7 ± 4.7 years compared to 59.9 ± 7.8 years, p = 0.005). At 2, 10, and 15-year follow-up, both groups achieved clinically significant improvements in outcomes. There was no significant association found between obesity and outcome using multiple linear regression. While propensity matching found PCS improvement at 2 years to be greater in obese patients, no significant association between obesity and 15-year outcome was found. All 13 patients who required revision, underwent total knee arthroplasty (TKA). The overall 15-year survivorship was 74.2% within the obese group and 92.4% within the control group. Conclusion Compared to non-obese patients, obese patients had poorer 15-year survivorship with greater odds of requiring revision surgery. However, assuming implant survival, obese patients can expect a non-inferior outcome relative to their non-obese counterparts in all patient reported outcome measures 15 years after surgery.
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Affiliation(s)
- Hong Jing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Headquarters & Clinical Sciences Building 11, Mandalay Road, Singapore, 308232, Singapore
| | - Sheng Xu
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
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Plancher KD, Briggs KK, Commaroto S, Dotterweich K, Wang K, Petterson SC. Unicompartmental knee arthroplasty improves mental health in patients with single compartment knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2024; 32:1324-1331. [PMID: 38529694 DOI: 10.1002/ksa.12090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE The purpose of this study was to determine if preoperative mental health status improves following unicompartmental knee arthroplasty (UKA) in patients with single compartment knee osteoarthritis (OA). METHODS A total of 163 patients underwent UKA [115 (71%) medial, 48 (29%) lateral] (mean age = 65 ± 11) completed preoperative and minimum 2-year postoperative veterans RAND 12 item health survey (VR-12) mental component score (MCS). VR-12 MCS was the primary outcome measure. Secondary measures included VR-12 physical component summary score (PCS), knee osteoarthritis outcome score (KOOS) and KOOS patient acceptable symptom state at the final follow-up. RESULTS The median VR-12 MCS improved from 50.5 [interquartile range (IQR): 43.7-56.8] to 55.0 [IQR: 52.3-57.0] (p < 0.001) at a mean follow-up of 9.5 ± 4 years (range 2-19 years) following UKA. Preoperative VR-12 MCS was significantly correlated with patients postoperative VR-12 PCS (ρ = 0.294, p < 0.01), KOOS pain (ρ = 0.201, p = 0.012), KOOS ADL (ρ = 0.243, p = 0.002) and KOOS quality of life (ρ = 0.233, p < 0.01). Sixty-three (39%) patients improved from low VR-12 MCS (<50) to normal VR-12 MCS (≥50). One hundred forty-two (87%) achieved a normal VR-12 MCS score (≥50) postoperatively. CONCLUSION At a mean of 10-year follow-up, patients who underwent UKA for single compartment osteoarthritic knee pain demonstrated significant improvement in mental health scores. UKA resulted in normal mental health in a majority of patients (87%). The resultant improved mental health scores were associated with improved patient pain and activities of daily living. LEVEL OF EVIDENCE Level III retrospective cohort study.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
- Plancher Orthopaedics & Sports Medicine, New York, New York, USA
- Orthopaedic Foundation, Stamford, Connecticut, USA
| | | | - Sarah Commaroto
- Plancher Orthopaedics & Sports Medicine, New York, New York, USA
| | | | - Karina Wang
- Orthopaedic Foundation, Stamford, Connecticut, USA
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El-Heis S, Barton SJ, Chang HF, Nield H, Cox V, Galani S, Cutfield W, Chan SY, Godfrey KM. Maternal mood, anxiety and mental health functioning after combined myo-inositol, probiotics, micronutrient supplementation from preconception: Findings from the NiPPeR RCT. Psychiatry Res 2024; 334:115813. [PMID: 38402742 DOI: 10.1016/j.psychres.2024.115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Observational studies have reported associations between nutrition during pregnancy and mental wellbeing. As secondary outcomes, the NiPPeR double-blind randomized trial in women planning conception investigated whether a myo-inositol, probiotics and enriched micronutrients formulation (intervention) taken preconception and throughout pregnancy could improve mental wellbeing during pregnancy and post-delivery, compared with a standard micronutrient supplement (control). Mood and anxiety symptoms were ascertained (Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-state)) at preconception (baseline), 7, 28 and 34 weeks gestation, 3-weeks and 6-months post-delivery. EPDS>=13 was categorised as low mood; STAI-state>=45 as high anxiety. Change in mental health functioning was assessed as difference between preconception baseline and 6-month post-delivery 12-item Short-Form Health Survey (SF-12v2) mental component scores. Adjusting for site, ethnicity and baseline scores, there were no robust differences in EPDS and STAI-state scores between intervention and control groups across pregnancy (n = 630) and post-delivery (n = 532). Compared to controls, intervention group women averaged a 1.21 (95 %CI 0.04,2.39) higher change in SF-12v2 mental component score from preconception to 6-months post-delivery. Taking a myo-inositol, micronutrient and probiotic supplement during preconception/pregnancy had no effect on mood and anxiety, but there was evidence of a modest improvement in mental health functioning from preconception to 6-months post-delivery.
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Affiliation(s)
- Sarah El-Heis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom.
| | - Sheila J Barton
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom
| | - Hsin Fang Chang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228
| | - Heidi Nield
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Vanessa Cox
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Sevasti Galani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Wayne Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, 119228; Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, 117609, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton, Southampton and University Hospital Southampton NHS Foundation Trust, SO16 6YD, United Kingdom
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van Hagen CCE, Huiberts AJ, Mutubuki EN, de Melker HE, Vos ERA, van de Wijgert JHHM, van den Hof S, Knol MJ, van Hoek AJ. Health-related quality of life during the COVID-19 pandemic: The impact of restrictive measures using data from two Dutch population-based cohort studies. PLoS One 2024; 19:e0300324. [PMID: 38498510 PMCID: PMC10947685 DOI: 10.1371/journal.pone.0300324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES We describe health-related quality of life during the COVID-19 pandemic in the general Dutch population and correlations with restrictive measures. METHODS Data were obtained from 18-85 year-old participants of two population-based cohort studies (February 2021-July 2022): PIENTER Corona (n = 8,019) and VASCO (n = 45,413). Per cohort, mean scores of mental and physical health and health utility from the SF-12 were calculated by age group, sex and presence of a medical risk condition. Spearman correlations with stringency of measures were calculated. RESULTS Both cohorts showed comparable results. Participants <30 years had lowest health utility and mental health score, and highest physical health score. Health utility and mental health score increased with age (up to 79 years), while physical health score decreased with age. Women and participants with a medical risk condition scored lower than their counterparts. Fluctuations were small over time but most pronounced among participants <60 years, and correlated weakly, but mostly positively with measure stringency. CONCLUSIONS During the Dutch COVID-19 epidemic, health utility and mental health scores were lower and fluctuated strongest among young adults compared to older adults. In our study population, age, sex and presence of a medical risk condition seemed to have more impact on health scores than stringency of COVID-19 non-pharmaceutical interventions.
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Affiliation(s)
- Cheyenne C. E. van Hagen
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Anne J. Huiberts
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Elizabeth N. Mutubuki
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Hester E. de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Eric R. A. Vos
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Janneke H. H. M. van de Wijgert
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Susan van den Hof
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Mirjam J. Knol
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Albert Jan van Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
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Moine E, Molinier V, Castanyer A, Calvat A, Coste G, Vernet A, Faugé A, Magrina P, Aliaga-Parera JL, Oliver N, Alexandre F, Heraud N. Safety and Efficacy of Pulmonary Rehabilitation for Long COVID Patients Experiencing Long-Lasting Symptoms. Int J Environ Res Public Health 2024; 21:242. [PMID: 38397731 PMCID: PMC10888408 DOI: 10.3390/ijerph21020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
Due to the high prevalence and persistence of long COVID, it is important to evaluate the safety and efficacy of pulmonary rehabilitation (PR) for patients who experience long-lasting symptoms more than six months after initial COVID-19 onset. Enrolled patients were admitted for a four-week in-patient-PR due to long COVID symptoms (n = 47). The safety of PR was confirmed by the absence of adverse events. Symptom-related outcomes were evaluated pre- and post-PR with significant score changes for: 6 min walking distance (61 [28 to 103] m), quality of life (mental Short Form-12: 10 [6 to 13], and physical: 9 [6 to 12]), Montreal Cognitive Assessment (1 [0 to 3]), fatigue (MFI-20: -19 [-28 to -8]), dyspnea (DYSPNEA-12: -7 [-9 to -2] and mMRC; -1 [-1 to 0]), Nijmegen questionnaire (-8 [-11 to -5]), anxiety and depression (HADS:-4 [-5 to -2] and -2 [-4 to -1], respectively) and posttraumatic stress disorder checklist scale (-8 [-12 to -4]). At the individual level, the percentage of symptomatic patients for each outcome decreased, with a high response rate, and the number of persistent symptoms per patient was reduced from six at PR initiation to three at the end of the program. Our results show that in-PR is safe and efficient at decreasing long-lasting symptoms experienced by long COVID patients at more than six months after initial disease onset.
