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Wang AWT, Stockton DJ, Flury A, Kim TG, Roffey DM, Lefaivre KA. Radiographic Union Assessment in Surgically Treated Distal Femur Fractures: A Systematic Review. JBJS Rev 2024; 12:01874474-202403000-00001. [PMID: 38446912 DOI: 10.2106/jbjs.rvw.23.00223] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Distal femur fractures are known to have challenging nonunion rates. Despite various available treatment methods aimed to improve union, optimal interventions are yet to be determined. Importantly, there remains no standard agreement on what defines radiographic union. Although various proposed criteria of defining radiographic union exist in the literature, there is no clear consensus on which criteria provide the most precise measurement. The use of inconsistent measures of fracture healing between studies can be problematic and limits their generalizability. Therefore, this systematic review aims to identify how fracture union is defined based on radiographic parameters for surgically treated distal femur fractures in current literature. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection databases were searched from inception to October 2022. Studies that addressed surgically treated distal femur fractures with reported radiographic union assessment were included. Outcomes extracted included radiographic definition of union; any testing of validity, reliability, or responsiveness; reported union rate; reported time to fracture union; and any functional outcomes correlated with radiographic union. RESULTS Sixty articles with 3,050 operatively treated distal femur fractures were included. Operative interventions included lateral locked plate (42 studies), intramedullary nail (15 studies), dynamic condylar screw or blade plate (7 studies), dual plate or plate and nail construct (5 studies), distal anterior-posterior/posterior-anterior screws (1 study), and external fixation with a circular frame (1 study). The range of mean follow-up time reported was 4.3 to 44 months. The most common definitions of fracture union included "bridging or callus formation across 3 of 4 cortices" in 26 (43%) studies, "bony bridging of cortices" in 21 (35%) studies, and "complete bridging of cortices" in 9 (15%) studies. Two studies included additional assessment of radiographic union using the Radiographic Union Scale in Tibial fracture (RUST) or modified Radiographic Union Scale in Tibial fracture (mRUST) scores. One study included description of validity, and the other study included reliability testing. The reported mean union rate of distal femur fractures was 89% (range 58%-100%). The mean time to fracture union was documented in 49 studies and found to be 18 weeks (range 12-36 weeks) in 2,441 cases. No studies reported correlations between functional outcomes and radiographic parameters. CONCLUSION The current literature evaluating surgically treated distal femur fractures lacks consistent definition of radiographic fracture union, and the appropriate time point to make this judgement is unclear. To advance surgical optimization, it is necessary that future research uses validated, reliable, and continuous measures of radiographic bone healing and correlation with functional outcomes. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alice Wei Ting Wang
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Stockton
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Andreas Flury
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Taylor G Kim
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Tucker A, Roffey DM, Guy P, Potter JM, Broekhuyse HM, Lefaivre KA. Evaluation of the trajectory of recovery following surgically treated acetabular fractures. Bone Joint J 2024; 106-B:69-76. [PMID: 38160696 DOI: 10.1302/0301-620x.106b1.bjj-2023-0499.r2] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Aims Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Methods Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established. Results We recruited 251 patients (253 fractures), with a 4:1 male to female ratio and mean age of 46.1 years (SD 16.4). Associated fracture patterns accounted for 56.5% of fractures (n = 143). Trajectory analysis showed all timepoints had significant disability versus baseline, including final follow-up (p < 0.001). Elementary fractures had higher SF-36 PCS at six months (p = 0.023) and one year (p = 0.007) compared to associated fractures, but not at two years (p = 0.135) or five years (p = 0.631). The MCID in SF-36 PCS was observed in 37.3% of patients (69/185) between six months and one year, 26.9% of patients (39/145) between one and two years, and 23.3% of patients (20/86) between two and five years, highlighting the long recovery potential of these injuries. A significant proportion of patients failed to attain the MCID after five years (38.1%; 40/105). Conversion to THA occurred in 13.1% of patients (11/110 elementary and 22/143 associated fractures). Approximately two-thirds of THAs (21/33 patients; 63.6%) were performed within two years of index surgery. Conclusion Acetabular fractures significantly impact physical function. Recovery trajectory is often elongated beyond one year, with two-thirds of our patients displaying persistent clinically relevant long-term disability.
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Affiliation(s)
- Adam Tucker
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
| | - Jeffrey M Potter
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, Canada
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Sepehri A, Stockton DJ, Roffey DM, Lefaivre KA, Potter JM, Guy P. Effect of humeral rotation on the reliability of radiographic measurements for proximal humerus fractures. J Orthop Sci 2023:S0949-2658(23)00179-3. [PMID: 37393111 DOI: 10.1016/j.jos.2023.06.006] [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: 12/29/2022] [Revised: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND There are concerns as to the reliability of proximal humerus radiographic measurements, particularly regarding the rotational position of the humerus when obtaining radiographs. METHODS Twenty-four patients with proximal humerus fractures fixed surgically with locked plates received postoperative anteroposterior radiographs with the humerus in neutral rotation and in 30° of internal and external rotation. Radiographic measurements for head shaft angle, humeral offset and humeral head height were performed in each humeral rotation position. Intra-class correlation coefficient was used to assess inter-rater and intra-rater reliability. Mean differences (md) in measurements between humeral positions was evaluated using one-way ANOVA. RESULTS Head shaft angle demonstrated good-to-excellent reliability; the highest estimates for inter-rater reliability (ICC: 0.85; 95% CI: 0.76, 0.94) and intra-rater reliability (ICC: 0.96; 95% CI: 0.93, 0.98) were achieved in neutral rotation. There were significant differences in measurement values between each rotational position, with mean head shaft angle of 133.1° in external rotation, and increasingly valgus measurements in neutral (md: 7.6°; 95% CI: 5.0, 10.3°; p < 0.001) and internal rotation (md: 26.4°; 95% CI: 21.8, 30.9°; p < 0.001). Humeral head height and humeral offset showed good-to-excellent reliability in neutral and external rotation, but poor inter-rater reliability in internal rotation. Humeral head height was significantly greater using internal compared to external rotation (md: 4.5 mm; 95% CI: 1.7, 7.3 mm; p = 0.002). Humeral offset was significantly greater in external compared to internal rotation (md: 4.6 mm; 95% CI: 2.6, 6.6 mm; p < 0.001). CONCLUSIONS Views of the humerus in neutral rotation and 30° of external rotation displayed superior reliability. Differences in radiographic measurement values, depending on humeral rotation views, can make for problematic correlations with patient outcome measures. Studies assessing radiographic outcomes following proximal humerus fractures should ensure standardized humeral rotation for obtaining anteroposterior shoulder radiographs, with neutral rotation and external rotation views likely yielding the most reliable results. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Aresh Sepehri
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - David J Stockton
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada.
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Jeffrey M Potter
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 11th Floor - Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, 3rd Floor - Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada
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Hoffer AJ, St George SA, Banaszek DK, Roffey DM, Broekhuyse HM, Potter JM. If at first you don't succeed, should you try again? The efficacy of repeated closed reductions of distal radius fractures. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04904-z. [PMID: 37178164 DOI: 10.1007/s00402-023-04904-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION A repeated closed reduction ("re-reduction") of a displaced distal radius fracture is a common procedure performed to obtain satisfactory alignment and avoid surgery when the initial reduction is deemed unsatisfactory. However, the efficacy of re-reduction is unclear. Compared to a single closed reduction, does a re-reduction of a displaced distal radius fracture: (1) improve radiographic alignment at the time of fracture union and, (2) decrease the rate of operative intervention? MATERIALS AND METHODS Retrospective cohort analysis of 99 adults aged 20-99 years with extra-articular or minimally displaced intra-articular, dorsally angulated, displaced distal radius fracture with or without an associated ulnar styloid fracture who underwent a re-reduction, compared against 99 adults matched for age and sex who were managed with a single reduction. Exclusion criteria were skeletal immaturity, fracture-dislocation and articular displacement greater than 2 mm. Outcome measures included radiographic alignment at fracture union and rate of surgical intervention. RESULTS At 6-8 weeks follow-up, the single reduction group had greater radial height (p = 0.045, CI 0.04 to 3.57), and less ulnar variance (p < 0.001, CI - 3.08 to - 1.00) compared to the re-reduction group. Immediately following re-reduction, 49.5% of patients met radiographic non-operative criteria, but by 6-8 weeks follow-up, only 17.5% of patients continued to meet these criteria. Patients in the re-reduction group were treated with surgery 34.3% of the time, compared to 14.1% of the time for patients in the single reduction group (p = 0.001). In patients aged under 65 years, 49.0% of those who underwent a re-reduction were managed with surgery, compared to 21.0% of those who had a single reduction (p = 0.004). CONCLUSION A re-reduction performed to improve radiographic alignment and avoid surgical management in this subset of distal radius fractures had minimal value. Alternative treatment options should be considered before attempting a re-reduction.
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Affiliation(s)
- Alexander J Hoffer
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Stefan A St George
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Daniel K Banaszek
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, 3rd Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, 3rd Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jeffrey M Potter
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Division of Orthopaedic Trauma, Vancouver General Hospital, 3rd Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
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Sepehri A, Guy P, Roffey DM, O’Brien PJ, Broekhuyse HM, Lefaivre KA. Assessing the Change in Operative Treatment Rates for Acute Midshaft Clavicle Fractures: Incorporation of Evidence-Based Surgery Results in Orthopaedic Practice. JB JS Open Access 2023; 8:JBJSOA-D-22-00096. [PMID: 37123504 PMCID: PMC10132723 DOI: 10.2106/jbjs.oa.22.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
In 2007, a randomized controlled trial (RCT) by the Canadian Orthopaedic Trauma Society (COTS) demonstrated better functional outcomes and a lower proportion of patients who developed malunion or nonunion following operative, compared with nonoperative, treatment of midshaft clavicle fractures. The primary aim of the present study was to compare the proportion of midshaft clavicle fractures treated operatively prior to and following the publication of the COTS RCT. An additional exploratory aim was to assess whether the proportion of midshaft clavicle fractures that were treated with surgery for malunion or nonunion decreased. Methods This retrospective cohort analysis used population-level administrative health data on the residents of British Columbia, Canada. Cases were identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes and procedure fee codes. Adult patients (≥18 years) with closed middle-third clavicle fractures between 1997 and 2018 were included. Multivariable logistic regression modeling compared the proportion of clavicle fractures treated operatively before and after January 1, 2007, controlling for patient factors. The Pearson chi-square test compared the proportion of fractures treated operatively for malunion or nonunion in the cohorts. Results A total of 52,916 patients were included (mean age, 47.5 years; 65.6% male). More clavicle fractures were treated operatively from 2007 onward: 6.9% compared with 2.2% prior to 2007 (odds ratio [OR] = 3.35, 95% confidence interval [CI] = 3.03 to 3.70, p < 0.001). Male sex, moderate-to-high income, and younger age were associated with a greater proportion of operative fixation. The rate of surgery for clavicle malunion or nonunion also increased over this time period (to 4.1% from 3.4%, OR = 1.26, 95% CI = 1.15 to 1.38, p < 0.001). Conclusions We found a significant change in surgeon practice regarding operative management of clavicle fractures following the publication of a Level-I RCT. With limited high-quality trials comparing operative and nonoperative management, it is important that clinicians, health-care institutions, and health-authority administrations determine what steps can be taken to increase responsiveness to new clinical studies and evidence-based guidelines. Level of Evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aresh Sepehri
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Darren M. Roffey
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Peter J. O’Brien
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Henry M. Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Kelly A. Lefaivre
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Email for corresponding author:
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Lawrence DC, Montazeripouragha A, Wai EK, Roffey DM, Phan KM, Phan P, Stratton A, Kingwell S, McIntosh G, Soroceanu A, Abraham E, Bailey CS, Christie S, Paquet J, Glennie A, Nataraj A, Hall H, Fisher C, Rampersaud YR, Thomas K, Manson N, Johnson M, Zarrabian M. Beneficial Effects of Preoperative Exercise on the Outcomes of Lumbar Fusion Spinal Surgery. Physiother Can 2023; 75:22-28. [PMID: 37250725 PMCID: PMC10211389 DOI: 10.3138/ptc-2021-0030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 02/11/2024]
Abstract
Purpose: To determine whether there was an association between self-reported preoperative exercise and postoperative outcomes after lumbar fusion spinal surgery. Method: We performed a retrospective multivariable analysis of the prospective Canadian Spine Outcomes and Research Network (CSORN) database of 2,203 patients who had elective single-level lumbar fusion spinal surgeries. We compared adverse events and hospital length of stay between patients who reported regular exercise (twice or more per week) prior to surgery ("Regular Exercise") to those exercising infrequently (once or less per week) ("Infrequent Exercise") or those who did no exercise ("No Exercise"). For all final analyses, we compared the Regular Exercise group to the combined Infrequent Exercise or No Exercise group. Results: After making adjustments for known confounding factors, we demonstrated that patients in the Regular Exercise group had fewer adverse events (adjusted odds ratio 0.72; 95% CI: 0.57, 0.91; p = 0.006) and significantly shorter lengths of stay (adjusted mean 2.2 vs. 2.5 d, p = 0.029) than the combined Infrequent Exercise or No Exercise group. Conclusions: Patients who exercised regularly twice or more per week prior to surgery had fewer postoperative adverse events and significantly shorter hospital lengths of stay compared to patients that exercised infrequently or did no exercise. Further study is required to determine effectiveness of a targeted prehabilitation programme.
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Affiliation(s)
| | | | - Eugene K. Wai
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Darren M. Roffey
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Kim M. Phan
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Philippe Phan
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexandra Stratton
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen Kingwell
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg McIntosh
- Research Operations, Canadian Spine Outcomes Research Network, Markdale, Ontario, Canada
| | - Alex Soroceanu
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Edward Abraham
- Canada East Spine Center and Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada
| | - Christopher S. Bailey
- Lawson Health Research Institute/London Health Sciences Centre, Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada
| | - Sean Christie
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jerome Paquet
- Hôpital de l’Enfant-Jésus, Laval University, Quebec City, Quebec, Canada
| | - Andrew Glennie
- Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Y. Raja Rampersaud
- Arthritis Program, Krembil Research Institute, University Health Network, Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Thomas
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Neil Manson
- Canada East Spine Center and Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada
| | - Michael Johnson
- Winnipeg Spine Program Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohammad Zarrabian
- Winnipeg Spine Program Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
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Hutchings L, Roffey DM, Lefaivre KA. Fragility Fractures of the Pelvis: Current Practices and Future Directions. Curr Osteoporos Rep 2022; 20:469-477. [PMID: 36342642 DOI: 10.1007/s11914-022-00760-9] [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] [Accepted: 08/31/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW To summarise the current evidence and clinical practices for patients with fragility fractures of the pelvis (FFP). RECENT FINDINGS FFPs are an increasingly prevalent and recognised problem in the elderly population. Recent evidence indicates they have a significant impact on function, morbidity and mortality. While traditional management of FFPs was predominantly non-surgical, surgical options have been increasingly used, with a range of surgical methods available. To date, limited consensus exists on the optimal strategy for suitable patient selection, and clinical trials in this population have proved problematic. The management of FFPs requires a multi-faceted approach to enhance patient care, including adequate pain control, minimisation of complications and optimisation of medical management. Early return to mobilisation should be a key treatment goal to maintain functional independence. The selection of patients who will maximally benefit from surgical treatment, and the most appropriate surgical strategy to employ, remains contentious.
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Affiliation(s)
- Lynn Hutchings
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
- Division of Orthopaedic Trauma, Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, 3rd Floor, DHCC, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
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Middleton SD, Guy P, Roffey DM, Broekhuyse HM, O'Brien PJ, Lefaivre KA. Long-Term Trajectory of Recovery Following Pilon Fracture Fixation. J Orthop Trauma 2022; 36:e250-e254. [PMID: 34799544 DOI: 10.1097/bot.0000000000002312] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe the trajectory of recovery following fixation of pilon fractures from baseline to 5-year follow-up. DESIGN Prospective cohort study. SETTING Level-1 trauma center. PATIENTS/PARTICIPANTS Patients with pilon fractures (OTA/AO 43.C) treated with open reduction and internal fixation. INTERVENTION None. MAIN OUTCOMES MEASURES Patient-reported outcome measures were measured at baseline, 6 months, 1 year, and 5 years using the Short-Form 36 Health Survey (SF-36) Physical Component Score and Mental Component Score, Short Musculoskeletal Functional Assessment, and the Foot and Ankle Outcome Score. RESULTS One hundred two patients were enrolled: mean age was 42.6 years; 69% were males; 88% had an injury severity score of 9; 74 patients (73%) completed 1-year follow-up; 40 patients (39%) completed 5-year follow-up. Trajectory of recovery of physical function showed a significant decline between baseline and 6 months, with significant improvement between 6 months and 1 year and then ongoing but slower improvement between 1 year and 5 years. Sixty-four patients returned to baseline SF-36 Physical Component Score at 5 years. Pain was a persistent issue and remained significantly worse at 5 years when compared with baseline. Psychological well-being (SF-36 Mental Component Score) did not significantly change from baseline at 5 years. CONCLUSION Functional recovery following open reduction and internal fixation for pilon fractures was characterized by an initial decrease in function from baseline, followed by an increase between 6 months and 1 year, and then slower but continued increases from 1 year to 5 years. Function did not return to baseline levels, pain was a persistent issue, and mental well-being showed no change from baseline at 5 years. This information may be useful when counselling patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Scott D Middleton
- Department of Orthopaedics, Faculty of Medicine, the University of British Columbia, Vancouver, BC, Canada ; and
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, the University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, the University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, the University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Peter J O'Brien
- Department of Orthopaedics, Faculty of Medicine, the University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, the University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
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9
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Sepehri A, Sleat GKJ, Roffey DM, Broekhuyse HM, O'Brien PJ, Guy P, Lefaivre KA. Responsiveness of the PROMIS physical function measure in orthopaedic trauma patients. Injury 2022; 53:2041-2046. [PMID: 35300869 DOI: 10.1016/j.injury.2022.03.017] [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: 04/14/2021] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the responsiveness of the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) to the 36-Item Short Form Survey Physical Component Score (SF36-PCS) in orthopaedic trauma patients from pre-injury to one year recovery. DESIGN AND SETTING Prospective cohort study at a Level 1 trauma centre. PARTICIPANTS Patients over the age of 18 with orthopaedic trauma injuries to the pelvis, lower extremity or upper extremity between 2017 and 2018. MAIN OUTCOMES MEASUREMENTS The PROMIS-PF and SF36-PCS assessments were conducted at baseline, 3 months, 6 months and 12 months. Responsiveness of each measure was assessed between time points by calculating the standardized response mean (SRM), the proportions of patients exceeding minimal clinically important difference (MCID), and the floor and ceiling effects. RESULTS Sixty-eight patients with completed assessments at every timepoint were included: mean age 44.7 years, 39 were male and mean Injury Severity Score (ISS) was 7.4 (range: 4-16). Mean time of completion for the SF-36 at all the time points was 5.6 min vs 1.7 min for the PROMIS-PF (p<0.01). The SRM was comparable between measures at all the time points. Although a greater proportion of patients achieved MCID for SF36-PCS between all the time points, this only approached statistical significance between the 6- and 12-month assessments (47.1% vs 33.8%; p = 0.15). There was a significant ceiling effect demonstrated with the PROMIS-PF at baseline and 12-month assessments, with 34 (50.0%) patients and 7 (10.3%) patients achieving the maximum scores at each time point, respectively. DISCUSSION AND CONCLUSIONS PROMIS-PF has a more favourable responder burden based on lower time to completion and comparable responsiveness to the SF-36 PCS. However, there are limitations in responsiveness with the PROMIS-PF in patients who are higher functioning as demonstrated by the ceiling effects in patients at baseline pre-injury and at 12 months post-injury timepoints.
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Affiliation(s)
- Aresh Sepehri
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Graham K J Sleat
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Peter J O'Brien
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada.
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10
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Falsetto A, Roffey DM, Jabri H, Kingwell SP, Stratton A, Phan P, Wai EK. Allogeneic blood transfusions and infection risk in lumbar spine surgery: An American College of Surgeons National Surgery Quality Improvement Program Study. Transfusion 2022; 62:1027-1033. [PMID: 35338708 DOI: 10.1111/trf.16864] [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] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/29/2022] [Accepted: 02/27/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Allogenic blood transfusions can lead to immunomodulation. Our purpose was to investigate whether perioperative transfusions were associated with postoperative infections and any other adverse events (AEs), after adjusting for potential confounding factors, following common elective lumbar spinal surgery procedures. STUDY DESIGN AND METHODS We performed a multivariate, propensity-score matched, regression-adjusted retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database between 2012 and 2016. All lumbar spinal surgery procedures were identified (n = 174,891). A transfusion group (perioperative transfusion within 72 h before, during, or after principal surgery; n = 1992) and a control group (no transfusion; n = 1992) were formed. Following adjustment for between-group baseline features, adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated using a multivariate logistic regression model for any surgical site infection (SSI), superficial SSI, deep SSI, wound dehiscence, pneumonia, urinary tract infection, sepsis, any infection, mortality, and any AEs. RESULTS Transfusion was associated with an increased risk of each specific infection, mortality, and any AEs. Statistically significant between-group differences were demonstrated with respect to any SSI (aOR: 1.48; 95% CI: 1.01-2.16), deep SSI (aOR: 1.66; 95% CI: 0.98-2.85), sepsis (aOR: 2.69; 95% CI: 1.43-5.03), wound dehiscence (aOR: 2.27; 95% CI: 0.86-6.01), any infection (aOR: 1.46; 95% CI: 1.13-1.88), any AEs (aOR: 1.80; 95% CI: 1.48-2.18), and mortality (aOR: 2.17; 95% CI: 0.77-6.36). CONCLUSION We showed an association between transfusion and infection in lumbar spine surgery after adjustment for various applicable covariates. Sepsis had the highest association with transfusion. Our results reinforce a growing trend toward minimizing perioperative transfusions, which may lead to reduced infections following lumbar spine surgery.