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Affiliation(s)
- Espérance Moine
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
| | - Virginie Molinier
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
| | | | - Amandine Calvat
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | | | - Antonin Vernet
- Clinique du Souffle La Solane, Inicea, 66340 Osséja, France
| | - Audrey Faugé
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | - Perrine Magrina
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | | | - Nicolas Oliver
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
- Clinique du Souffle La Vallonie, Inicea, 34700 Lodève, France
| | - François Alexandre
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
| | - Nelly Heraud
- Direction de la Recherche Clinique et de l’Innovation en Santé, Clariane, 34700 Lodève, France
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Guida S, Vitale J, Gianola S, Castellini G, Swinnen E, Beckwée D, Gelfi C, Torretta E, Mangiavini L. Effects of tele-prehabilitation on clinical and muscular recovery in patients awaiting knee replacement: protocol of a randomised controlled trial. BMJ Open 2023; 13:e073163. [PMID: 37793919 PMCID: PMC10551960 DOI: 10.1136/bmjopen-2023-073163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The increasing prevalence of knee osteoarthritis and total knee arthroplasty (TKA) impose a significant socioeconomic burden in developed and developing countries. Prehabilitation (rehabilitation in the weeks immediately before surgery) may be crucial to prepare patients for surgery improving outcomes and reducing assistance costs. Moreover, considering the progress of telemedicine, candidates for TKA could potentially benefit from a tele-prehabilitation programme. We aim to evaluate the effects of a home-based tele-prehabilitation program for patients waiting for total knee replacement. METHODS AND ANALYSIS Forty-eight male patients, aged 65-80, on a waiting list for TKA will be recruited and randomly assigned to the tele-prehabilitation intervention or control groups. Both groups will undergo the same 6-week exercise program (five sessions/week) and the same educational session (one per week). The tele-prehabilitation group will perform asynchronous sessions using a tablet, two accelerometers and a balance board (Khymeia, Padova, Italy), while the control group will use a booklet. The Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire, at the end of the prehabilitation, will be the primary outcome. Secondary outcomes will include self-reported outcomes, performance tests and change in expressions of blood and muscle biomarkers. Ten healthy subjects, aged 18-30, will be also recruited for muscle and blood samples collection. They will not undergo any intervention and their data will be used as benchmarks for the intervention and control groups' analyses. ETHICS AND DISSEMINATION This randomised controlled trial will be conducted in accordance with the ethical principles of the Declaration of Helsinki. This study has been approved by the Ethics Committee of Vita-Salute San Raffaele University (Milan, Italy. No. 50/INT/2022). The research results will be published in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05668312.
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Affiliation(s)
- Stefania Guida
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jacopo Vitale
- Spine Center, Schulthess Klinik, Zurich, Switzerland
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Eva Swinnen
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Deparment, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
| | - Cecilia Gelfi
- Laboratory of Proteomics and Lipidomics, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Enrica Torretta
- Laboratory of Proteomics and Lipidomics, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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McCormick BP, Trent S, Geng X, Lee JW, Boucher HR. Robotic-assisted technology does not influence functional outcomes among obese and morbidly obese total knee arthroplasty patients. J Exp Orthop 2023; 10:76. [PMID: 37523073 PMCID: PMC10390435 DOI: 10.1186/s40634-023-00634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
PURPOSE Despite benefits of total knee arthroplasty (TKA) on function and quality of life, obese patients have less improved functional outcomes following TKA compared to their normal weight counterparts. Furthermore, obesity is a risk factor for aseptic loosening and revision surgery following TKA. With known benefits of robotic-assisted TKA (RaTKA) in precision and patient satisfaction, we aimed to evaluate the differences in patient reported outcome and early complication rates for patients undergoing RaTKA versus conventional TKA among patients of varying BMI groups. METHODS This study was a retrospective cohort study of patients who underwent conventional versus RaTKA. Patients were grouped by BMI range (< 30 kg/m2, 30-40 kg/m2, and > 40 kg/m2). Patient-reported outcomes were measured by Oxford Knee Scores and 12-Item Short Form Survey scores preoperatively, 6-month, 1-year, and 2-year postoperatively. Mixed-effects linear models were built for each patient-reported outcome to assess the interaction between type of surgery and BMI while adjusting for known confounders such as demographic variables. RESULTS A total of 350 patients (n = 186 RaTKA, n = 164 conventional TKA) met inclusion criteria. SF-12 physical scores were significantly higher at 2-year follow-up among non-obese patients compared to obese and morbidly obese patients (p = 0.047). There was no statistically significant interaction between the type of surgery performed (RaTKA versus conventional TKA) and obesity regarding their effects on patient reported outcomes. CONCLUSIONS This study demonstrates no differences in functional outcomes among patients undergoing RaTKA compared to conventional TKA. Furthermore, obesity had no significant effect on this association. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Brian P McCormick
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD, 21218, USA.
| | - Sarah Trent
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra / Northwell, Great Neck, NY, USA
| | - Xue Geng
- Department of Biostatistics, Georgetown University School of Medicine, Washington, D.C, USA
| | - Ji Won Lee
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD, 21218, USA
| | - Henry R Boucher
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD, 21218, USA
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Beiene ZA, Tanghe KK, Kahlenberg CA, McLawhorn AS, MacLean CH, Gausden EB. Defining a successful total knee arthroplasty: a systematic review of metrics of clinically important changes. Arthroplasty 2023; 5:25. [PMID: 37198708 DOI: 10.1186/s42836-023-00178-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/07/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Despite the increasing use of patient-reported outcome measures (PROMs), the methodology used to evaluate clinically significant postoperative outcomes after total knee arthroplasty (TKA) is variable. The review aimed to survey studies with identified PROM-based metrics of clinical efficacy and the assessment procedures after TKA. METHODS The MEDLINE database was queried from 2008-2020. Inclusion criteria were: full texts, English language, primary TKA with minimum one-year follow-up, use of metrics for assessing clinical outcomes with PROMs, and primary derivations of metrics. The following PROM-based metrics were identified: minimal clinically important difference (MCID), minimum detectable change (MDC), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB). Study design, PROM value data, and methods of derivation for metrics were recorded. RESULTS We identified 18 studies (including 46,173 patients) that met the inclusion criteria. Across these studies, 10 different PROMs were employed, and MCID was derived in 15 studies (83%). The MCID was calculated using anchor-based techniques in nine studies (50%) and distribution techniques in eight studies (44%). PASS values were presented in two studies (11%) and SCB in one study (6%) using an anchor-based method; MDC was derived in four studies (22%) using the distribution method. CONCLUSION There is variability in the TKA literature with respect to the definition and derivation of measurements of clinically significant outcomes. Standardization of these values may have implications for optimal case selection and PROM-based quality measurement, ultimately improving patient satisfaction and outcomes.
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Affiliation(s)
- Zodina A Beiene
- Department of Anesthesiology and Critical Care, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Kira K Tanghe
- Albert Einstein Medical College, Bronx, NY, 10461, USA
| | - Cynthia A Kahlenberg
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Alexander S McLawhorn
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Catherine H MacLean
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA
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Hamilton JL, Mills JA, Stebbins GT, Long JD, Fuller RLM, Sathe S, Roché M, Sampaio C. Defining Clinical Meaningfulness in Huntington's Disease. Mov Disord 2023. [PMID: 37147862 DOI: 10.1002/mds.29394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/10/2023] [Accepted: 03/15/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Minimal clinically important difference (MCID) represents the smallest within-person change on an outcome measure considered meaningful to the patient. Anchor-based MCID methods evaluate the relationship between changes in an outcome measure and the patient-reported clinical importance of that change. OBJECTIVE This study aims to estimate longitudinal MCID for clinically relevant outcome measures for individuals who have Stages 2 or 3 disease as measured by the Huntington's Disease Integrated Staging System (HD-ISS). METHODS Data were drawn from Enroll-HD, a large global longitudinal, observational study and clinical research platform for HD family members. We analyzed HD participants (N = 11,070) by staging group using time frames ranging from 12 to 36 months. The anchor was the physical component summary score of the 12-item short-form health survey. HD-relevant motor, cognitive, and functional outcome measures were independent, external criterion outcomes. Complex analysis was conducted using multiple, independent, linear mixed effect regression models with decomposition to calculate MCID for each external criterion by group. RESULTS MCID estimates varied by progression stage. MCID estimates increased as stage progression increased and as the time frame increased. MCID values for key HD measures are provided. For example, starting in HD-ISS stage 2, meaningful group change over 24 months equals an average increase of 3.6 or more points on the Unified Huntington's Disease Rating Scale Total Motor Score. CONCLUSIONS This is the first study to examine MCID estimation thresholds for HD. The results can be used to improve clinical interpretation of study outcomes and enable treatment recommendations to support clinical decision-making and clinical trial methodology. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jamie L Hamilton
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | - James A Mills
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
| | - Glenn T Stebbins
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeffrey D Long
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
| | - Rebecca L M Fuller
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | - Swati Sathe
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | - Matt Roché
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | - Cristina Sampaio
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
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10
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Wang Y, Owen A, Franks A, Ackerman I, Fitzgerald SM, Liew S, Woods RL, Wluka AE, McNeil JJ, Cicuttini FM. Functional outcomes following knee replacement in community-dwelling older adults. BMC Geriatr 2023; 23:261. [PMID: 37131170 PMCID: PMC10152584 DOI: 10.1186/s12877-023-03925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/24/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Knee replacements are increasingly performed in older adults but uncertainty remains regarding their benefits in the context of age-related decline in physical function and other comorbidities. This study aimed to examine (1) the effect of knee replacement on functional outcomes in the context of age-related decline in physical function and (2) the factors associated with minimal important improvement in physical function after knee replacement in community-dwelling older adults aged ≥ 70 years. METHODS This cohort study was performed within the ASPREE trial, with 889 participants undergoing knee replacement during the trial and 858 age- and sex-matched controls without knee or hip replacement identified from 16,703 Australian participants aged ≥ 70 years. Health-related quality of life was assessed annually using the SF-12, including its physical and mental component summary (PCS and MCS). Gait speed was measured biennially. Multiple linear regression and analysis of covariance were used to adjust for potential confounders. RESULTS Participants with knee replacement had significantly lower pre- and post-replacement PCS scores and gait speed compared with age- and sex-matched controls. Participants with knee replacement had significant improvement in PCS score following knee replacement (mean change 3.6, 95% CI 2.9-4.3) while PCS score remaining unchanged in age- and sex-matched controls (-0.02, 95% CI -0.6 to 0.6) during follow-up period. The greatest improvements were observed for bodily pain and physical function. Following knee replacement, 53% of participants experienced minimal important improvement in PCS score (increased by ≥ 2.7), while 24% experienced worsened PCS score (reduced by > 2.7). Participants experiencing improved PCS score postoperatively had significantly lower PCS and higher MCS scores pre-surgery. CONCLUSIONS Although community-based older adults experienced a significant improvement in PCS scores after knee replacement, their postoperative physical functional status remained significantly lower than age- and sex-matched controls. The degree of preoperative physical function impairment was a strong predictor of functional improvement, suggesting that this could be an important consideration when identifying older people most likely to benefit from knee replacement surgery.