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Affiliation(s)
- Amedeo Falsetto
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Darren M Roffey
- uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hussam Jabri
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ontario, Canada.,Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stephen P Kingwell
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexandra Stratton
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Philippe Phan
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eugene K Wai
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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11
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Abstract
OBJECTIVES To quantify the severity of urinary and sexual dysfunction and to evaluate the relationship between urinary and sexual dysfunction, injury, and treatment factors in patients with pelvic fracture. DESIGN Prospective cohort study. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS One hundred thirteen patients with surgically treated pelvic fracture (65.5% OTA/AO 61B fractures; 7 open fractures; 74 men). INTERVENTIONS Surgical pelvic stabilization. MAIN OUTCOME MEASURES The 36-Item Short Form Health Survey and International Consultation Incontinence Questionnaire responses were collected at baseline, 6 months, and 1, 2, and 5 years. Patients were scored on symptoms of voiding and incontinence, and filling (for women), to derive urinary function. Sexual function was scored as a single domain. Both genders reported urinary and sexual bothersome symptoms. Regression analysis was used to isolate the importance of predictive factors on urinary and sexual function, urinary and sexual bother, and their impact on quality of life. RESULTS Patients with pelvic fracture have significant urinary and sexual dysfunction, which is sustained or worsens over time. Male urinary function was predicted by Injury Severity Score (P = 0.03) and 61C fracture (odds ratio: 3.23, P = 0.04). Female urinary function was predicted by urinary tract injury at admission (odds ratio: 7.57, P = 0.03). Neurologic injury and anterior fixation were identified as significant predictors for male sexual function and sexual bother, whereas urological injuries were important in predicting female urinary and sexual bother (P < 0.01). Sexual function (P = 0.02) and sexual bother (P < 0.001) were important predictors of overall mental well-being in men. CONCLUSIONS Urinary and sexual dysfunction are prevalent and sustained in men and women and do not follow the prolonged slow recovery trajectory seen in physical function. Male urinary and sexual dysfunction was closely tied to neurologic injury, whereas female urinary and sexual dysfunction was predicted by the presence of a urinary tract injury. Urinary and sexual dysfunction were important to overall mental well-being in men. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Darren M Roffey
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Pierre Guy
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Peter J O'Brien
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Henry M Broekhuyse
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada ; and
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
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12
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Peters MJ, Roffey DM, Lefaivre KA. Effect of orthopaedic resident education on screening for intimate partner violence. Inj Epidemiol 2021; 8:62. [PMID: 34715939 PMCID: PMC8554514 DOI: 10.1186/s40621-021-00355-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/30/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Intimate Partner Violence (IPV) is prevalent in women presenting to orthopaedic fracture clinics. Rates of IPV have increased during the COVID-19 global pandemic. Our aim was to determine the effect of educational experiences on IPV knowledge and IPV screening to inform best-practices in resident education. METHODS Cross-sectional online survey of orthopaedic surgery residency programs in Canada. Demographics, IPV educational experiences, IPV knowledge, and frequency of IPV screening were collected via a modified version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS). Descriptive statistics and regression modeling identified predictors of IPV knowledge and frequency of IPV screening. RESULTS Responses were obtained from 105 orthopaedic residents; 84% participated in classroom training, 39% underwent mentorship training, 32% received both classroom training and mentorship, and 10% reported neither. Classroom training had no statistically significant association with IPV knowledge or frequency of IPV screening. Residents who received mentorship were 4.1 times more likely to screen for IPV (95% CI: 1.72-10.05), older residents were more likely to screen for IPV (OR: 8.3, 95% CI: 2.64-29.84), and senior residents were less likely to screen for IPV than junior residents (OR: 0.29, 95% CI: 0.09-0.82). CONCLUSIONS Classroom training was not associated with any effect on IPV knowledge nor the frequency of IPV screening. Educational efforts should be targeted at increasing mentorship opportunities in order to improve IPV screening practices in Canadian orthopaedic residents.
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Affiliation(s)
- Mikaela J. Peters
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia: Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Darren M. Roffey
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia: Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health: Diamond Health Care Centre, 3rd Floor - 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Kelly A. Lefaivre
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia: Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health: Diamond Health Care Centre, 3rd Floor - 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
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13
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Sepidarkish M, Rezamand G, Qorbani M, Heydari H, Estêvão MD, Omran D, Morvaridzadeh M, Roffey DM, Farsi F, Ebrahimi S, Shokri F, Heshmati J. Effect of omega-3 fatty acids supplementation on adipokines: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr 2021; 62:7561-7575. [PMID: 33998914 DOI: 10.1080/10408398.2021.1915743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although a large body of literature reported the beneficial effects of omega-3 fatty acids (omega-3 FAs) consumption on adipokines levels, but recent findings from clinical trials are not univocal. The aim of this systematic review and meta-analysis was to evaluate the effect of omega-3 FAs supplements on adipokines. METHODS We searched Medline, Web of Science, Scopus, Embase, and Cochrane Library from inception to August 2020 without any particular language limitations. Outcomes were summarized as standardized mean difference (SMD) with 95% confidence intervals (CIs) estimated from Hedge's g and random effects modeling. RESULTS Fifty-two trials involving 4,568 participants were included. Omega-3 FAs intake was associated with a significant increase in plasma adiponectin levels (n = 43; 3,434 participants; SMD: 0.21, 95% CI: 0.04, 0.37; p = 0.01; I2= 80.14%). This meta-analysis indicates that supplementing participants with omega-3 fatty acids more than 2000 mg daily and more than 10 weeks resulted in a significant and more favorable improvement in plasma adiponectin levels. However, omega-3 FAs intake had no significant effect on leptin levels (SMD: -0.02, 95% CI: -0.20, 0.17, I2= 54.13%). CONCLUSION The evidence supports a beneficial effect of omega-3 FAs intake on serum adiponectin levels but does not appear to impact on leptin concentrations. Larger well-designed RCTs are still required to evaluate the effect of omega-3 FAs on leptin in specific diseases.
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Affiliation(s)
- Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Gholamreza Rezamand
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hafez Heydari
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - M Dulce Estêvão
- Universidade do Algarve, Escola Superior de Saúde, Campus de Gambelas, Faro, Portugal
| | - Dalia Omran
- Department of Endemic Medicine and Hepatology, Thabet hospital for Endemic diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mojgan Morvaridzadeh
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Darren M Roffey
- Vancouver General Hospital, Vancouver Coastal Health, Vancouver, Canada
| | - Farnaz Farsi
- Student Research Committee, Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Ebrahimi
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Fatemeh Shokri
- Department of Health Education and Promotion, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Heshmati
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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14
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Garland K, Chen BP, Poitras S, Wai EK, Kingwell SP, Roffey DM, Beaulé PE. Capturing adverse events in elective orthopedic surgery: comparison of administrative, surgeon and reviewer reporting. Can J Surg 2020; 63:E35-E37. [PMID: 31967444 DOI: 10.1503/cjs.019117] [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] [Indexed: 12/20/2022] Open
Abstract
Summary Ensuring adverse event (AE) recording is standardized and accurate is paramount for patient safety. In this discussion, we outline our comparison of AE data collected by orthopedic surgeons and independent clinical reviewers using the Spine Adverse Events Severity System (SAVES) and Orthopedic Surgical Adverse Events Severity System (OrthoSAVES) against AE data recorded by hospital administrative discharge abstract coders. In 164 spine, hip, knee and shoulder patients, reviewers recorded significantly more AEs than coders, and coders recorded significantly more AEs than surgeons. The AEs were recorded similarly by reviewers using SAVES and OrthoSAVES in 48 spine patients. Despite our small sample size and use of different AE tools, we believe it is important to highlight that coders, surgeons and reviewers recorded AEs differently. While further investigations on its utility and cost-effectiveness are necessary, we assert that it is feasible to use Ortho-SAVES to prospectively record AEs across all orthopedic subspecialties.
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Affiliation(s)
- Katie Garland
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ont., (Garland, Chen, Wai, Kingwell, Beaulé); the School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras); the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Poitras, Wai, Kingwell, Beaulé); the uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé)
| | - Brian P. Chen
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ont., (Garland, Chen, Wai, Kingwell, Beaulé); the School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras); the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Poitras, Wai, Kingwell, Beaulé); the uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé)
| | - Stephane Poitras
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ont., (Garland, Chen, Wai, Kingwell, Beaulé); the School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras); the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Poitras, Wai, Kingwell, Beaulé); the uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé)
| | - Eugene K. Wai
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ont., (Garland, Chen, Wai, Kingwell, Beaulé); the School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras); the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Poitras, Wai, Kingwell, Beaulé); the uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé)
| | - Stephen P. Kingwell
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ont., (Garland, Chen, Wai, Kingwell, Beaulé); the School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras); the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Poitras, Wai, Kingwell, Beaulé); the uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé)
| | - Darren M. Roffey
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ont., (Garland, Chen, Wai, Kingwell, Beaulé); the School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras); the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Poitras, Wai, Kingwell, Beaulé); the uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé)
| | - Paul E. Beaulé
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ont., (Garland, Chen, Wai, Kingwell, Beaulé); the School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras); the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Poitras, Wai, Kingwell, Beaulé); the uOttawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Wai, Kingwell, Roffey, Beaulé)
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15
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Turner A, Zhao L, Gauthier P, Chen S, Roffey DM, Wai EK. Management of cervical spine epidural abscess: a systematic review. Ther Adv Infect Dis 2019; 6:2049936119863940. [PMID: 31367375 PMCID: PMC6643182 DOI: 10.1177/2049936119863940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 11/14/2018] [Accepted: 06/24/2019] [Indexed: 01/15/2023] Open
Abstract
Background: Cervical spinal epidural abscess (CSEA) is a localized infection between the
thecal sac and cervical spinal column which may result in neurological
deficit and death if inadequately treated. Two treatment options exist:
medical management and surgical intervention. Our objective was to analyze
CSEA patient outcomes in order to determine the optimal method of
treatment. Methods: An electronic literature search for relevant case series and retrospective
reviews was conducted through June 2016. Data abstraction and study quality
assessment were performed by two independent reviewers. A lack of available
data led to a post hoc decision not to perform meta-analysis of the results;
study findings were synthesized qualitatively. Results: 927 studies were identified, of which 11 were included. Four studies were
ranked as good quality, and seven ranked as fair quality. In total, data
from 173 patients were included. Mean age was 55 years; 61.3% were male.
Intravenous drug use was the most common risk factor for CSEA development.
Staphylococcus aureus was the most commonly cultured
pathogen. 140 patients underwent initial surgery, an additional 18 patients
were surgically treated upon failure of medical management, and 15 patients
were treated with antibiotics alone. Conclusion: The rates of medical management failure described in our review were much
higher than those reported in the literature for thoracolumbar spinal
epidural abscess patients, suggesting that CSEA patients may be at a greater
risk for poor outcomes following nonoperative treatment. Thus, early surgery
appears most viable for optimizing CSEA patient outcomes. Further research
is needed in order to corroborate these recommendations.
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Affiliation(s)
- Anastasia Turner
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H8L1, Canada
| | - Linlu Zhao
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada
| | - Paul Gauthier
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Suzan Chen
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada
| | - Darren M Roffey
- Ottawa Spine Collaborative Analytics Network, The Ottawa Hospital, Ottawa, ON, Canada
| | - Eugene K Wai
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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16
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Phan P, Budhram B, Zhang Q, Rivers CS, Noonan VK, Plashkes T, Wai EK, Paquet J, Roffey DM, Tsai E, Fallah N. Highlighting discrepancies in walking prediction accuracy for patients with traumatic spinal cord injury: an evaluation of validated prediction models using a Canadian Multicenter Spinal Cord Injury Registry. Spine J 2019; 19:703-710. [PMID: 30179672 DOI: 10.1016/j.spinee.2018.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/06/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Models for predicting recovery in traumatic spinal cord injury (tSCI) patients have been developed to optimize care. Several models predicting tSCI recovery have been previously validated, yet recent findings question their accuracy, particularly in patients whose prognoses are the least predictable. PURPOSE To compare independent ambulatory outcomes in AIS (ASIA [American Spinal Injury Association] Impairment Scale) A, B, C, and D patients, as well as in AIS B+C and AIS A+D patients by applying two existing logistic regression prediction models. STUDY DESIGN A prospective cohort study. PARTICIPANT SAMPLE Individuals with tSCI enrolled in the pan-Canadian Rick Hansen SCI Registry (RHSCIR) between 2004 and 2016 with complete neurologic examination and Functional Independence Measure (FIM) outcome data. OUTCOME MEASURES The FIM locomotor score was used to assess independent walking ability at 1-year follow-up. METHODS Two validated prediction models were evaluated for their ability to predict walking 1-year postinjury. Relative prognostic performance was compared with the area under the receiver operating curve (AUC). RESULTS In total, 675 tSCI patients were identified for analysis. In model 1, predictive accuracies for 675 AIS A, B, C, and D patients as measured by AUC were 0.730 (95% confidence interval [CI] 0.622-0.838), 0.691 (0.533-0.849), 0.850 (0.771-0.928), and 0.516 (0.320-0.711), respectively. In 160 AIS B+C patients, model 1 generated an AUC of 0.833 (95% CI 0.771-0.895), whereas model 2 generated an AUC of 0.821 (95% CI 0.754-0.887). The AUC for 515 AIS A+D patients was 0.954 (95% CI 0.933-0.975) with model 1 and 0.950 (0.928-0.971) with model 2. The difference in prediction accuracy between the AIS B+C cohort and the AIS A+D cohort was statistically significant using both models (p=.00034; p=.00038). The models were not statistically different in individual or subgroup analyses. CONCLUSIONS Previously tested prediction models demonstrated a lower predictive accuracy for AIS B+C than AIS A+D patients. These models were unable to effectively prognosticate AIS A+D patients separately; a failure that was masked when amalgamating the two patient populations. This suggests that former prediction models achieved strong prognostic accuracy by combining AIS classifications coupled with a disproportionately high proportion of AIS A+D patients.