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Affiliation(s)
- Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Angus Franks
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ilana Ackerman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sharyn M Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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11
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Mayer M, Badesch DB, Nielsen KH, Kawut S, Bull T, Ryan JJ, Sager J, Mazimba S, Hemnes A, Klinger J, Runo J, McConnell JW, De Marco T, Chakinala MM, Yung D, Elwing J, Kaplan A, Argula R, Pomponio R, Peterson R, Hountras P. Impact of the COVID-19 pandemic on chronic disease management and patient reported outcomes in patients with pulmonary hypertension: The Pulmonary Hypertension Association Registry. Pulm Circ 2023; 13:e12233. [PMID: 37159803 PMCID: PMC10163321 DOI: 10.1002/pul2.12233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023] Open
Abstract
To better understand the impact of the COVID-19 pandemic on the care of patients with pulmonary hypertension, we conducted a retrospective cohort study evaluating health insurance status, healthcare access, disease severity, and patient reported outcomes in this population. Using the Pulmonary Hypertension Association Registry (PHAR), we defined and extracted a longitudinal cohort of pulmonary arterial hypertension (PAH) patients from the PHAR's inception in 2015 until March 2022. We used generalized estimating equations to model the impact of the COVID-19 pandemic on patient outcomes, adjusting for demographic confounders. We assessed whether insurance status modified these effects via covariate interactions. PAH patients were more likely to be on publicly-sponsored insurance during the COVID-19 pandemic compared with prior, and did not experience statistically significant delays in access to medications, increased emergency room visits or nights in the hospital, or worsening of mental health metrics. Patients on publicly-sponsored insurance had higher healthcare utilization and worse objective measures of disease severity compared with privately insured individuals irrespective of the COVID-19 pandemic. The relatively small impact of the COVID-19 pandemic on pulmonary hypertension-related outcomes was unexpected but may be due to pre-established access to high quality care at pulmonary hypertension comprehensive care centers. Irrespective of the COVID-19 pandemic, patients who were on publicly-sponsored insurance seemed to do worse, consistent with prior studies highlighting outcomes in this population. We speculate that previously established care relationships may lessen the impact of an acute event, such as a pandemic, on patients with chronic illness.
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Affiliation(s)
- Megan Mayer
- Pulmonary Sciences & Critical Care Medicine, University of ColoradoAuroraColoradoUSA
| | - David B. Badesch
- Pulmonary Sciences & Critical Care Medicine, University of ColoradoAuroraColoradoUSA
| | - Kelly H. Nielsen
- Pulmonary Sciences & Critical Care Medicine, University of ColoradoAuroraColoradoUSA
| | - Steven Kawut
- Department of Medicine, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Todd Bull
- Pulmonary Sciences & Critical Care Medicine, University of ColoradoAuroraColoradoUSA
| | - John J. Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of UtahSalt Lake CityUtahUSA
| | - Jeffrey Sager
- Cottage Health Pulmonary Hypertension CenterSanta BarbaraCaliforniaUSA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Anna Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Vanderbilt UniversityNashvilleTennesseeUSA
| | | | - James Runo
- Division of Pulmonary & Critical Care Medicine, University of WisconsinMadisonWisconsinUSA
| | | | - Teresa De Marco
- Division of Cardiology, University of California, San FranciscoSan Francisco Medical CenterCaliforniaUSA
| | - Murali M. Chakinala
- Division of Pulmonary & Critical Care Medicine, Washington University School of MedicineSt. LouisMissouriUSA
| | - Delphine Yung
- Division of Pediatric CardiologyUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Jean Elwing
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Adolfo Kaplan
- Department of Internal MedicineUniversity of Texas‐Rio Grande ValleyMcAllenTexasUSA
| | - Rahul Argula
- Division of Pulmonary and Critical care medicine, Medical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Raymond Pomponio
- Department of Biostatistics & Informatics, Colorado School of Public HealthUniversity of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Ryan Peterson
- Department of Biostatistics & Informatics, Colorado School of Public HealthUniversity of Colorado‐Anschutz Medical CampusAuroraColoradoUSA
| | - Peter Hountras
- Pulmonary Sciences & Critical Care Medicine, University of ColoradoAuroraColoradoUSA
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12
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Bay AA, Ramachandran S, Ni L, Prusin T, Hackney ME. Differences in Balance Confidence, Fear of Falling, and Fall Risk Factors Among White and Black Community-Dwelling Older Adults. J Geriatr Phys Ther 2023; 46:122-131. [PMID: 35981334 PMCID: PMC10189616 DOI: 10.1519/jpt.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Falling among older adults is common and can cause chronic health complications. Fear of falling, a lasting concern about falling that can lead an individual to avoid activities he or she can perform, is strongly associated with falling and fall risk. Although White older adults fall more often, Black older adults have more fall risk factors. The purpose of this study was to investigate factors that explain fear of falling and differences between White and Black community-dwelling older adults in fear of falling, balance confidence, and fall risk factors. METHODS Using a cross-sectional, retrospective design, 84 community-dwelling older adults (mean age [SD] = 69.0 [5.2], range: 55-80; White, n = 37, 44%; Black, n = 47, 56%, M/F = 20/64) were assessed. Assessments were conducted in a laboratory for human studies. Fall history and risk factors, and subjective fear of falling, were collected. The Montreal Cognitive Assessment (MoCA), Activities-Specific Balance Confidence (ABC) score, preferred, backward, and fast Gait Speed, Short Form-12 Physical and Mental Component Scores, fear of falling rating scale, and demographics questionnaires were administered. Analyses included a proportional odds logistic regression model to examine which factors predicted ABC score and which factors were associated with subjective fear of falling, 1-way analysis of variance for continuous variables, the Fisher exact test for categorical variables, and the Mann-Whitney-Wilcoxon test for ordinal variables. RESULTS Black participants had significantly fewer years of education ( P = .007), lower MoCA scores ( P = .002), and slower fast gait speed ( P = .032) than White participants. Black participants reported less subjective fear of falling ( P = .043). In the final ABC model (Akaike information criterion 208.26), lower ABC scores were predicted by White race, slower preferred and fast gait speeds, and worse Short Form-12 Mental Composite Scores. DISCUSSION Despite Black participants demonstrating typical characteristics of higher fall risk including lower cognitive scores, slower gait speed, and lower ABC scores, Black participants reported fewer falls. Understanding racial differences is an important factor in fear of falling and balance confidence. CONCLUSION Reasons for racial differences should be examined further in fear of falling and balance confidence to facilitate the development of patient-centered falls prevention physical therapy programs.
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Affiliation(s)
- Allison A. Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Todd Prusin
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Madeleine E. Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
- Geriatric Research, Education, and Clinical Center (GRECC), Birmingham/Atlanta Veterans Affairs Medical Centers, Birmingham, Alabama
- Emory University Department of Rehabilitation Medicine, Atlanta, Georgia
- Emory University School of Nursing, Atlanta, Georgia
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13
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Deckey DG, Verhey JT, Gerhart CRB, Christopher ZK, Spangehl MJ, Clarke HD, Bingham JS. Reply to the Letter to the Editor: There are Considerable Inconsistencies Among Minimum Clinically Important Differences in TKA: A Systematic Review. Clin Orthop Relat Res 2023; 481:843-844. [PMID: 36827490 PMCID: PMC10013672 DOI: 10.1097/corr.0000000000002592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/26/2023]
Affiliation(s)
- David G. Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jens T. Verhey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | | | - Mark J. Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Henry D. Clarke
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Joshua S. Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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14
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Lavoie F, Denis A, Chergui S, Al-Shakfa F, Sabouret P. Bicruciate-retaining total knee arthroplasty non-inferior to posterior-stabilized prostheses after 5 years: a randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:1034-42. [PMID: 36329189 DOI: 10.1007/s00167-022-07210-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Bicruciate-retaining (BCR) prostheses may improve satisfaction of patient undergoing total knee arthroplasty (TKA). The objective of this randomized controlled trial was to assess whether BCR prostheses provide better clinical outcomes than posterior-stabilized (PS) prostheses. MATERIALS AND METHODS This is a randomized single-blind control trial involving a total of 77 patients with knee osteoarthritis, randomly assigned to undergo TKA with a BCR or PS implant between 2015 and 2019. Mean follow-up period was 39 months. Clinical and demographic data were extracted manually from medical records. Data acquisition included patient demographics, knee range of motion, and patient-reported outcomes via KSS, KOOS, WOMAC, and SF-12 scores. RESULTS A total of 38 patients were randomized to the PS group and 39 to the BCR group. At the 5-year follow-up, no statistical differences were noted for knee range of motion or patient-reported outcomes between the two groups, except for a greater knee flexion in the early follow-up period in the PS group. Five adverse events occurred in the BCR group compared to none in the PS group (p = 0.02). CONCLUSION BCR TKA yield similar clinical and patient-reported outcomes 5 years following the intervention compared with PS TKA. The BCR TKA had more complications. LEVEL OF EVIDENCE I (Randomized Controlled Trial).
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15
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Boyett B, Nadipelli VR, Solem CT, Chilcoat H, Bickel WK, Ling W. Continued Posttrial Benefits of Buprenorphine Extended Release: RECOVER Study Findings. J Addict Med 2023; 17:182-9. [PMID: 36111991 DOI: 10.1097/ADM.0000000000001070] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This analysis describes participants' opioid use disorder (OUD) outcomes for 18 months after discontinuing extended-release buprenorphine injection (BUP-XR, SUBLOCADE). METHODS The RECOVER (Remission From Chronic Opioid Use: Studying Environmental and Socioeconomic Factors on Recovery) study recruited participants from BUP-XR clinical trials (NCT02357901, NCT025100142, and NCT02896296) to assess whether there were sustained benefits after leaving the trial. Abstinence from opioids and from all illicit substances (excluding medical cannabis), health-related quality of life, depression, and employment were measured after BUP-XR discontinuation and change in outcomes assessed at 6, 12, and 18 months. Results were analyzed within the full cohort and by duration of BUP-XR treatment (0-2 months, 3-5 months, 6-11 months, 12 months, or 13-18 months) with and without inverse probability weights adjusting for differences in baseline characteristics. RESULTS Of 533 participants, 529 were assessed over the 18-month study period. Further posttrial pharmacotherapy was reported by 33% of participants. At RECOVER baseline, longer BUP-XR was associated with higher abstinence (0-2 months BUP-XR [n = 116]: 38.8%; 3-5 months BUP-XR [n = 61]: 41.0%; 6-11 months BUP-XR [n = 86]: 68.6%; 12 months BUP-XR [n = 135]: 71.9%; 18 months BUP-XR [n = 131]: 88.2%) and greater 12-Item Short Form Health Survey mental component scores. Over 60% of participants had stable or improved outcomes at 6, 12, and 18 months assessments. Overall 47% of participants self-reported sustained opioid abstinence for the full 18-month follow-up, with greater sustained abstinence associated with longer BUP-XR treatment duration. A sensitivity analysis, removing patients receiving medications for OUD, yielded similar results. CONCLUSIONS Participants from BUP-XR clinical trials who continued into RECOVER maintained or improved on numerous outcomes over 18 months, demonstrating the long-term positive impact of OUD pharmacotherapy.