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Affiliation(s)
- Philippe Phan
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Clinical Epidemiology Program, The Ottawa Hospital,, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
| | - Brandon Budhram
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada
| | - Qiong Zhang
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada; The University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Carly S Rivers
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Vanessa K Noonan
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada; The University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Tova Plashkes
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Eugene K Wai
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Clinical Epidemiology Program, The Ottawa Hospital,, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada
| | - Jérôme Paquet
- Département Sciences Neurologiques, Pavillon Enfant-Jésus, CHU de Québec, 1401 18e rue, Québec, QC G1J 1Z4, Canada
| | - Darren M Roffey
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Clinical Epidemiology Program, The Ottawa Hospital,, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada
| | - Eve Tsai
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Clinical Epidemiology Program, The Ottawa Hospital,, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada
| | - Nader Fallah
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada; The University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
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Coyle MJ, Roffey DM, Phan P, Kingwell SP, Wai EK. The Use of a Self-Administered Questionnaire to Reduce Consultation Wait Times for Potential Elective Lumbar Spinal Surgical Candidates: A Prospective, Pragmatic, Blinded, Randomized Controlled Quality Improvement Study. J Bone Joint Surg Am 2018; 100:2125-2131. [PMID: 30562293 DOI: 10.2106/jbjs.18.00423] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In a public health-care system, patients often experience lengthy wait times to see a spine surgeon for consultation, and most patients are found not to be surgical candidates, thereby prolonging the wait time for those who are. The aim of this study was to evaluate whether a self-administered 3-item questionnaire (3IQ) could reprioritize consultation appointments and reduce wait times for lumbar spinal surgical candidates. METHODS This prospective, pragmatic, blinded, randomized controlled quality improvement study was conducted at a single Canadian academic health-care center. This study enrolled 227 consecutive eligible participants with an elective lumbar condition who were referred for consultation with a spine surgeon. All participants were mailed the 3IQ after their referral was received. Patients were randomized into the intervention group, in which leg-dominant pain reported on the 3IQ resulted in an upgrade in priority to be seen, or into the control group, in which no change to wait-list priority occurred. The main outcome measured was time to consultation for participants who were deemed surgical candidates following consultation. RESULTS There were no significant differences between groups with regard to demographics, overall group wait times, proportion of surgical candidates, or disability. A total of 33 patients were deemed surgical candidates after consultation. The median wait from referral to consultation was shorter for the 16 surgical candidates in the intervention group (2.5 months; interquartile range [IQR]: 2.0 to 4.8 months) compared with the 17 surgical candidates in the control group (4.5 months; IQR: 3.4 to 6.9 months; p = 0.090). The odds of seeing a surgical candidate within the acceptable time frame of 3 months were 5.4 times greater (95% confidence interval: 1.2 to 24.5 times; p = 0.024) in the intervention group. CONCLUSIONS The use of a simple, self-administered questionnaire to reprioritize referrals resulted in shorter consultation wait times for patients who required a surgical procedure and significantly increased the number of surgical candidates seen within the acceptable time frame. It may be valuable to consider adding the 3IQ to clinical care practices to better triage these patients on waiting lists.
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Affiliation(s)
- Matthew J Coyle
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Darren M Roffey
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Philippe Phan
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Stephen P Kingwell
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Eugene K Wai
- Division of Orthopaedic Surgery (M.J.C., P.P., S.P.K, and E.K.W.), Department of Surgery, and the Combined Adult Spinal Surgery Program (D.M.R., P.P., S.P.K., and E.K.W.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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18
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Zeglinski-Spinney A, Wai DC, Phan P, Tsai EC, Stratton A, Kingwell SP, Roffey DM, Wai EK. Increased Prevalence of Chronic Disease in Back Pain Patients Living in Car-dependent Neighbourhoods in Canada: A Cross-sectional Analysis. J Prev Med Public Health 2018; 51:227-233. [PMID: 30286594 PMCID: PMC6182270 DOI: 10.3961/jpmph.18.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives Chronic diseases, including back pain, result in significant patient morbidity and societal burden. Overall improvement in physical fitness is recommended for prevention and treatment. Walking is a convenient modality for achieving initial gains. Our objective was to determine whether neighbourhood walkability, acting as a surrogate measure of physical fitness, was associated with the presence of chronic disease. Methods We conducted a cross-sectional study of prospectively collected data from a prior randomized cohort study of 227 patients referred for tertiary assessment of chronic back pain in Ottawa, ON, Canada. The Charlson Comorbidity Index (CCI) was calculated from patient-completed questionnaires and medical record review. Using patients’ postal codes, neighbourhood walkability was determined using the Walk Score, which awards points based on the distance to the closest amenities, yielding a score from 0 to 100 (0-50: car-dependent; 50-100: walkable). Results Based on the Walk Score, 134 patients lived in car-dependent neighborhoods and 93 lived in walkable neighborhoods. A multivariate logistic regression model, adjusted for age, gender, rural postal code, body mass index, smoking, median household income, percent employment, pain, and disability, demonstrated an adjusted odds ratio of 2.75 (95% confidence interval, 1.16 to 6.53) times higher prevalence for having a chronic disease for patients living in a car-dependent neighborhood. There was also a significant dose-related association (p=0.01; Mantel-Haenszel chi-square=6.4) between living in car-dependent neighbourhoods and more severe CCI scores. Conclusions Our findings suggest that advocating for improved neighbourhood planning to permit greater walkability may help offset the burden of chronic disease.
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Affiliation(s)
- Amy Zeglinski-Spinney
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Denise C Wai
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Philippe Phan
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Eve C Tsai
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Neurosurgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexandra Stratton
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Stephen P Kingwell
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Darren M Roffey
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Eugene K Wai
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
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19
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Beaupre LA, Wai EK, Hoover DR, Noveck H, Roffey DM, Cook DR, Magaziner JS, Carson JL. A comparison of outcomes between Canada and the United States in patients recovering from hip fracture repair: secondary analysis of the FOCUS trial. Int J Qual Health Care 2018; 30:97-103. [PMID: 29385446 DOI: 10.1093/intqhc/mzx199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/03/2018] [Indexed: 12/28/2022] Open
Abstract
Objective To determine if adjusted mortality, walking ability or return home differed after hip fracture surgery between Canada and the USA. Design Secondary analysis of the Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial data. Setting Data were collected from 47 American and Canadian hospitals. Participants Overall, 2016 subjects with a hip fracture (USA = 1222 (60.6%); Canada = 794 (39.4%)) were randomized to a liberal or restrictive transfusion strategy. Subjects were 50 years and older, with cardiovascular disease and/or risk factors and hemoglobin <100 g/L within 3 days post-surgery. The average age was 82 years and 1527(76%) subjects were females. Intervention Demographics, health status and health services data were collected up to 60 days post-surgery and mortality to a median of 3 years post-surgery. Main outcomes Mortality, inability to walk and return home. Results US subjects had higher adjusted mortality than Canadians at 30 days (odds ratio = 1.78; 95% confidence interval: 1.09-2.90), 60 days (1.53; 1.02-2.29) and up to 3 years (hazard ratio = 1.25; 1.07-1.45). There were no differences in adjusted outcomes for walking ability or return home at 30 or 60 days post-surgery. Median hospital length of stay was longer (P < 0.0001) in Canada (9 days; interquartile range: 5-18 days) than the US (3 days; 2-5 days). US subjects (52.9%) were more likely than Canadians (16.8%) to be discharged to nursing homes for rehabilitation (P < 0.001). Conclusions Adjusted survival favored Canadians post hip fracture while walking ability and return home were not different between countries. The reason(s) for mortality differences warrant further investigation.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Eugene K Wai
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada.,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, The State University of New Jersey, 473 Hill Center, Busch Campus Rutgers University 110 Frelinghuysen Road Piscataway, NJ 08854-8019, USA
| | - Helaine Noveck
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, 125 Paterson St, New Brunswick, NJ 08901, USA
| | - Darren M Roffey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Donald R Cook
- Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, FMC North Tower, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Jay S Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Suite 200, Howard Hall, 660 West Redwood Street, Baltimore, MD 21201, USA
| | - Jeffrey L Carson
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, 125 Paterson St, New Brunswick, NJ 08901, USA
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20
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Layne EI, Roffey DM, Coyle MJ, Phan P, Kingwell SP, Wai EK. Activities performed and treatments conducted before consultation with a spine surgeon: are patients and clinicians following evidence-based clinical practice guidelines? Spine J 2018; 18:614-619. [PMID: 28882524 DOI: 10.1016/j.spinee.2017.08.259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/31/2017] [Revised: 08/03/2017] [Accepted: 08/29/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Clinical practice guidelines (CPGs) are designed to ensure that evidence-based treatment is easily put into action. Whether patients and clinicians follow these guidelines is equivocal. PURPOSE The objectives of this study were to examine how many patients complaining of low back pain (LBP) underwent evidence-based medical interventional treatment in line with CPG recommendations before consultation with a spine surgeon, and to evaluate any associations between adherence to CPG recommendations and baseline factors. STUDY DESIGN/SETTING This is a cross-sectional cohort analysis at a tertiary care center. PATIENT SAMPLE A total of 229 patients were referred for surgical consultation for an elective lumbar spinal condition. OUTCOME MEASURES The outcome measures include the number of CPG-recommended treatments undertaken by patients at or before the time of referral, the validated pain score, the EuroQol-5D (EQ-5D) health status, and the Oswestry Disability Index (ODI) score. METHODS Questionnaires assessing demographic and functional characteristics as well as overall health care use were sent to patients immediately after their referral was received by the surgeon's office. RESULTS Medications were the most common modality before consultation (74.2% of patients), of which 46.3% received opioids. The number of medications taken was significantly related to a higher ODI score (R=0.23, p=.0004), a higher pain score (R=0.15, p=.026), and a lower EQ-5D health status (R=-0.15, p=.024). In contrast, a lower pain score (7.2 vs. 7.7, p=.037) and a lower ODI score (26.6 vs. 29.9, p=.0023) were associated with performing adequate amounts of exercise. There was a significant association between lower numbers of treatments received and higher numerical pain rating scores (R=-0.14, p=.035). The majority (61.1%) of patients received two or less forms of treatment. CONCLUSIONS Evidence-based medical interventional treatments for patients with LBP are not being taken advantage of before spine surgery consultation. If more patients were to undertake CPG-endorsed conservative modalities, it may result in fewer unnecessary referrals from primary care physicians, and patients might not deteriorate as much while lingering on long wait lists. Further studies incorporating knowledge translation or health system pathway changes are necessary.
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Affiliation(s)
- Elliot I Layne
- Ottawa Hospital Combined Spinal Surgery Program, Department of Surgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Darren M Roffey
- Ottawa Hospital Combined Spinal Surgery Program, Department of Surgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Matthew J Coyle
- Faculty of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Philippe Phan
- Ottawa Hospital Combined Spinal Surgery Program, Department of Surgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada; Faculty of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Stephen P Kingwell
- Ottawa Hospital Combined Spinal Surgery Program, Department of Surgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada; Faculty of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Eugene K Wai
- Ottawa Hospital Combined Spinal Surgery Program, Department of Surgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada; Faculty of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.
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21
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Hicks KE, Zhao Y, Fallah N, Rivers CS, Noonan VK, Plashkes T, Wai EK, Roffey DM, Tsai EC, Paquet J, Attabib N, Marion T, Ahn H, Phan P. A simplified clinical prediction rule for prognosticating independent walking after spinal cord injury: a prospective study from a Canadian multicenter spinal cord injury registry. Spine J 2017; 17:1383-1392. [PMID: 28716636 DOI: 10.1016/j.spinee.2017.05.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 08/17/2016] [Revised: 02/21/2017] [Accepted: 05/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Traumatic spinal cord injury (SCI) is a debilitating condition with limited treatment options for neurologic or functional recovery. The ability to predict the prognosis of walking post injury with emerging prediction models could aid in rehabilitation strategies and reintegration into the community. PURPOSE To revalidate an existing clinical prediction model for independent ambulation (van Middendorp et al., 2011) using acute and long-term post-injury follow-up data, and to investigatethe accuracy of a simplified model using prospectively collected data from a Canadian multicenter SCI database, the Rick Hansen Spinal Cord Injury Registry (RHSCIR). STUDY DESIGN Prospective cohort study. PARTICIPANT SAMPLE The analysis cohort consisted of 278 adult individuals with traumatic SCI enrolled in the RHSCIR for whom complete neurologic examination data and Functional Independence Measure (FIM) outcome data were available. OUTCOME MEASURES The FIM locomotor score was used to assess independent walking ability (defined as modified or complete independence in walk or combined walk and wheelchair modality) at 1-year follow-up for each participant. METHODS A logistic regression (LR) model based on age and four neurologic variables was applied to our cohort of 278 RHSCIR participants. Additionally, a simplified LR model was created. The Hosmer-Lemeshow goodness of fit test was used to check if the predictive model is applicable to our data set. The performance of the model was verified by calculating the area under the receiver operating characteristic curve (AUC). The accuracy of the model was tested using a cross-validation technique. This study was supported by a grant from The Ottawa Hospital Academic Medical Organization ($50,000 over 2 years). The RHSCIR is sponsored by the Rick Hansen Institute and is supported by funding from Health Canada, Western Economic Diversification Canada, and the provincial governments of Alberta, British Columbia, Manitoba, and Ontario. ET and JP report receiving grants from the Rick Hansen Institute (approximately $60,000 and $30,000 per year, respectively). DMR reports receiving remuneration for consulting services provided to Palladian Health, LLC and Pacira Pharmaceuticals, Inc ($20,000-$30,000 annually), although neither relationship presents a potential conflict of interest with the submitted work. KEH received a grant for involvement in the present study from the Government of Canada as part of the Canada Summer Jobs Program ($3,000). JP reports receiving an educational grant from Medtronic Canada outside of the submitted work ($75,000 annually). TM reports receiving educational fellowship support from AO Spine, AO Trauma, and Medtronic; however, none of these relationships are financial in nature. All remaining authors have no conflicts of interest to disclose. RESULTS The fitted prediction model generated 85% overall classification accuracy, 79% sensitivity, and 90% specificity. The prediction model was able to accurately classify independent walking ability (AUC 0.889, 95% confidence interval [CI] 0.846-0.933, p<.001) compared with the existing prediction model, despite the use of a different outcome measure (FIM vs. Spinal Cord Independence Measure) to qualify walking ability. A simplified, three-variable LR model based on age and two neurologic variables had an overall classification accuracy of 84%, with 76% sensitivity and 90% specificity, demonstrating comparable accuracy with its five-variable prediction model counterpart. The AUC was 0.866 (95% CI 0.816-0.916, p<.01), only marginally less than that of the existing prediction model. CONCLUSIONS A simplified predictive model with similar accuracy to a more complex model for predicting independent walking was created, which improves utility in a clinical setting. Such models will allow clinicians to better predict the prognosis of ambulation in individuals who have sustained a traumatic SCI.
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Affiliation(s)
- Katharine E Hicks
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Yichen Zhao
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada; The University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Nader Fallah
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada; The University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Carly S Rivers
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Vanessa K Noonan
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada; The University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Tova Plashkes
- Rick Hansen Institute, Blusson Spinal Cord Centre, 6400-818 W. 10th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Eugene K Wai
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Darren M Roffey
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Eve C Tsai
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada
| | - Jerome Paquet
- Département Sciences Neurologiques, Pavillon Enfant-Jésus, CHU de Québec, 1401 18e rue, QC G1J 1Z4, Canada
| | - Najmedden Attabib
- Dalhousie University, Saint John Regional Hospital, PO Box 2100, Saint John, NB E2L 4L2, Canada
| | - Travis Marion
- Division of Orthopaedics, Department of Surgery, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - Henry Ahn
- University of Toronto Spine Program, St. Michael's Hospital, 55 Queen St E., Suite 1008, Toronto, ON M5C 1R6, Canada
| | - Philippe Phan
- Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada.
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Gartke K, Roffey DM, Dobransky J, Devine F, Denroche S, Kingwell SP, Poitras S, Beaule PE. Continuous Quality Improvement in Orthopaedic Surgery: Improving Patient Experience, Safety and Outcomes. UOJM 2017. [DOI: 10.18192/uojm.v7i1.2003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
As the demand for accountability and transparency surrounding the supply of increasingly expensive medical services grows, health- care providers have put continuous quality improvement (CQI) programs in place to optimize care and improve efficiencies. CQI pro- grams that rigorously evaluate healthcare services can lead to informed decisions about the direction of planned improvements through evolving knowledge translation. Successful end products may include better patient satisfaction, improved patient-reported outcomes, highly-efficient care pathways, and overall cost-savings. There are numerous steps involved in implementing CQI programs that require collaboration and cooperation from physicians, allied health care workers, support staff and hospital management in order to achieve desirable goals. The Division of Orthopaedic Surgery at The Ottawa Hospital (TOH) has initiated a CQI program which is designed as a classic Donabedian Construct with a triple aim framework of: 1. improving care, 2. improving patient experience, and 3. lowering cost. The development of our electronic CQI database will be a key component in the 5-year (2015-2020) Strategic Plan for the Division, and is in keeping with the goal of TOH becoming a top 10% performer in quality and safety of patient care in North America. The aim of this paper is to outline our compliance with the ongoing activities required to meet clearly delineated quality metrics, and the development of the many facets of our CQI program. RÉSUMÉ En réponse à la demande croissante de transparence et de responsabilité concernant les services de santé dispendieux, les fournis- seurs de soins de santé ont mis sur pied des programmes d’amélioration continue de la qualité (ACQ) pour optimiser les soins et l’efficience. Les programmes d’ACQ qui évaluent rigoureusement les services de santé permettent des décisions plus éclairées quant aux améliorations à apporter, grâce au transfert de connaissances. Parmi les résultats positifs de ces programmes, on peut compter une plus grande satisfaction et une amélioration des résultats rapportés par les patients, des plans d’intervention particulièrement efficients, et une réduction des coûts. De nombreuses étapes dans la mise en place des programmes d’ACQ nécessitent une collabora- tion entre les médecins, le personnel de soutien, les gestionnaires de l’hôpital et les autres professionnels de la santé afin d’atteindre les objectifs désirés. La Division de chirurgie orthopédique de l’Hôpital d’Ottawa a lancé un programme d’ACQ conçu selon le modèle classique Donabedian, qui poursuit un triple objectif : 1. améliorer les soins, 2. améliorer l’expérience des patients, et 3. minimiser les coûts. La création d’une base de données électronique pour l’ACQ sera une composante clé du plan stratégique de 5 ans (2015-2020) de la Division, et se conforme à l’objectif de l’Hôpital d’Ottawa de devenir l’un des plus performants en Amérique du Nord, sur le plan de la qualité et de la sécurité des soins aux patients. Le but de cet article est de décrire brièvement le développement de nombreuses facettes de notre programme d’ACQ, et notre conformité aux normes de la qualité.
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Beaulé PE, Roffey DM, Poitras S. Continuous quality improvement in orthopedic surgery: changes and implications with health system funding reform. Can J Surg 2017; 59:149-50. [PMID: 27240282 DOI: 10.1503/cjs.005416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Paul E Beaulé
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Beaulé); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey); and the Physiotherapy Program, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras)
| | - Darren M Roffey
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Beaulé); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey); and the Physiotherapy Program, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras)
| | - Stéphane Poitras
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Beaulé); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey); and the Physiotherapy Program, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont. (Poitras)
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Chen BP, Garland K, Roffey DM, Poitras S, Dervin G, Lapner P, Phan P, Wai EK, Kingwell SP, Beaulé PE. Can Surgeons Adequately Capture Adverse Events Using the Spinal Adverse Events Severity System (SAVES) and OrthoSAVES? Clin Orthop Relat Res 2017; 475:253-260. [PMID: 27511203 PMCID: PMC5174042 DOI: 10.1007/s11999-016-5021-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Received: 05/13/2016] [Accepted: 08/03/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Physicians have consistently shown poor adverse-event reporting practices in the literature and yet they have the clinical acumen to properly stratify and appraise these events. The Spine Adverse Events Severity System (SAVES) and Orthopaedic Surgical Adverse Events Severity System (OrthoSAVES) are standardized assessment tools designed to record adverse events in orthopaedic patients. These tools provide a list of prespecified adverse events for users to choose from-an aid that may improve adverse-event reporting by physicians. QUESTIONS/PURPOSES The primary objective was to compare surgeons' adverse-event reporting with reporting by independent clinical reviewers using SAVES Version 2 (SAVES V2) and OrthoSAVES in elective orthopaedic procedures. METHOD This was a 10-week prospective study where SAVES V2 and OrthoSAVES were used by six orthopaedic surgeons and two independent, non-MD clinical reviewers to record adverse events after all elective procedures to the point of patient discharge. Neither surgeons nor reviewers received specific training on adverse-event reporting. Surgeons were aware of the ongoing study, and reported adverse events based on their clinical interactions with the patients. Reviewers recorded adverse events by reviewing clinical notes by surgeons and other healthcare professionals (such as nurses and physiotherapists). Adverse events were graded using the severity-grading system included in SAVES V2 and OrthoSAVES. At discharge, adverse events recorded by surgeons and reviewers were recorded in our database. RESULTS Adverse-event data for 164 patients were collected (48 patients who had spine surgery, 51 who had hip surgery, 34 who had knee surgery, and 31 who had shoulder surgery). Overall, 99 adverse events were captured by the reviewers, compared with 14 captured by the surgeons (p < 0.001). Surgeons adequately captured major adverse events, but failed to record minor events that were captured by the reviewers. A total of 93 of 99 (94%) adverse events reported by reviewers required only simple or minor treatment and had no long-term adverse effect. Three patients experienced adverse events that resulted in use of invasive or complex treatment that had a temporary adverse effect on outcome. CONCLUSION Using SAVES V2 and OrthoSAVES, independent reviewers reported more minor adverse events compared with surgeons. The value of third-party reviewers requires further investigation in a detailed cost-benefit analysis. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Brian P. Chen
- Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Katie Garland
- Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Darren M. Roffey
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, Ottawa, ON Canada ,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Stephane Poitras
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON Canada ,Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Road, CCW 1646, Ottawa, ON K1H 8L6 Canada
| | - Geoffrey Dervin
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Road, CCW 1646, Ottawa, ON K1H 8L6 Canada
| | - Peter Lapner
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Road, CCW 1646, Ottawa, ON K1H 8L6 Canada
| | - Philippe Phan
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, Ottawa, ON Canada ,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada ,Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Road, CCW 1646, Ottawa, ON K1H 8L6 Canada
| | - Eugene K. Wai
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, Ottawa, ON Canada ,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada ,Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Road, CCW 1646, Ottawa, ON K1H 8L6 Canada
| | - Stephen P. Kingwell
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, Ottawa, ON Canada ,Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Road, CCW 1646, Ottawa, ON K1H 8L6 Canada
| | - Paul E. Beaulé
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada ,Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Road, CCW 1646, Ottawa, ON K1H 8L6 Canada
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Wilson CA, Roffey DM, Chow D, Alkherayf F, Wai EK. A systematic review of preoperative predictors for postoperative clinical outcomes following lumbar discectomy. Spine J 2016; 16:1413-1422. [PMID: 27497886 DOI: 10.1016/j.spinee.2016.08.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 01/25/2016] [Revised: 06/24/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Sciatica is often caused by a herniated lumbar intervertebral disc. When conservative treatment fails, a lumbar discectomy can be performed. Surgical treatment via lumbar discectomy is not always successful and may depend on a variety of preoperative factors. It remains unclear which, if any, preoperative factors can predict postsurgical clinical outcomes. PURPOSE This review aimed to determine preoperative predictors that are associated with postsurgical clinical outcomes in patients undergoing lumbar discectomy. STUDY DESIGN This is a systematic review. METHODS This systematic review of the scientific literature followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. MEDLINE and PubMed were systematically searched through June 2014. Results were screened for relevance independently, and full-text studies were assessed for eligibility. Reporting quality was assessed using a modified Newcastle-Ottawa Scale. Quality of evidence was assessed using a modified version of Sackett's Criteria of Evidence Support. No financial support was provided for this study. No potential conflict of interest-associated biases were present from any of the authors. RESULTS The search strategy yielded 1,147 studies, of which a total of 40 high-quality studies were included. There were 17 positive predictors, 20 negative predictors, 43 non-significant predictors, and 15 conflicting predictors determined. Preoperative predictors associated with positive postoperative outcomes included more severe leg pain, better mental health status, shorter duration of symptoms, and younger age. Preoperative predictors associated with negative postoperative outcomes included intact annulus fibrosus, longer duration of sick leave, worker's compensation, and greater severity of baseline symptoms. Several preoperative factors including motor deficit, side and level of herniation, presence of type 1 Modic changes and degeneration, age, and gender had non-significant associations with postoperative clinical outcomes. CONCLUSIONS It may be possible for certain preoperative factors to be targeted for clinical evaluation by spine surgeons to assess the suitability of patients for lumbar discectomy surgery, the hope being to thereby improve postoperative clinical outcomes. Prospective cohort studies are required to increase the level of evidence with regard to significant predictive factors.