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16
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Deckey DG, Verhey JT, Gerhart CRB, Christopher ZK, Spangehl MJ, Clarke HD, Bingham JS. There are Considerable Inconsistencies Among Minimum Clinically Important Differences in TKA: A Systematic Review. Clin Orthop Relat Res 2023; 481:63-80. [PMID: 36200846 PMCID: PMC9750659 DOI: 10.1097/corr.0000000000002440] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are frequently used to assess the impact of total knee arthroplasty (TKA) on patients. However, mere statistical comparison of PROMs is not sufficient to assess the value of TKA to the patient, especially given the risk profile of arthroplasty. Evaluation of treatment effect sizes is important to support the use of an intervention; this is often quantified with the minimum clinically important difference (MCID). MCIDs are unique to specific PROMs, as they vary by calculation methodology and study population. Therefore, a systematic review of calculated MCID values, their respective ranges, and assessment of their applications is important to guide and encourage their use as a critical measure of effect size in TKA outcomes research. QUESTIONS/PURPOSES In this systematic review of MCID calculations and reporting in primary TKA, we asked: (1) What are the most frequently reported PROM MCIDs and their reported ranges in TKA? (2) What proportion of studies report distribution- versus anchor-based MCID values? (3) What are the most common methods by which these MCID values are derived for anchor-based values? (4) What are the most common derivation methods for distribution-based values? (5) How do the reported medians and corresponding interquartile ranges (IQR) compare between calculation methods for each PROM? METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted using the PubMed, EMBASE, and MEDLINE databases from inception through March 2022 for TKA articles reporting an MCID value for any PROMs. Two independent reviewers screened articles for eligibility, including any article that calculated new MCID values for PROMs after primary TKA, and extracted these data for analysis. Overall, 576 articles were identified, 38 of which were included in the final analysis. These studies had a total of 710,128 patients with a median age of 67.7 years and median BMI of 30.9 kg/m 2 . Women made up more than 50% of patients in most studies, and the median follow-up period was 17 months (range 0.25 to 72 months). The overall risk of bias was assessed as moderate using the Jadad criteria for one randomized controlled trial (3 of 5 ideal global score) and the modified Methodological Index for Non-randomized Studies criteria for comparative studies (mean 17.2 ± 1.8) and noncomparative studies (mean 9.6 ± 1.3). There were 49 unique PROMs for which 233 MCIDs were reported. Calculated values were classified as anchor-based, distribution-based, or not reported. MCID values for each PROM, MCID calculation method, number of patients, and study demographics were extracted from each study. Anchor-based and distribution-based MCIDs were compared for each unique PROM using a Wilcoxon rank sum test given non-normal distribution of values. RESULTS The WOMAC Function and Pain subscores were the most frequently reported MCID value, comprising 9% (22 of 233) and 9% (22 of 233), respectively. The composite Oxford Knee Score (OKS) was the next most frequently reported (9% [21 of 233]), followed by the WOMAC composite score (6% [13 of 233]). The median anchor-based values for WOMAC Function and Pain subscores were 23 (IQR 16 to 33) and 25 (IQR 14 to 31), while the median distribution-based values were 11 (IQR 10.8 to 11) and 22 (IQR 17 to 23), respectively. The median anchor-based MCID value for the OKS was 6 (IQR 4 to 7), while the distribution-based value was 7 (IQR 5 to 10). Thirty-nine percent (15 of 38) used an anchor-based method to calculate a new MCID, while 32% (12 of 38) used a distribution-based technique. Twenty-nine percent of studies (11 of 38) calculated MCID values using both methods. For studies reporting an anchor-based calculation method, a question assessing patient satisfaction, pain relief, or quality of life along a five-point Likert scale was the most commonly used anchor (40% [16 of 40]), followed by a receiver operating characteristic curve estimation (25% [10 of 40]). For studies using distribution-based calculations, all articles used a measure of study population variance in their derivation of the MCID, with the most common method reported as one-half the standard deviation of the difference between preoperative and postoperative PROM scores (45% [14 of 31]). Most reported median MCID values (15 of 19) did not differ by calculation method for each unique PROM (p > 0.05) apart from the WOMAC Function component score and the Knee Injury and Osteoarthritis Outcome Score Pain and Activities of Daily Living subscores. CONCLUSION Despite variability of MCIDs for each PROM, there is consistency in the methodology by which MCID values have been derived in published studies. Additionally, there is a consensus about MCID values regardless of calculation method across most of the PROMs we evaluated. CLINICAL RELEVANCE Given their importance to treatment selection and patient safety, authors and journals should report MCID values with greater consistency. We recommend using a 7-point increase as the MCID for the OKS, consistent with the median reported anchor-based value derived from several high-quality studies with large patient groups that used anchor-based approaches for MCID calculation, which we believe are most appropriate for most applications in clinical research. Likewise, we recommend using a 10-point to 15-point increase for the MCID of composite WOMAC, as the median value was 12 (IQR 10 to 17) with no difference between calculation methods. We recommend use of median reported values for WOMAC function and pain subscores: 21 (IQR 15 to 33) and 23 (IQR 13 to 29), respectively.
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Affiliation(s)
- David G. Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jens T. Verhey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | | | - Mark J. Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Henry D. Clarke
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Joshua S. Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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Fu JCM, Fu PK, Cheng YY. Benefits of Cycling Wheelchair Training for Elderly with Physical Disability: A Prospective Cohort Study. Int J Environ Res Public Health 2022; 19:16773. [PMID: 36554652 PMCID: PMC9779290 DOI: 10.3390/ijerph192416773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
AIM In order to investigate the effect of cycling wheelchair training as an exercise for aged 65+ disabled patients on cognitive function, quality of life, aerobic capacity and physiological parameters. METHODS Participants in nursing home performed cycling wheelchair training for 30 min a day, 5 days a week, for a total of 4 weeks. The main outcome measure was the short form 12 survey (SF-12). Other outcome measures included the Mini-Mental State Examination (MMSE), aero bike work rate test, resting blood pressure, and heart rate. RESULTS In this study, 41 volunteers were recruited and no participants dropped out of the study voluntarily during training, and no serious adverse effect was identified. Physical and mental component summary total scores of SF-12 were significantly higher after training with statistical significance (p = 0.001). 8 subscales also showed significant improvements after training (p = 0.025 ~ <0.001). Total MMSE score has no difference before and after training. Attention/calculation (p = 0.018), short term memory (p = 0.041), and aerobic capacity (p < 0.001) as measured by subscales of MMSE and aero bike test showed marked improvements, while resting systolic blood pressure (p = 0.931) and heart rate (p = 0.793) did not change. CONCLUSIONS Cycling wheelchair is practical for the disabled elderly to exercise, and a 4-week exercise program enhanced their quality of life and aerobic capacity.
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Affiliation(s)
- Jimmy Chun-Ming Fu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Pin-Kuei Fu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- College of Human Science and Social Innovation, Hungkuang University, Taichung 433304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
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18
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Jacques N, Karoutsos S, Marais L, Nathan-Denizot N. Quality of life after trigeminal nerve block in refractory trigeminal neuralgia: A retrospective cohort study and literature review. J Int Med Res 2022; 50:3000605221132027. [PMID: 36281027 PMCID: PMC9608051 DOI: 10.1177/03000605221132027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effect of trigeminal nerve block (TNB) on patients' quality of life (QOL) 15 days after the procedure in patients with refractory TN. METHODS This retrospective observational cohort study involved patients receiving TNB (levobupivacaine, clonidine, corticosteroid) between 2014 and 2018 at a postoperative pain clinic in France. Change in QOL from Day 0 (before block) to Day 15 was assessed according to SF-12. RESULTS 21 patients (62 ± 14 y) were included in the study. Most patients (71%) were referred following surgery or dentistry. Of the 9 patients (43%) who exhibited >10% increase in SF-12 scores and so were deemed responders, SF12-physical and SF12-mental were increased by mean differences of 17 and 9 points, respectively. The mean duration of block lasted 15 ± 59 days (range 1 to 90 days) and no severe adverse effects were observed. CONCLUSION Improved QOL was observed in approximately 50% of patients with trigeminal neuralgia (TN) two weeks after specific nerve block. The technique was easy to administer and well accepted by the patients.
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Affiliation(s)
- Nicolas Jacques
- Department of Anaesthesiology and Intensive Care Medicine, Limoges University Hospital, Limoges, France,Nicolas Jacques, Département d’Anesthésie Réanimation, CHU Limoges, 2 avenue Martin Luther King 87042 Limoges, France.
| | - Simon Karoutsos
- Department of Anaesthesiology and Intensive Care Medicine, Limoges University Hospital, Limoges, France
| | - Loïc Marais
- Centre d'Epidémiologie, de Biostatistique et de Méthodologie de la Recherche (CEBIMER), Limoges, France
| | - Nathalie Nathan-Denizot
- Department of Anaesthesiology and Intensive Care Medicine, Limoges University Hospital, Limoges, France,Faculty of Medicine, Limoges, France
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Trieu J, Schilling CG, Spelman T, Dowsey MM, Choong PF. No Difference in Quality-Of-Life Outcomes in the First 7 Years Following Primary Total Knee Arthroplasty Performed Using Computer Navigation Versus Conventional Referencing: A Propensity Score-Matched Analysis. J Arthroplasty 2022; 37:1783-1792. [PMID: 35447276 DOI: 10.1016/j.arth.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/03/2022] [Accepted: 04/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Computer navigation techniques can potentially improve both the accuracy and precision of prosthesis implantation in total knee arthroplasty (TKA) but its impact on quality-of-life outcomes following surgery remains unestablished. METHODS An institutional arthroplasty registry was queried to identify patients with TKA performed between January 1, 2007 and December 31, 2019. Propensity score matching based on demographical, medical, and surgical variables was used to match computer-navigated to conventionally referenced cases. The primary outcomes were Veterans RAND 12 Item Health Survey scores (VR-12 PCS and MCS), Short Form 6 Dimension utility values (SF-6D), and quality-adjusted life years (QALYs) in the first 7 years following surgery. RESULTS A total of 629 computer-navigated TKAs were successfully matched to 1,351 conventional TKAs. The VR-12 PCS improved by a mean of 12.75 and 11.94 points in computer-navigated and conventional cases at 12-month follow-up (P = .25) and the VR-12 MCS by 6.91 and 5.93 points (P = .25), respectively. The mean VR-12 PCS improvement at 7-year follow-up (34.4% of the original matched cohort) for navigated and conventional cases was 13.00 and 12.92 points (P = .96) and for the VR-12 MCS was 4.83 and 6.30 points (P = .47), respectively. The mean improvement in the SF-6D utility score was 0.164 and 0.149 points at 12 months (P = .11) and at 7 years was 0.115 and 0.123 points (P = .69), respectively. Computer-navigated cases accumulated 0.809 QALYs in the first 7 years, compared to 0.875 QALYs in conventionally referenced cases (P = .65). There were no differences in these outcomes among a subgroup analysis of obese patients (body mass index ≥ 30 kg/m2). CONCLUSION The use of computer navigation did not provide an incremental benefit to quality-of-life outcomes at a mean of 2.9 years following primary TKA performed for osteoarthritis when compared to conventional referencing techniques.
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Affiliation(s)
- Jason Trieu
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia
| | - Chris G Schilling
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia
| | - Tim Spelman
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Khow YZ, Liow MHL, Goh GS, Chen JY, Lo NN, Yeo SJ. Defining the minimal clinically important difference for the knee society score following revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:2744-52. [PMID: 34117505 DOI: 10.1007/s00167-021-06628-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND No previous study has evaluated the MCID for revision total knee arthroplasty (TKA). This study aimed to identify the MCID for the Knee Society Score (KSS), for revision TKA. METHODS Prospectively collected data from 270 patients who underwent revision TKA at a single institution was analysed. Clinical assessment was performed preoperatively, at 6 months and 2 years using Knee Society Function Score (KSFS) and Knee (KSKS) Scores, and Oxford Knee Score (OKS). MCID was evaluated with a three-pronged methodology, using (1) anchor-based method with linear regression, (2) anchor-based method with receiver operating characteristic (ROC) and area under curve (AUC), (3) distribution-based method with standard deviation (SD). The anchors used were improvement in OKS ≥ 5, patient satisfaction, and implant survivorship following revision TKA. RESULTS The cohort comprised 70% females, with mean age of 69.0 years, that underwent unilateral revision TKA. The MCID determined by anchor-based linear regression method using OKS was 6.3 for KSFS, and 6.6 for KSKS. The MCID determined by anchor-based ROC was between 15 and 20 for KSFS (AUC: satisfaction = 71.8%, survivorship = 61.4%) and between 33 and 34 for KSKS (AUC: satisfaction = 76.3%, survivorship = 67.1%). The MCID determined by distribution-based method of 0.5 SD was 11.7 for KSFS and 11.9 for KSKS. CONCLUSION The MCID of 6.3 points for KSFS, and 6.6 points for KSKS, is a useful benchmark for future studies looking to compare revision against primary TKA outcomes. Clinically, the MCID between 15 and 20 for KSFS and between 33 and 34 for KSKS is a powerful tool for discriminating patients with successful outcomes after revision TKA. Implant survivorship is an objective and naturally dichotomous outcome measure that complements the subjective measure of patient satisfaction, which future MCID studies could consider utilizing as anchors in ROC. LEVEL OF EVIDENCE II.
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21
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Clement ND, Weir D, Deehan D. Meaningful values in the Short Form Health Survey-36 after total knee arthroplasty - an alternative to the EuroQol five-dimension index as a measure for health-related quality of life : minimal clinically important difference, minimal important change, patient-acceptable symptom state thresholds, and responsiveness. Bone Joint Res 2022; 11:477-483. [PMID: 35796196 PMCID: PMC9350705 DOI: 10.1302/2046-3758.117.bjr-2021-0493.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims To identify the responsiveness, minimal clinically important difference (MCID), minimal clinical important change (MIC), and patient-acceptable symptom state (PASS) thresholds in the 36-item Short Form Health Survey questionnaire (SF-36) (v2) for each of the eight dimensions and the total score following total knee arthroplasty (TKA). Methods There were 3,321 patients undergoing primary TKA with preoperative and one-year postoperative SF-36 scores. At one-year patients were asked how satisfied they were and “How much did the knee arthroplasty surgery improve the quality of your life?”, which was graded as: great, moderate, little (n = 277), none (n = 98), or worse. Results Physical function, role limitations due to physical problems (‘role physical’), bodily pain, and the total score SF-36 scores demonstrated the greatest effect sizes (> 0.9). The MCID for each of SF-36 dimensions ranged from 1.7 for role emotional to 6.4 for bodily pain. The MICs for a cohort of patients ranged from -1.0 for general health to 11.1 for bodily pain. The MICs for an individual patient were marginally greater (one to two points) compared to those for a cohort, and ranging from 0.0 for general and mental health to 13.5 for physical function. The lowest PASS score threshold was associated with physical function (> 34 points) whereas the greatest threshold (> 69 points) was associated with mental health. Conclusion The SF-36 is a responsive tool, and the estimates for MCID, MIC, and PASS thresholds that can be used to power studies, assess whether there has been a meaningful change in patients’ health-related quality of life, and can be used as a marker of achieving patient satisfaction following TKA. Cite this article: Bone Joint Res 2022;11(7):477–483.
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Affiliation(s)
- Nick D Clement
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David Weir
- Department of Orthopaedics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Deehan
- Department of Orthopaedics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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22
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Clement ND, Lin CMA, McCone E, Weir DJ, Deehan DJ. Depression Is Not Independently Associated with a Clinically Worse Functional Improvement but Associated with a Lower Reported Satisfaction Rate after Total Knee Arthroplasty. J Knee Surg 2022; 35:684-691. [PMID: 32942332 DOI: 10.1055/s-0040-1716669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to assess whether depression had a clinically significant influence on the functional improvement of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and whether it influences patient satisfaction at 1 year. A retrospective cohort of 3,510 primary TKA was identified from an arthroplasty database. Patient demographics, comorbidities, WOMAC, and Short Form-12 (SF-12) scores were collected preoperatively and 1 year postoperatively. Patient satisfaction (overall, pain relief, return to work, and recreational activity) was assessed at 1 year. There were 444 (12.6%) patients who self-reported depression. Patients with depression were younger (p < 0.001), had a higher body mass index (BMI; p < 0.001), were more likely to be female (p < 0.001), had lung (p < 0.001), neurological (p = 0.018), kidney (p = 0.001), liver (p < 0.001), and gastric (p < 0.001) disease, report associated diabetes (p = 0.001), and back pain (p < 0.001) relative to the subgroup without depression. All preoperative WOMAC functional measures were significantly (p < 0.001) worse in patients with reported depression. When adjusting for these confounding differences, patients with depression had a clinically equal improvement in their WOMAC scores at 1 year compared to those patients without. Depression was not associated with a clinically significant difference in improvement of knee-specific outcome (WOMAC) but was independently associated with a lower rate of patient satisfaction 1 year after TKA. Patients with depression were approximately twice as likely to be dissatisfied at 1 year when compared with those without depression. This is a prognostic retrospective cohort study and reflects level of evidence III.
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Affiliation(s)
- Nicholas D Clement
- Department of Orthopaedics, Freeman Hospital, High Heaton, Newcastle upon Tyne, United Kingdom
| | - Chung M A Lin
- Department of Orthopaedics, Freeman Hospital, High Heaton, Newcastle upon Tyne, United Kingdom
| | - Emma McCone
- Department of Orthopaedics, Freeman Hospital, High Heaton, Newcastle upon Tyne, United Kingdom
| | - David J Weir
- Department of Orthopaedics, Freeman Hospital, High Heaton, Newcastle upon Tyne, United Kingdom
| | - David J Deehan
- Department of Orthopaedics, Freeman Hospital, High Heaton, Newcastle upon Tyne, United Kingdom
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Ulivi M, Orlandini L, Meroni V, Viganò M, D’Errico M, Perrotta R, Nannini A, Peretti GM, Mangiavini L. Italian Translation, Adaptation, and Validation of the Novel Satisfaction Measure Assessment after Primary Total Joint Arthroplasty: The Goodman Score Questionnaire. Healthcare (Basel) 2022; 10:769. [PMID: 35627906 PMCID: PMC9141051 DOI: 10.3390/healthcare10050769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Patient satisfaction after total joint arthroplasties (TJA) represents a key element for the evaluation of surgery success in relation to subjects' needs and expectations. The assessment tools are applied inconsistently throughout the literature, and thus, it is difficult to compare results among different studies. Goodman et al. proposed a standardized questionnaire with strong psychometric properties for the assessment of satisfaction. The present study aims to translate, adapt, and validate the Goodman questionnaire for the Italian population. After translation and back translation, the questionnaire was administrated to 50 patients. Internal consistency, test-retest reliability, floor and ceiling effects, and construct validity were evaluated (correlation with KOOS/HOOS, SF-12 PCS/MCS, EQ-5D). Responsiveness was evaluated with respect to SF-12 PCS improvements. The Italian version of the Goodman score questionnaire demonstrated psychometric properties similar to those of the original version. The translated questionnaire showed good internal consistency (Cronbach's alpha = 0.836) and test-retest reliability (ICC: 0.507). Moderate/strong correlations were observed between the Italian version of the Goodman score and other scores. The score significantly discriminated patients who improved from those who did not improve in SF-12 PCS after treatment. This study provides an adapted and validated Italian version of the Goodman score questionnaire, with psychometric properties similar to those of its original counterpart.