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Affiliation(s)
- Courtney A Wilson
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Darren M Roffey
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, Canada K1Y 4E9
| | - Donald Chow
- Division of Orthopaedic Surgery, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Fahad Alkherayf
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neurosurgery, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Eugene K Wai
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, Canada K1Y 4E9; Division of Orthopaedic Surgery, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9.
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Beaulé PE, Roffey DM, Poitras S. [Amélioration continue de la qualité en chirurgie orthopédique: modifications et répercussions de la réforme du financement du système de santé]. Can J Surg 2016; 59:151-3. [PMID: 27240283 DOI: 10.1503/cjs.006316] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Paul E Beaulé
- Division de la chirurgie orthopédique, L'Hôpital d'Ottawa, Ottawa, Ont. (Beaulé); Programme d'épidémiologie clinique, Institut de recherche de L'Hôpital d'Ottawa, Ottawa, Ont. (Roffey); Programme de physiothérapie, Faculté des sciences de la santé, Université d'Ottawa, Ottawa, Ont. (Poitras)
| | - Darren M Roffey
- Division de la chirurgie orthopédique, L'Hôpital d'Ottawa, Ottawa, Ont. (Beaulé); Programme d'épidémiologie clinique, Institut de recherche de L'Hôpital d'Ottawa, Ottawa, Ont. (Roffey); Programme de physiothérapie, Faculté des sciences de la santé, Université d'Ottawa, Ottawa, Ont. (Poitras)
| | - Stéphane Poitras
- Division de la chirurgie orthopédique, L'Hôpital d'Ottawa, Ottawa, Ont. (Beaulé); Programme d'épidémiologie clinique, Institut de recherche de L'Hôpital d'Ottawa, Ottawa, Ont. (Roffey); Programme de physiothérapie, Faculté des sciences de la santé, Université d'Ottawa, Ottawa, Ont. (Poitras)
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Aleem I, Xu Y, Rampersaud YR, Pahuta M, St-Pierre GH, Crawford E, Zarrabian M, St-Pierre GH, Yang M, Scheer J, St-Pierre GH, Lou E, Malleck S, Soroceanu A, Soroceanu A, White B, Holtz KA, Fallah N, Noonan V, Finkelstein J, Rivers C, Tee J, Paquet J, Rutges J, Martin AR, Martin AR, Jack A, Malakoutian M, Kwon B, St-Pierre GH, Nater A, Versteeg A, Pahuta M, Fenton E, Nagoshi N, Tetreault L, Witiw C, Santaguida C, Aziz M, Khashan M, Tomkins-Lane C, Miyanji F, Johnson M, Tee J, Roffey DM, Evaniew N, Nouri A, Tetreault L, Arnold P, Tetreault L, Fehlings M, Wilson J, Smith JS, Charest-Morin R, Charest-Morin R, Marion T, Marion T, Kato S, Miyanji F, Enright A, Daly E, Fehlings M, Dakson A, Dakson A, Leck E, Khashan M, Abraham E, Manson N, Pahuta M, Duncan J, Ahmed A, Eck J, Rhee J, Currier B, Nassr A, Yen D, Johnson A, Bidos A, Schultz S, Fanti C, Young B, Drew B, Puskas D, Henry D, Frombach A, Mitera G, Coyle D, Werier J, Wai E, Hurlbert J, Ravinsky R, Bidos A, Rampersaud YR, Bidos A, Fanti C, Young B, Drew B, Puskas D, Rampersaud R, Yang M, Hurlbert J, Thomas K, St-Pierre GH, Duplessis S, Ailon T, Smith J, Shaffrey C, Klineberg E, Schwab F, Ames C, Yang M, Hurlbert J, Thomas K, Nataraj A, Zheng R, Hill D, Moreau M, Hedden D, Southon S, Johnson M, Goytan M, Passmore S, McIntosh G, Smith J, Lafage V, Klineberg E, Ailon T, Ames C, Shaffrey C, Gupta M, Kebaish K, Scubbia D, Hart R, Hostin R, Schwab F, Kelly M, Smith J, Scheer J, Lafage V, Protopsaltis T, Lafage R, Hostin R, Kebaish K, Gupta M, Hart R, Schwab F, Ames C, Dea N, Street J, Dvorak M, Lipson R, Noonan VK, Kwon BK, Mills PB, Noonan V, Shum J, Rivers C, Street J, Park SE, Chan E, Plashkes T, Dvorak M, Fallah N, Bedi M, Chan E, Rivers C, Street J, Plashkes T, Dvorak M, Noonan V, Fallah N, Ho C, Tsai E, Rivers C, Truchon C, Linassi AG, O’Connell C, Townson A, Ahn H, Drew B, Dvorak M, Fehlings MG, Schwartz C, Noreau L, Warner F, Noonan V, Fallah N, Fisher C, O’Connell C, Tsai E, Ahn H, Attabib N, Christie S, Drew B, Finkelstein J, Fourney D, Paquet J, Parent S, Kuerban D, Dvorak M, Paquet J, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Kuerban D, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Fisher C, Dvorak M, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Kuerban D, Dvorak M, Kwon B, Dvorak M, Aleksanderek I, Cohen-Adad J, Cadotte DW, Kalsi-Ryan S, De Leener B, Wang J, Crawley A, Mikulis DJ, Ginsberg H, Fehlings MG, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N, Cadotte DW, Crawley A, Ginsberg H, Mikulis DJ, Fehlings MG, Nataraj A, Fouad K, Street J, Wilke HJ, Stavness I, Dvorak M, Fels S, Oxland T, Streijger F, Fallah N, Noonan V, Paquette S, Boyd M, Ailon T, Street J, Fisher C, Dvorak M, Hurlbert J, Fehlings M, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A, Dea N, Boriani S, Varga PP, Luzzati A, Fehlings M, Bilsky M, Rhines L, Reynolds J, Dekutoski M, Gokaslan Z, Germscheid N, Fisher C, van Walraven C, Coyle D, Werier J, Wai E, Mercier P, Bains I, Jacobs WB, Tetreault L, Nakashima H, Nouri A, Fehlings M, Kopjar B, Wilson J, Arnold P, Fehlings M, Tetreault L, Kopjar B, Massicotte E, Fehlings M, Fehlings M, Kopjar B, Arnold P, Defino H, Kale S, Yoon ST, Barbagallo G, Bartels R, Zhou Q, Vaccaro A, Johnson M, Passmore S, Goytan M, Glazebrook C, Golan J, McIntosh G, Barker J, Weber M, Hu R, Norden J, Sinha A, Smuck M, Desai S, Samdani AF, Shah SA, Asghar J, Yaszay B, Shufflebarger HL, Betz RR, Newton P, Passmore S, McCammon J, Goytan M, McIntosh G, Fisher C, Alfasi A, Hashem EL, Papineau GD, Kingwell SP, Wai EK, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF, Tetreault L, Dalzell K, Zamorano JJ, Fehlings M, Shamji M, Rhee J, Wilson J, Andersson I, Dembek A, Pagarigan K, Dettori J, Fehlings M, Kopjar B, Tetreault L, Nakashima H, Fehlings M, Kopjar B, Arnold P, Kotter M, Fehlings M, Wilson J, Arnold P, Shaffrey C, Shamji M, Mroz T, Skelly A, Chapman J, Tetreault L, Aarabi B, Casha S, Jaglal S, Voth J, Yee A, Fehlings M, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, Protopsaltis T, Scheer JK, Ailon T, Ramachandran S, Daniels A, Mundis G, Gupta M, Deviren V, Ames CP, Street J, Stobart L, Ryerson CJ, Flexman A, Street J, Flexman A, Rivers C, Kuerban D, Cheng C, Noonan V, Dvorak M, Fisher C, Kwon B, Street J, Ailon T, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Lewis S, Reilly C, Shah SA, Clements DH, Samdani AF, Desai S, Lonner BS, Shufflebarger HL, Betz RR, Newton P, Johnson M, Passmore S, Goytan M, Manson N, Bigney E, Wagg K, Abraham E, Nater A, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A, Leck E, Christie S, Leck E, Christie S, Dakson A, Christie S, Weber M, McIntosh G, Barker J, Golan J, Wagg K, Armstrong M, Bigney E, Daly E, Manson N, Bigney E, Wagg K, Daly E, Abraham E, Perruccio A, Badley E, Rampersaud R. 2016 Canadian Spine Society Abstracts. Can J Surg 2016; 59:S39-63. [PMID: 27240290 DOI: 10.1503/cjs.006916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Zhao L, Roffey DM, Chen S. Genetics of adolescent idiopathic scoliosis in the post-genome-wide association study era. Ann Transl Med 2015; 3:S35. [PMID: 26046082 DOI: 10.3978/j.issn.2305-5839.2015.03.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/20/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Linlu Zhao
- 1 Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada ; 2 University of Ottawa Spine Program, The Ottawa Hospital, Ottawa, ON, Canada ; 3 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Darren M Roffey
- 1 Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada ; 2 University of Ottawa Spine Program, The Ottawa Hospital, Ottawa, ON, Canada ; 3 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Suzan Chen