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Affiliation(s)
- Michele Ulivi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Luca Orlandini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Valentina Meroni
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Mario D’Errico
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Riccardo Perrotta
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Alessandra Nannini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
| | - Giuseppe M. Peretti
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, 20133 Milano, Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.U.); (L.O.); (V.M.); (M.D.); (R.P.); (A.N.); (G.M.P.); (L.M.)
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 31, 20133 Milano, Italy
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Abstract
OBJECTIVE To investigate the effects of kinesio taping and cold therapy on pain, edema, range of motion, muscle strength, functional level and quality of life in patients with total knee arthroplasty. DESIGN Randomised controlled trial. SETTING A university hospital. SUBJECTS One-hundred patients were included. INTERVENTION Patients were allocated into three groups; control group, kinesio group and cold therapy group. The control group received a standard rehabilitation program. Kinesio taping group received two fan-shaped kinesio taping bands and cold therapy group received cold packs in addition to the standard rehabilitation program. MAIN MEASURES The outcome measures were pain, edema, range of motion, muscle strength, functional level and quality of life. Participants were assessed at preoperative, discharge and postoperative third month. RESULTS The groups were similar at preoperative. A significant difference was determined in terms of pain in kinesio taping group compared to the control group at the discharge. Cold therapy was efficient in reducing postoperative swelling but kinesio taping had no significant effects on swelling control. There was no difference between the groups in terms of range of motion, muscle strength, functional level and quality of life. The groups were similar in all parameters at the postoperative third month measurements. CONCLUSION Fan-shaped kinesio taping is an effective technique in terms of postoperative pain relief. Cold therapy is an effective method in terms of edema control. Kinesio taping and cold therapy has no specific beneficial effect on functional level, muscle strength and quality of life compared to control group.
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Affiliation(s)
- Ertugrul Yuksel
- Graduate School of Health Sciences, 37508Dokuz Eylul University, Izmir, Turkey
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, 37508Dokuz Eylul University, Izmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopedics and Traumatology, School of Medicine, 37508Dokuz Eylul University, Izmir, Turkey
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25
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Wang BB, Patel KF, Wolfe AE, Wiechman S, McMullen K, Gibran NS, Kowalske K, Meyer WJ, Kazis LE, Ryan CM, Schneider JC. Adolescents with and without head and neck burns: comparison of long-term outcomes in the burn model system national database. Burns 2022; 48:40-50. [PMID: 33975762 PMCID: PMC8526620 DOI: 10.1016/j.burns.2021.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Facial burns account for persistent differences in psychosocial functioning in adult burn survivors. Although adolescent burn survivors experience myriad chronic sequelae, little is known about the effect of facial injuries. This study examines differences in long-term outcomes with and without head and neck involvement. METHODS Data collected for 392 burn survivors between 14-17.9 years of age from the Burn Model System National Database (2006-2015) were analyzed. Comparisons were made between two groups based on presence of a head and neck burn (H&N) using the following patient reported outcome measures: Satisfaction with Appearance Scale, Satisfaction with Life Scale, Community Integration Questionnaire, and Short Form-12 Health Survey at 6, 12, and 24 months after injury. Regression analyses were used to assess association between outcome measures and H&N group at 12-months. RESULTS The H&N group had more extensive burns, had longer hospital stays, were more likely to be burned by fire/flame and were more likely to be Hispanic compared to the non-H&N group. Regression analysis found that H&N burn status was associated with worse SWAP scores. No significant associations were found between H&N burn status and other outcome measures. CONCLUSIONS Adolescents with H&N burn status showed significantly worse satisfaction with appearance at 12-months after injury. Future research should examine interventions to help improve body image and coping for adolescent burn survivors with head and neck burns.
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Affiliation(s)
| | - Khushbu F. Patel
- Shriners Hospitals for Children – Boston, Boston, MA United States,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Audrey E. Wolfe
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Nicole S. Gibran
- Department of Surgery, University of Washington Harborview, Seattle, WA, United States
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Walter J. Meyer
- Department of Psychiatry, University of Texas Medical Branch, Galveston, TX, United States
| | - Lewis E. Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Colleen M. Ryan
- Shriners Hospitals for Children – Boston, Boston, MA United States,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States,Corresponding author. (J.C. Schneider)
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26
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van der Willik EM, Lengton R, Hemmelder MH, Hoogeveen EK, Bart HAJ, van Ittersum FJ, ten Dam MAGJ, Bos WJW, Dekker FW, Meuleman Y. Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms – results from the RENINE/PROMs registry. Nephrol Dial Transplant 2022; 37:1731-1741. [PMID: 35098998 PMCID: PMC9395377 DOI: 10.1093/ndt/gfac022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background Itching (pruritus) is common in dialysis patients, but little is known about its impact on health-related quality of life (HRQOL), sleep problems and psychological symptoms. This study investigates the impact of itching in dialysis patients by looking into the persistence of itching, the effect of itching on the course of HRQOL and the combined effect of itching with sleep problems and with psychological symptoms on HRQOL. Methods Data were obtained from the RENINE/PROMs registry and included 2978 dialysis patients who completed patient-reported outcome measures between 2018 and 2020. Itching, sleep problems and psychological symptoms were assessed with the Dialysis Symptom Index (DSI) and HRQOL with the 12-item Short Form Health Survey. Effects of itching on HRQOL and interactions with sleep problems and psychological symptoms were investigated cross-sectionally and longitudinally using linear regression and linear mixed models. Results Half of the patients experienced itching and in 70% of them, itching was persistent. Itching was associated with a lower physical and mental HRQOL {−3.35 [95% confidence interval (CI) −4.12 to −2.59) and −3.79 [95% CI −4.56 to −3.03]}. HRQOL remained stable during 2 years and trajectories did not differ between patients with or without itching. Sleep problems (70% versus 52%) and psychological symptoms (36% versus 19%) were more common in patients with itching. These symptoms had an additional negative effect on HRQOL but did not interact with itching. Conclusions The persistence of itching, its impact on HRQOL over time and the additional effect on HRQOL of sleep problems and psychological symptoms emphasize the need for recognition and effective treatment of itching to reduce symptom burden and improve HRQOL.
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Affiliation(s)
- Esmee M van der Willik
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robin Lengton
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Maastricht University Medical Center and CARIM school for cardiovascular diseases, Maastricht University, Maastricht, The Netherlands
| | - Ellen K Hoogeveen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Hans A J Bart
- Dutch Kidney Patients Association (NVN), Bussum, The Netherlands
| | - Frans J van Ittersum
- Department of Nephrology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marc A G J ten Dam
- Nefrovisie Foundation, Utrecht, The Netherlands
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Willem Jan W Bos
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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27
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Khow YZ, Liow MHL, Goh GS, Chen JY, Lo NN, Yeo SJ. The oxford knee score minimal clinically important difference for revision total knee arthroplasty. Knee 2021; 32:211-217. [PMID: 34509827 DOI: 10.1016/j.knee.2021.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Minimal clinically important difference (MCID) is crucial for interpreting meaningful improvements in patient-reported outcome measures (PROMs). No previous study has evaluated the MCID for the Oxford Knee Score (OKS) in revision total knee arthroplasty (TKA). This study aimed to propose the OKS MCID for revision TKA. METHODS Prospectively collected data from 191 patients who underwent revision TKA at a single institution was analysed. Clinical assessment was performed preoperatively and at 2 years using OKS and Short-Form 36 Physical Component Score (SF-36 PCS). MCID was evaluated with a three-pronged methodology, using (1) anchor-based method with linear regression, (2) anchor-based method with receiver operating characteristic (ROC) and area under curve (AUC), (3) distribution-based method with standard deviation (SD). The anchors used were improvement in SF-36 PCS ≥ 12, patient satisfaction, and implant survivorship following revision TKA. RESULTS The MCID determined by anchor-based linear regression method using improvements in SF-36 PCS was 4.9 points. The MCID determined by anchor-based ROC was 10.5 points for satisfaction (AUC = 74.8%) and 13.5 points for implant survivorship (AUC = 73.7%). The MCID determined by distribution-based method of 0.5 SD was 4.7. CONCLUSION The proposed MCID for OKS following revision TKA is 4.9 points. Patients who achieve an improvement in OKS of at least 10.5-13.5 points by 2 years are likely to be satisfied with their surgery and not require a subsequent re-revision TKA. Patients undergoing revision TKA should aim for an improvement in OKS of at least 10.5-13.5 points as a target score.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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28
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Ulivi M, Orlandini L, Meroni V, D'Errico M, Fontana A, Viganò M, Mangiavini L, D'Anchise R, Parente F, Pozzoni R, Sansone V, Zagra L, Peretti GM. Remote Management of Patients after Total Joint Arthroplasty via a Web-Based Registry during the COVID-19 Pandemic. Healthcare (Basel) 2021; 9:1296. [PMID: 34682976 DOI: 10.3390/healthcare9101296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: In 2020, due to the outbreak of the COVID-19 (Coronavirus Disease 2019) pandemic, patients who underwent total joint arthroplasty were not able to undergo the proper postoperative surgical and rehabilitative care. This study aims to evaluate the potential of a web-cloud-based database on patients’ follow-up in extraordinary situations, when a traditional in-person follow-up cannot be warranted. Methods: Patients who underwent joint arthroplasty at our Institute between 21 February and 16 March 2020 were included in the study group and were matched to a similar population undergoing joint arthroplasty in February/March 2019. All patients routinely complete questionnaires before and after treatment, including patient-reported outcome measures such as the Visual Analogues Scale (VAS), Knee/Hip Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS/HOOS-PS) and Short-Form Health Survey (SF-12) for the monitoring of clinical improvements. Results: 56 (study group) and 144 (control group) patients were included in the study. Both groups demonstrated significant improvements at 3 months. HOOS-PS improvement was significantly reduced in the 2020 group compared to 2019 (21.7 vs. 33.9, p < 0.001). This reduction was related to intense physical activities. Similarly, the functional score improvement related to these activities was reduced for patients undergoing knee replacement (8 vs. 10, p < 0.05). Conclusions: The web-based Institute Registry emerged as a meaningful and sensitive tool during an extraordinary situation such as the COVID-19 pandemic to monitor patients’ progression after total joint arthroplasties. Thanks to this tool, it was possible to observe that the prevention of usual postoperative care due to pandemic-related restrictions did not alter the benefits observed after joint replacement surgeries, even if this condition reduced the postoperative improvements in the most burdensome physical activities. A broader use of this kind of tool would improve and potentially reduce the burden and costs of postoperative patients’ monitoring in standard and extraordinary conditions. In addition, the systematic remote collection of data would allow for the identification of relevant differences in clinical outcomes in specific conditions or following the modification of treatment and rehabilitation protocols.