- 1 Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada ; 2 University of Ottawa Spine Program, The Ottawa Hospital, Ottawa, ON, Canada ; 3 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Burgers PTPW, Poolman RW, Van Bakel TMJ, Tuinebreijer WE, Zielinski SM, Bhandari M, Patka P, Van Lieshout EMM, Devereaux PJ, Guyatt GH, Einhorn TA, Thabane L, Schemitsch EH, Koval KJ, Frihagen F, Poolman RW, Tetsworth K, Guerra-Farfan E, Walter SD, Sprague S, Swinton M, Scott T, McKay P, Madden K, Heels-Ansdell D, Buckingham L, Duraikannan A, Silva H, Heetveld MJ, Van Lieshout EMM, Burgers PT, Zura RD, Avram V, Manjoo A, Williams D, Antoniou J, Ramsay T, Bogoch ER, Trenholm A, Lyman S, Mazumdar M, Bozic KJ, Luborsky M, Goodman S, Muray S, Korley R, Buckley R, Duffy P, Puloski S, Carcary K, Lorenzo M, McKee MD, Hall JA, Nauth A, Whelan D, Daniels TR, Waddell JP, Ahn H, Vicente MR, Hidy JT, MacNevin MT, Kreder H, Axelrod T, Jenkinson R, Nousiainen M, Stephen D, Wadey V, Kunz M, Milner K, Cagaanan R, MacNevin M, O’Brien PJ, Blachut PA, Broekhuyse HM, Guy P, Lefaivre KA, Slobogean GP, Johal R, Leung I, Coles C, Leighton R, Richardson CG, Biddulph M, Gross M, Dunbar M, Amirault JD, Alexander D, Coady C, Glazebrook M, Johnston D, Oxner W, Reardon G, Wong I, Trask K, MacDonald S, Furey A, Stone C, Parsons M, Stone T, Zomar M, McCormack R, Apostle K, Boyer D, Moola F, Perey B, Viskontas D, Moon K, Moon R, Laflamme Y, Benoit B, Ranger P, Malo M, Fernandes J, Tardif K, Fournier J, Vendittoli PA, Massé V, Roy AG, Lavigne M, Lusignan D, Davis C, Stull P, Weinerman S, Weingarten P, Lindenbaum S, Hewitt M, Danielwicz R, Baker J, Mont M, Delanois DE, Kapadia B, Issa K, Mullen M, Sems A, Foreman B, Parvizi J, Morrison T, Lewis C, Caminiti S, Tornetta P, Creevy WR, Lespasio MJ, Carlisle H, Marcantonio A, Kain M, Specht L, Tilzey J, Garfi J, Mehta S, Esterhai JL, Ahn J, Donegan D, Horan A, McGinnis K, Roberson J, Bradbury T, Erens G, Webb K, Mullis B, Shively K, Parr A, Ertl J, Worman R, Webster M, Cummings J, Frizzell V, Moore M, Jones CB, Ringler JR, Sietsema DL, Walker JE, Kanlic E, Abdelgawad A, Shunia J, DePaolo C, Sutherland S, Alosky R, Zura R, Manson M, Strathy G, Peter K, Johnson P, Morton M, Shaer J, Schrickel T, Hileman B, Hanes M, Chance E, Heinrich EM, Dodgin D, LaBadie M, Zamorano D, Tynan M, Schwarzkopf R, Scolaro JA, Gupta R, Bederman S, Bhatia N, Hoang B, Kiester D, Jones N, Rafijah G, Alavekios D, Lee J, Mehta A, Schroder S, Chao T, Colin V, Dang P(P, Heng SK, Lopez G, Galle S, Pahlavan S, Phan DL, Tapadia M, Bui C, Jain N, Moore T, Moroski N, Pourmand D, Kubiak EN, Gililland J, Rothberg D, Peters C, Pelt C, Stuart AR, Corbey K, Shuler FD, Day J, Garabekyan T, Cheung F, Oliashirazi A, Salava J, Morgan L, Wilson-Byrne T, Cordle MB, Elmans LH, van den Hout JA, Joosten AJP, van Beurden AFA, Bolder SBT, Eygendaal D, Moonen AF, van Geenen RCI, Hoebink EA, Wagenmakers R, van Helden W, van Jonbergen HPW, Roerdink H, Reuver JM, Barnaart AFW, Flikweert ER, Krips R, Mullers JB, Schüller H, Falke MLM, Kurek FJ, Slingerland ACH, van Dijk JP, van Helden WH, Bolhuis HW, Bullens PHJ, Hogervorst M, de Kroon KE, Jansen RH, Steenstra F, Raven EEJ, Fontijne WPJ, Wiersma SC, Boetes B, ten Holder EJT, van der Heide HJL, Nagels J, van der Linden-van der Zwaag EH, Keizer SB, Swen JWA, den Hollander PHC, Thomassen BJW, Molekamp WJK, de Meulemeester FR, Kleipool AEB, Haverlag R, Simons MP, Mutsaerts EL, Kooijman R, Postema RR, Bleker RJ, Lampe HIH, Schuman L, Cheung J, van Bommel F, Winia WP, Haverkamp D, van der Vis H, Nolte PA, van den Bekerom MPJ, de Jong T, van Noort A, Vergroesen DA, Schutte BG, van der Vis HM, Beimers L, de Vries J, Zurcher AW, Albers GR, Rademakers M, Breugem S, van der Haven I, Jan Damen P, Bulstra GH, Campo MM, Somford MP, Haverkamp D, Liew S, Bedi H, Carr A, Chia A, Csongvay S, Donohue C, Doig S, Edwards E, Esser M, Freeman R, Gong A, Li D, Miller R, Ton L, Wang O, Young I, Dowrick A, Murdoch Z, Sage C, Page R, Bainbridge D, Angliss R, Miller B, Thomson A, Brown G, Williams S, Eng K, Bowyer D, Skelley J, Goyal C, Beattie S, Guerado E, Cruz E, Cano JR, Froufe MA, Serra LM, Al-dirra S, Martinez C, Tarazona Santabalbina FJ, Serra JT, Hernandez JT, Garcia MA, Garcia VM, Barrera S, Garrido M, Nordsletten L, Clarke-Jenssen J, Hjorthaug G, Brekke AC, Vesterhus EB, Skaugrud I, Tripathi P, Katiyar S, Shukla P, Swiontkowski M, Guyatt G, Jeray K, Walter S, Viveiros H, Truong V, Koo K, Zhou Q, Maddock D, Simunovic N, Agel J, Zielinski SM, Rangan A, Hanusch BC, Kottam L, Clarkson R, Della Rocca GJ, Slobogean G, Katz J, Gillespie B, Greendale GA, Hartman C, Rubin C, Waddell J, Lemke HM, Oatt A, Buckley RE, Korley R, Johnston K, Powell J, Sanders D, Lawendy A, Tieszer C, Murnaghan J, Nam D, Yee A, Whelan DB, Wild LM, Khan RM, Coady C, Amirault D, Richardson G, Dobbin G, Bicknell R, Yach J, Bardana D, Wood G, Harrison M, Yen D, Lambert S, Howells F, Ward A, Zalzal P, Brien H, Naumetz V, Weening B, Wai EK, Papp S, Gofton WT, Kingwell SP, Johnson G, O’Neil J, Roffey DM, Borsella V, Oliver TM, Jones V, Endres TJ, Agnew SG, Jeray KJ, Broderick JS, Goetz DR, Pace TB, Schaller TM, Porter SE, Tanner SL, Snider RG, Nastoff LA, Bielby SA, Switzer JA, Cole PA, Anderson SA, Lafferty PM, Li M, Ly TV, Marston SB, Foley AL, Vang S, Wright DM, Marcantonio AJ, Kain MSH, Iorio R, Specht LM, Tilzey JF, Lobo MJ, Garfi JS, Vallier HA, Dolenc A, Robinson C, Prayson MJ, Laughlin R, Rubino LJ, May J, Rieser GR, Dulaney-Cripe L, Gayton C, Gorczyca JT, Gross JM, Humphrey CA, Kates S, Noble K, McIntyre AW, Pecorella K, Davis CA, Lindenbaum S, Schwappach J, Baker JK, Rutherford T, Newman H, Lieberman S, Finn E, Robbins K, Hurley M, Lyle L, Mitchell K, Browner K, Whatley E, Payton K, Reeves C, Cannada LK, Karges D, Hill L, Esterhai J, Horan AD, Kaminski CA, Kowalski BN, Keeve JP, Anderson CG, McDonald MD, Hoffman JM, Tarkin I, Siska P, Gruen G, Evans A, Farrell DJ, Irrgang J, Luther A, Cross WW, Cass JR, Sems SA, Torchia ME, Scrabeck T, Jenkins M, Dumais J, Romero AW, Sagebien CA, Butler MS, Monica JT, Seuffert P, Hsu JR, Ficke J, Charlton M, Napierala M, Fan M, Tannoury C, Archdeacon M, Finnan R, Le T, Wyrick J, Hess S, Brennan ML, Probe R, Kile E, Mills K, Clipper L, Yu M, Erwin K, Horwitz D, Strohecker K, Swenson TK, Schmidt AH, Westberg JR, Aurang K, Zohman G, Peterson B, Huff RB, Baele J, Weber T, Edison M, McBeth J, Ertl JP, Parr JA, Moore MM, Tobias E, Thomas E, DePaolo CJ, Shell LE, Hampton L, Shepard S, Nanney T, Cuento C, Cantu RV, Henderson ER, Eickhoff LS, Hammerberg EM, Stahel P, Hak D, Mauffrey C, Gibula D, Gissel H, Henderson C, Zamorano DP, Tynan MC, Lawson D, Crist BD, Murtha YM, Anderson LK, Linehan C, Pilling L, Lewis CG, Sullivan RJ, Roper E, Obremskey W, Kregor P, Richards JE, Stringfellow K, Dohm MP, Zellar A, Segers MJM, Zijl JAC, Verhoeven B, Smits AB, de Vries JPPM, Fioole B, van der Hoeven H, Theunissen EBM, de Vries Reilingh TS, Govaert L, Wittich P, de Brauw M, Wille J, Go PM, Ritchie ED, Wessel RN, Hammacher ER, Visser GA, Stockmann H, Silvis R, Snellen JP, Rijbroek B, Scheepers JJG, Vermeulen EGJ, Siroen MPC, Vuylsteke R, Brom HLF, Rijna H, de Rijcke PAR, Koppert CL, Buijk SE, Groenendijk RPR, Dawson I, Tetteroo GWM, Bruijninckx MMM, Doornebosch PG, de Graaf EJR, van der Elst M, van der Pol CC, van’t Riet M, Karsten TM, de Vries MR, Stassen LPS, Schep NWL, Ben Schmidt G, Hoffman WH, van der Heijden FH, Willems WJ, van der Hart CP, Turckan K, Festen S, de Nies F, Out NJM, Bosma J, van Kampen A, Biert J, van Vugt AB, Edwards MJR, Blokhuis TJ, Frölke JPM, Geeraedts LMG, Gardeniers JWM, Tan ET, Poelhekke LM, de Waal Malefijt MC, Schreurs B, Roukema GR, Josaputra HA, Keller P, de Rooij PD, Kuiken H, Boxma H, Cleffken BI, Liem R, Rhemrev SJ, Bosman CHR, de Mol van Otterloo A, Hoogendoorn J, de Vries AC, Meylaerts SAG, Verhofstad MHJ, Meijer J, van Egmond T, van der Brand I, Patka P, Eversdijk MG, Peters R, Den Hartog D, Van Waes OJF, Oprel P, Campo M, Verhagen R, Albers GR, Simmermacher RKJ, van Mulken J, van Wessem K, van Gaalen SM, Leenen LPH, Bronkhorst MW, Guicherit OR, Goslings JC, Ponsen KJ, Bhatia M, Arora V, Tyagi V, Gupta A, Jain N, Khan F, Sharma A, Sanghavi A, Trivedi M, Rai A, Subash, Rai K, Yadav V, Singh S, Prasad AS, Mishra V, Sundaresh DC, Khanna A, Cherian JJ, Olakkengil DJ, Sharma G, Dadi A, Palla N, Ganguly U, Rai BS, Rajakumar J, Hull P, Lewis S, Evans S, Nanda R, Logishetty R, Anand S, Bowler C, Jennings A, Chuter G, Rose G, Horner G, Clark C, Eke K, Reed M, Herriott C, Dobb C, Curry H, Etherington G, Jain A, Moaveni A, Russ M, Donald G, Weinrauch P, Pincus P, Yang S, Halliday B, Gervais T, Holt M, Flynn A, Pirpiris M, Love D, Bucknill A, Farrugia RJ, Ianssen T, Amundsen A, Brattgjerd JE, Borch T, Bøe B, Flatøy B, Hasselund S, Haug KJ, Hemlock K, Hoseth TM, Jomaas G, Kibsgård T, Lona T, Moatshe G, Müller O, Molund M, Nicolaisen T, Nilsen F, Rydinge J, Smedsrud M, Stødle A, Trommer A, Ugland S, Karlsten A, Ekås G, Pape HC, Knobe M, Pfeifer R. Reliability, validity, and responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index for elderly patients with a femoral neck fracture. J Bone Joint Surg Am 2015; 97:751-7. [PMID: 25948522 DOI: 10.2106/jbjs.n.00542] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 02/01/2023]
Abstract
BACKGROUND The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture. METHODS Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older. RESULTS The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%). CONCLUSIONS The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations. CLINICAL RELEVANCE The results are based on two clinical trials. The questionnaires used concern pure, clinically relevant issues (ability to walk, climb stairs, etc.). Moreover, the results can be used for future research comparing clinical outcomes (or treatments) for populations with a femoral neck fracture.