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Stulberg BN, Zadzilka JD, Kreuzer S, Kissin YD, Liebelt R, Long WJ, Campanelli V. Safe and effective use of active robotics for TKA: Early results of a multicenter study. J Orthop 2021; 26:119-25. [PMID: 34393411 DOI: 10.1016/j.jor.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background A novel active robotic system for total knee arthroplasty (TKA) performs automated milling of bone surfaces. Study objectives were to assess system safety and effectiveness in a US population. Methods A multicenter clinical trial was conducted, following 115 patients for at least 6-months. A pre-defined list of robot-related adverse events was used to evaluate safety. Efficacy was assessed radiographically comparing planned versus achieved coronal limb alignment. Results No pre-defined adverse events occurred and postoperative limb alignment more than ±3° from plan occurred in 11.2 % of cases. Conclusion Active robotics for TKA is safe and effective as demonstrated in this trial.
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Jennum P, Coaquira Castro J, Mettam S, Kharkevitch T, Cambron-Mellott MJ. Socioeconomic and humanistic burden of illness of excessive daytime sleepiness severity associated with obstructive sleep apnoea in the European Union 5. Sleep Med 2021; 84:46-55. [PMID: 34102429 DOI: 10.1016/j.sleep.2021.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/25/2021] [Accepted: 05/09/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE/BACKGROUND Evaluate the impact of excessive daytime sleepiness (EDS) severity on burden of illness among adults with obstructive sleep apnoea (OSA) in European Union 5 (EU5) countries (France, Germany, Italy, Spain, United Kingdom). PATIENTS/METHODS This retrospective observational study used data from the 2017 EU5 National Health and Wellness Survey, a self-administered, internet-based, non-screening survey. Respondents who self-reported both having experienced OSA in the last 12 months and having had their OSA diagnosed by a physician were considered to have OSA. Respondents completed the Epworth Sleepiness Scale (ESS) and were consequently categorised into 4 groups: OSA-with-EDS (ESS >10) subdivided by EDS severity (mild [ESS = 11-12], moderate [ESS = 13-15], severe [ESS = 16-24]), and OSA-without-EDS (ESS ≤10). Bivariate and multivariable analyses examined group differences in health-related quality of life (HRQoL), work productivity and activity impairment, and health care utilisation. RESULTS The analysis included 2008 respondents with OSA: n = 661 (32.9%) with EDS (29.5% mild, 34.5% moderate, 36.0% severe) and n = 1347 without EDS. Compared with the OSA-without-EDS group, the OSA-with-EDS subgroups generally had higher rates of obesity, depression, and other reported comorbidities. Greater severity of EDS was associated with worse self-reported HRQoL (all domains, P < 0.001) and work productivity and activity impairment (absenteeism, P = 0.031; presenteeism, overall work impairment, and non-work activity impairment, P < 0.001), as well as increased numbers of health care provider visits (P < 0.001). CONCLUSIONS Compared to patients with OSA but without EDS, those with EDS had substantially higher socioeconomic and humanistic burden of disease, which was more profound among those reporting greater EDS.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Copenhagen, Denmark.
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Murali CN, Slater B, Musaad S, Cuthbertson D, Nguyen D, Turner A, Azamian M, Tosi L, Rauch F, Sutton VR, Lee B, Nagamani SCS. Health-related quality of life in adults with osteogenesis imperfecta. Clin Genet 2021; 99:772-779. [PMID: 33580568 DOI: 10.1111/cge.13939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
Patient-reported outcome measures (PROMs) are increasingly utilized as endpoints in clinical trials. The Short Form Health Survey-12 (SF-12v2) is a generic PROM for adults. We sought to evaluate the validity of SF-12v2 in adults with osteogenesis imperfecta (OI). Physical and mental health-related quality of life (HRQoL) were assessed in a large cohort of adults in a multicenter, observational, natural history study. Physical HRQoL scores were correlated with the Gillette Functional Assessment Questionnaire (GFAQ). We calculated sample sizes required in clinical trials with crossover and parallel-group designs to detect clinically meaningful changes in physical HRQoL. Three hundred and two adults with OI types I, III, and IV were enrolled. Physical HRQoL scores in the study population were lower than population norms. Physical HRQoL scores moderately correlated with GFAQ for OI types I and IV. We found no correlations between mental and physical HRQoL. From a clinical trial readiness perspective, we show that SF-12v2 reliably measures physical function in adults with OI and can be utilized in crossover trials to detect meaningful physical HRQoL changes with small sample sizes. This study shows that SF-12v2 can be used to measure changes in physical HRQoL in response to interventions in OI.
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Affiliation(s)
- Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
| | - Brady Slater
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Salma Musaad
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas, USA.,Children's Nutrition Research Center, United States Department of Agriculture/Agricultural Research Service, Houston, Texas, USA
| | - David Cuthbertson
- College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Dianne Nguyen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Alicia Turner
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Mahshid Azamian
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Laura Tosi
- Bone Health Program, Children's National Health System, Washington D.C., Washington, USA
| | - Frank Rauch
- Shriner's Hospital of Children, McGill University, Montreal, Quebec, Canada
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
| | - Brendan Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
| | | | - Sandesh C S Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
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Karaborklu Argut S, Celik D, Kilicoglu OI. The Combination of Exercise and Manual Therapy Versus Exercise Alone in Total Knee Arthroplasty Rehabilitation: A Randomized Controlled Clinical Trial. PM R 2020; 13:1069-1078. [PMID: 33352007 DOI: 10.1002/pmrj.12542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/13/2020] [Accepted: 12/14/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic surgeries in the lower extremity. However, patient dissatisfaction and functional disability are mostly experienced because of pain and limited range of motion (ROM). Although manual therapy is commonly implemented to improve ROM and modulate pain in the management of musculoskeletal disorders, there is a lack of evidence about its clinical effectiveness on postoperative TKA rehabilitation. OBJECTIVE To investigate the effectiveness of an exercise program combined with manual therapy compared with an exercise program only for pain, ROM, function, quality of life, and patient satisfaction outcomes. DESIGN A randomized controlled clinical trial. SETTING Rehabilitation unit of a university hospital. PARTICIPANTS Forty-two patients (68.45 ± 6.3 years) scheduled for unilateral TKA as a treatment of severe osteoarthritis. INTERVENTIONS Joint and soft tissue mobilizations in addition to exercise therapy were provided to the mobilization group (n = 21) while the control group received exercise therapy only (n = 21). MAIN OUTCOME MEASURES The outcome measures were numeric pain-rating scale, knee ROMs, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, 10-meter walk test (10MWT), 5-times sit to stand test (5SST), and Short Form-12 (SF-12). RESULTS Improvements in pain outcomes were significantly higher in the mobilization group than in the control group (P = .001, F [3, 33] = 7.06) and the between-group difference in change score was 1.3 points (P = .001). Although the between-group difference in change score was 12.8° for knee flexion at 2 months (P = .001), the overall group-by-time interactions were not significant for flexion and extension ROMs (P = .175, F [3, 33] = 1.75 and P = .57, F [2, 34] = 0.56, respectively). Additionally, there were statistically meaningful group-by-time interactions on total WOMAC score (P = .006, F [2, 34] = 5.29), 10MWT (P = .002, F [3, 33] = 5.98), and SF-12 mental component summary (P = .01, F [2, 34] = 4.92) favoring the mobilization group. Also, patient satisfaction was higher in the mobilization group (P = .02). CONCLUSIONS A structured exercise program combined with manual therapy can be more beneficial in improving pain, function, and patient satisfaction compared to exercise program alone for postoperative TKA patients.
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Affiliation(s)
- Sezen Karaborklu Argut
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Derya Celik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Onder I Kilicoglu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Larghi MM, Grassi M, Luca F, Placenza E, Rampulla C, Manzotti A. Clinical outcome before and after COVID-19 quarantine in patients affect of knee and hip osteoarthritis. Acta Biomed 2020; 91:e2020150. [PMID: 33525204 PMCID: PMC7927509 DOI: 10.23750/abm.v91i4.10275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/09/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The emergency caused by COVID-19 Pandemia has resulted in a complete suspension and consequent delay of common planned surgery such total hip replacement in patients affect by osteoarthritis. At the same time, the issue of the quarantine imposed changes to the normal lifestyle of these patients. The purpose of our study is to evaluate how the presence of these two factors affect the quality of live of patients living in the Italian red zone. METHODS From outpatient pre-operative assessment we collect data about: demographic data, WOMAC score, NRS (Numeric rating scale 0-10), PCS SF12 and MCS SF12 score. Selected patients were therefore contacted by telephone call and re-assess using the same score. In addition, patients were asked if they intended to undergo the planned surgery again despite the current emergency Results: 14 patient have been recruited for the study. Male/female ration was 10/4, mean age was 70 years. Pre operative outpatient assessment mean WOMAC score was 44,86 (SD ± 8,52) , mean NRS was 8,07 (SD ± 1,33), PCS SF12 was 30,33 (SD ± 5,0) and MCS SF12 was 40,95 (SD ± 3,51). At re-evalutation the mean WOMAC score was 32,86 (SD ± 17,88) , mean NRS was 5,79 (SD ± 3,66), PCS SF12 was 39,9 (SD ± 3,70) and MCS SF12 was 50,14 (SD ± 6,86) Conclusion: The exceptionale pandemic from Covid-19 has profoundly changed our lifestyle, impacting normal daily activities but also on regular surgical activity in patients affected by osteoarthritis. Our study suggested that the lifestyle changes imposed by the situation led to an improvement of clinical score. This shows how an exceptional event can affect many aspects of daily life.
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Affiliation(s)
- Marco Mattia Larghi
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano.
| | - Miriam Grassi
- Orthopaedic and Trauma Department, "Luigi Sacco" Hospital, ASST FBF-Sacco, Milan, Italy.
| | - Faugno Luca
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano.
| | - Emanuele Placenza
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano.
| | - Corrado Rampulla
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano.
| | - Alfonso Manzotti
- Orthopaedic and Trauma Department, "Luigi Sacco" Hospital, ASST FBF-Sacco, Milan, Italy.
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Busija L, Ackerman IN, Haas R, Wallis J, Nolte S, Bentley S, Miura D, Hawkins M, Buchbinder R. Adult Measures of General Health and Health‐Related Quality of Life. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:522-564. [DOI: 10.1002/acr.24216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Romi Haas
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
| | - Jason Wallis
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
| | - Sandra Nolte
- Charité – Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany, ICON GmbH, Munich, Germany, and Deakin University Burwood Victoria Australia
| | - Sharon Bentley
- Queensland University of Technology Kelvin Grove Queensland Australia
| | | | - Melanie Hawkins
- Deakin University, Burwood, Victoria, Australia, and Swinburne University of Technology Melbourne Victoria Australia
| | - Rachelle Buchbinder
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
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Trieu J, Gould DJ, Schilling C, Spelman T, Dowsey MM, Choong PF. Patient-Reported Outcomes Following Total Knee Replacement in Patients <65 Years of Age-A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E3150. [PMID: 33003394 DOI: 10.3390/jcm9103150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022] Open
Abstract
An increasing number of total knee replacements (TKRs) are being performed in response to the growing burden of osteoarthritis. Patients <65 years of age represent the fastest growing group of TKR recipients and are expected to account for an increasing number of primary and revision procedures. Concerns have been raised about the outcomes that can be expected by this age demographic who are more active, physically demanding, and have longer life expectancies compared to older TKR recipients. This systematic review and meta-analysis evaluated the effectiveness of TKR for osteoarthritis in patients <65 years of age, compared to older individuals. A systematic search of Embase and Medline was conducted to identify studies which examined patient-reported outcomes measured using disease-specific and generic health-related quality of life instruments. Ten studies met our inclusion criteria and were included in this review. These studies comprised 1747 TKRs performed between 1977 and 2014. In the meta-analysis of two prospective studies (288 TKRs), patients <65 years of age were able to attain large and clinically meaningful improvements in pain, function, and quality of life. One of these studies (61 TKRs) suggested that patients <55 years of age attained a larger degree of improvement compared to older individuals. Results into the second postoperative decade were less certain, with some data suggesting a high prevalence of pain and patterns of functional decline. Further research is required to investigate longer-term outcomes following TKR for osteoarthritis in younger patients.
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Gwynne-Jones DP, Gwynne-Jones JH, Wilson RA. The Functional Outcomes of Patients With Knee Osteoarthritis Managed Nonoperatively at the Joint Clinic at 5-Year Follow-Up: Does Surgical Avoidance Mean Success? J Arthroplasty 2020; 35:2350-2356.e1. [PMID: 32448492 DOI: 10.1016/j.arth.2020.04.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Nonoperative management of patients with knee osteoarthritis (OA) through multidisciplinary programs may delay or reduce the need for total knee arthroplasty (TKA). However, avoidance of surgery may not represent success for the patient. METHODS A cohort of 120 patients with knee OA managed with at least 6 months of supervised nonoperative treatment coordinated through the Joint Clinic were reviewed at 5 years. Outcomes including Oxford knee score (OKS), Short Form 12 (SF-12), and SF-6D and other measures including analgesia use, global change, and perception of need for surgery were collected and compared with those from the cohort who had undergone TKA. RESULTS Seventy (62.5%) surviving patients were still being managed nonoperatively. There was no significant change in any outcome score (OKS, SF-12 physical component score, SF-12 mental component score, SF-6D) (P = .26 to .84). Forty-two patients had undergone TKA with mean time to surgery 29.0 months (range, 9-69 months). In this group, the mean OKS fell from 17.9 at baseline to 10.3 (range, 3-21) preoperatively (P < .0001) and at 5 years there was a significant improvement from baseline in OKS, SF-12 physical component score, and SF-6D scores (P < .0001). All outcome scores and change in scores were significantly higher for the surgical group (all P < .001). CONCLUSION Although a high proportion of patients with knee OA have avoided surgery at 5 years, their outcomes show no improvement from baseline and are poorer than those who have undergone TKA. Avoidance of surgery should not necessarily be regarded as an indicator of success of nonoperative treatment for the patient.
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Clement ND, Weir D, Holland J, Deehan DJ. Sex does not clinically influence the functional outcome of total knee arthroplasty but females have a lower rate of satisfaction with pain relief. Knee Surg Relat Res 2020; 32:32. [PMID: 32660629 DOI: 10.1186/s43019-020-00048-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background The aims were to assess whether sex had a clinically significant independent influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Short Form (SF-) 12 scores and patient satisfaction at 1 year. Methods A retrospective cohort of 3510 primary TKA were identified. Patient demographics, comorbidities, WOMAC and SF-12 scores were collected preoperatively and 1 year postoperatively. Patient satisfaction were assessed at 1 year. Results There were 1584 males and 1926 females. The preoperative WOMAC and SF-12 scores were significantly (p < 0.001) worse in females but were not greater than the minimal clinically important difference (MCID). When adjustments had been made for confounding differences, females showed a significantly greater improvement in their function (1.5 points, p = 0.03) and total (1.5 points, p = 0.03) WOMAC scores compared to males, but these were not greater than the MCID. When adjustments had been made for confounding differences, females were less likely to be satisfied with their pain relief (p = 0.03) relative to males. Conclusion Sex does not clinically influence the knee specific outcome (WOMAC) or overall generic (SF-12) health 1 year after TKA. However, satisfaction with pain relief after TKA was significantly less likely in female patients. Level of evidence II Prognostic retrospective cohort study.
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Albanese AM, Bartz-Overman C, Parikh Md T, Thielke SM. Associations Between Activities of Daily Living Independence and Mental Health Status Among Medicare Managed Care Patients. J Am Geriatr Soc 2020; 68:1301-1306. [PMID: 32196634 DOI: 10.1111/jgs.16423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/29/2020] [Accepted: 02/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Although there is a strong cross-sectional association between dependence in activities of daily living (ADLs) and decreased mental health, it is largely unknown how the loss of specific ADLs, or the combination of ADLs, influences mental health outcomes. We examined the effect of ADL independence on mental health among participants in a large survey of Medicare managed care recipients. DESIGN/SETTING Retrospective cohort study. PARTICIPANTS A total of 104,716 participants in cohort 17 of the Medicare Health Outcomes Survey, who completed the baseline and follow-up surveys in 2014 and 2016. MEASUREMENTS Linear regression models estimated the effects of loss of ADL independence on change in Mental Component Summary (MCS) score. RESULTS In an adjusted model, loss of independence in eating, bathing, dressing, and toileting were associated with three- to four-point declines in MCS, suggesting meaningful worsening. In a model that also included all six ADLs, loss of independence in each ADL was associated with declines in MCS, with the largest effects for eating and bathing. MCS decreased by 1.3 per each additional summative loss of ADL independence (P < .001). CONCLUSION Loss of ADL independence was associated with large declines in mental health, with personal care activities showing the largest effects. Additional research can help to characterize the causes of ADL loss, to explore how older adults cope with it, and to identify ways of maximizing resilience. J Am Geriatr Soc 68:1301-1306, 2020.
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Affiliation(s)
- Anita M Albanese
- University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | | | - Toral Parikh Md
- University of Washington School of Medicine, Seattle, Washington, USA
- Health Services Research and Development, Puget Sound Veterans Affairs Medical Center, Seattle, Washington, USA
| | - Stephen M Thielke
- University of Washington School of Medicine, Seattle, Washington, USA
- Geriatric Research, Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, Washington, USA
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Maredupaka S, Meshram P, Chatte M, Kim WH, Kim TK. Minimal clinically important difference of commonly used patient-reported outcome measures in total knee arthroplasty: review of terminologies, methods and proposed values. Knee Surg Relat Res 2020; 32:19. [PMID: 32660584 PMCID: PMC7219224 DOI: 10.1186/s43019-020-00038-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/13/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose The aim of this article was to highlight various terminologies and methods of calculation of minimal clinically important difference (MCID) and summarize MCID values of frequently used patient-reported outcome measures (PROMs) evaluating total knee arthroplasty (TKA). Materials and methods PubMed and EMBASE databases were searched through May 2019. Of 71 articles identified, 18 articles matched and underwent a comprehensive analysis for terminologies used to indicate clinical significance, method of calculation, and reported MCID values. Results MCID was the most common terminology (67% studies) and anchor-based methods were most commonly employed (67% studies) to calculate it. The analytical methods used to calculate and the estimated values of MCID for clinical use are highly variable. MCID values reported for WOMAC scores are 20.5 to 36.0, 17.6 to 33.0 and 12.9 to 25.0 for pain, function and stiffness sub-scales, respectively, and 4.7 to 10.0 for OKS. Conclusion There was lack of standardization in the methodology employed to calculate MCID in the available studies. MCID values reported in this review could be used for patients undergoing TKA, although caution is advised in their interpretation and application.
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Affiliation(s)
- Siddhartha Maredupaka
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Manish Chatte
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Woo Hyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Tae Kyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
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Smith T. Avoiding 'Fake News' in orthopaedic research - measuring the right outcomes and their interpretation. Knee 2019; 26:811-812. [PMID: 31327511 DOI: 10.1016/j.knee.2019.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/25/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Toby Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford.
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