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Affiliation(s)
- Paul T P W Burgers
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
| | - Rudolf W Poolman
- Joint Research, Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, the Netherlands. E-mail address:
| | - Theodorus M J Van Bakel
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
| | - Wim E Tuinebreijer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
| | - Stephanie M Zielinski
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
| | - Mohit Bhandari
- Department of Clinical Epidemiology and Biostatistics, McMaster University, HSC 2C, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada. E-mail address:
| | - Peter Patka
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address:
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. E-mail address for P.T.P.W. Burgers: . E-mail address for T.M.J. Van Bakel: . E-mail address for W.E. Tuinebreijer: . E-mail address for S.M. Zielinski: . E-mail address for E.M.M. Van Lieshout:
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Albrecht JS, Marcantonio ER, Roffey DM, Orwig D, Magaziner J, Terrin M, Carson JL, Barr E, Brown JP, Gentry EG, Gruber-Baldini AL. Stability of postoperative delirium psychomotor subtypes in individuals with hip fracture. J Am Geriatr Soc 2015; 63:970-6. [PMID: 25943948 DOI: 10.1111/jgs.13334] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine the stability of psychomotor subtypes of delirium over time and identify characteristics associated with delirium psychomotor subtypes in individuals undergoing surgical repair of hip fracture. DESIGN Prospective cohort study. SETTING The Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair Cognitive Ancillary Study was conducted at 13 participating sites from 2008 to 2009. PARTICIPANTS Individuals who had undergone surgical repair of hip fracture (N=139). MEASUREMENTS Delirium was assessed up to four times postoperatively using the Confusion Assessment Method (CAM) and the Memorial Delirium Assessment Scale. Psychomotor subtypes of delirium were categorized as hypoactive, hyperactive, mixed, and normal psychomotor activity. RESULTS Incidence of postoperative delirium was 41% (n=57). Of 90 CAM-positive (CAM+) observations, 56% were hypoactive, 10% were hyperactive, 21% were mixed, and 14% had normal psychomotor symptoms. Of 26 participants with more than one CAM+ assessment, 50% maintained subtype stability over time. Participants with hypoactive or normal psychomotor symptoms (n=31) were less likely to have chart documentation of delirium than participants with any hyperactive symptoms (n=19) (22% vs 58%, P=.009). CONCLUSION Psychomotor subtypes of delirium often fluctuate from assessment to assessment, rather than representing fixed categories of delirium. Hypoactive delirium is the most common presentation of delirium but is the least likely to be documented by healthcare providers.
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Affiliation(s)
- Jennifer S Albrecht
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Edward R Marcantonio
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Darren M Roffey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denise Orwig
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Jay Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Michael Terrin
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Jeffrey L Carson
- Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey
| | - Erik Barr
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Jessica P Brown
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Emma G Gentry
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
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Chen S, Zhao L, Roffey DM, Phan P, Wai EK. Association of rs11190870 near LBX1 with adolescent idiopathic scoliosis in East Asians: a systematic review and meta-analysis. Spine J 2014; 14:2968-75. [PMID: 24878781 DOI: 10.1016/j.spinee.2014.05.019] [Citation(s) in RCA: 20] [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: 12/09/2013] [Revised: 03/27/2014] [Accepted: 05/19/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The rs11190870 single nucleotide polymorphism in the 3'-flanking region of the LBX1 gene has been implicated in the etiology of adolescent idiopathic scoliosis (AIS). A thorough appraisal of the evidence supporting this association has not been previously attempted. PURPOSE To provide a comprehensive assessment and synthesis of the currently available evidence on the association between rs11190870 and AIS. STUDY DESIGN A systematic review and meta-analysis. METHODS This review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed (MEDLINE), EMBASE, Scopus, and HuGE Literature Finder databases were systematically searched through November 2013 to identify relevant studies following a sensitive strategy. Summary odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using the fixed-effect inverse variance model for allelic (T vs. C) and genotypic comparisons. RESULTS Meta-analysis of four studies conducted in East Asian populations (n=3,215 AIS cases and n=15,347 controls) found a highly statistically significant and robust association between rs11190870 and AIS. Comparison of summary ORs indicated a codominant model effect of the T allele. Carriers of the TC and TT genotypes were 69% (OR=1.69, 95% CI: 1.48-1.94, p<.001) and 162% (OR=2.62, 95% CI: 2.28-3.02, p<.001), respectively, more likely to have AIS compared with carriers of the CC genotype. CONCLUSIONS Based on a comprehensive analysis of the currently available evidence, rs11190870 is likely a susceptibility variant for AIS in East Asians. Further investigation of this association is necessary in other populations.
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Affiliation(s)
- Suzan Chen
- University of Ottawa Spine Program, The Ottawa Hospital, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y 4E9.
| | - Linlu Zhao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St., New Haven, CT, USA, 06510
| | - Darren M Roffey
- University of Ottawa Spine Program, The Ottawa Hospital, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y 4E9; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, Ontario, Canada, K1Y 4E9
| | - Philippe Phan
- University of Ottawa Spine Program, The Ottawa Hospital, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y 4E9; Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y 4E9
| | - Eugene K Wai
- University of Ottawa Spine Program, The Ottawa Hospital, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y 4E9; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, Ontario, Canada, K1Y 4E9; Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y 4E9
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Gruber-Baldini AL, Marcantonio E, Orwig D, Magaziner J, Terrin M, Barr E, Brown JP, Paris B, Zagorin A, Roffey DM, Zakriya K, Blute MR, Hebel JR, Carson JL. Delirium outcomes in a randomized trial of blood transfusion thresholds in hospitalized older adults with hip fracture. J Am Geriatr Soc 2013; 61:1286-95. [PMID: 23898894 DOI: 10.1111/jgs.12396] [Citation(s) in RCA: 44] [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] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine whether a higher blood transfusion threshold would prevent new or worsening delirium symptoms in the hospital after hip fracture surgery. DESIGN Ancillary study to a randomized clinical trial. SETTING Thirteen hospitals in the United States and Canada. PARTICIPANTS One hundred thirty-nine individuals hospitalized with hip fracture aged 50 and older (mean age 81.5 ± 9.1) with cardiovascular disease or risk factors and hemoglobin concentrations of less than 10 g/dL within 3 days of surgery recruited in an ancillary study of the Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair. INTERVENTION Individuals in the liberal treatment group received one unit of packed red blood cells and as much blood as needed to maintain hemoglobin concentrations at greater than 10 g/dL; those in the restrictive treatment group received transfusions if they developed symptoms of anemia or their hemoglobin fell below 8 g/dL. MEASUREMENTS Delirium assessments were performed before randomization and up to three times after randomization. The primary outcome was severity of delirium according to the Memorial Delirium Assessment Scale (MDAS). The secondary outcome was the presence or absence of delirium defined according to the Confusion Assessment Method (CAM). RESULTS The liberal group received a median two units of blood and the restrictive group zero units of blood. Hemoglobin concentration on Day 1 after randomization was 1.4 g/dL higher in the liberal group. Treatment groups did not differ significantly at any time point or over time on MDAS delirium severity (P = .28) or CAM delirium presence (P = .83). CONCLUSION Blood transfusion to maintain hemoglobin concentrations greater than 10 g/dL alone is unlikely to influence delirium severity or rate in individuals with hip fracture after surgery with a hemoglobin concentration less than 10 g/dL.
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Affiliation(s)
- Ann L Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W. Redwood St., Howard Hall Suite 200, Baltimore, MD 21201, USA.
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Pakzad H, Roffey DM, Knight H, Dagenais S, Yelle JD, Wai EK. Delay in operative stabilization of spine fractures in multitrauma patients without neurologic injuries: effects on outcomes. Can J Surg 2011; 54:270-6. [PMID: 21651838 DOI: 10.1503/cjs.008810] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Optimal timing for surgical stabilization of the fractured spine is controversial. Early stabilization facilitates mobilization and theoretically reduces associated complications. METHODS We identified consecutive patients without neurologic injury requiring stabilization surgery for a spinal fracture at an academic tertiary-care hospital over a 12-year period. Incidences of postoperative complications were prospectively evaluated. We analyzed results based on the time elapsed before the final surgical stabilization procedure. Multivariate analyses were performed to explore the effects of potential confounders. RESULTS A total of 83 patients (60 men, 23 women; mean age 39.4 yr) met the eligibility criteria and were enrolled. The mean Injury Severity Score (ISS) was 27.1 (range 12.0-57.0); 35% of patients had a cervical fracture and 65% had a thoraco-lumbar fracture. No statistically significant associations were uncovered between time to surgical stabilization and age, ISS or comorbidities. Comparing patients stabilized after 24 hours with those stabilized within 24 hours, there was an almost 8-fold greater risk of a complication related to prolonged recumbency (p = 0.007). We observed similar effects for other types of complications. Delays of more than 72 hours had a negative effect on complication rates; these effects remained significant after multivariate adjustments for age, comorbidity and ISS. CONCLUSION This study demonstrates a strong relation between timing of surgical stabilization of spinal fractures in multitrauma patients without neurologic injuries and complications. Further studies with larger samples may allow for better adjustment of potentially confounding factors and identify subgroups in which this effect is most pronounced.
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Affiliation(s)
- Hossein Pakzad
- Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont
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Roffey DM, Ashdown LC, Dornan HD, Creech MJ, Dagenais S, Dent RM, Wai EK. Pilot evaluation of a multidisciplinary, medically supervised, nonsurgical weight loss program on the severity of low back pain in obese adults. Spine J 2011; 11:197-204. [PMID: 21377601 DOI: 10.1016/j.spinee.2011.01.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [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] [Received: 08/20/2010] [Revised: 12/17/2010] [Accepted: 01/26/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a prevalent and costly condition. Although its etiology is largely unknown, a link to obesity is suspected, and weight loss programs are often recommended to obese patients with LBP. PURPOSE To assess the efficacy of a pilot, multidisciplinary, medically supervised, nonsurgical weight loss program involving meal replacement, caloric restriction, education, exercise, and group therapy at reducing the severity of LBP in obese adults. STUDY DESIGN Pilot prospective cohort study. PATIENT SAMPLE A total of 46 obese adults (mean body mass index [BMI] 44.7±7.6 kg/m2) referred to an academic hospital for a multidisciplinary, medically supervised, nonsurgical weight loss program who reported LBP were enrolled. OUTCOME MEASURES The severity of LBP was measured using the Numerical Pain Scale (NPS) and modified Oswestry Disability Index (ODI) at baseline (Week 1), Week 14, and Week 53; weight, BMI, dietary adherence, and physical activity levels were also measured. METHODS The 52-week weight loss program was administered by a team of physicians, dietitians, exercise specialists, and nurses and included liquid meal replacements for 12 weeks, followed by supervised caloric restriction diets for 13 weeks. Participants also attended weekly group therapy and educational meetings for the first 26 weeks, after which they were instructed to continue caloric restriction diets, engage in 60 to 90 minutes of daily physical activity, and attend monthly group meetings for an additional 26 weeks. RESULTS At baseline, NPS was mild in 61% (n=28), moderate in 30% (n=14), and severe in 9% (n=4), whereas ODI was moderate in 48% (n=22), severe in 17% (n=8), and crippling in 4% (n=2). At Week 14 (n=42; 92% follow-up), there were significant improvements in NPS (p=.001) and ODI (p=.0005), and significant weight loss (p<.0001). At Week 53 (n=28; 61% follow-up), there was a trend toward improvement in NPS (p=.07), significant improvement in ODI (p=.0009), and significant weight loss (p=.0005); reduction in BMI was significantly associated with clinically important improvements in ODI (p=.046). CONCLUSIONS This pilot prospective cohort study suggests that a 52-week multidisciplinary, medically supervised, nonsurgical weight loss program in obese patients with LBP improved both pain and function.
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Affiliation(s)
- Darren M Roffey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Spine Unit, The Ottawa Hospital, Ottawa, Ontario, Canada, K1Y 4E9
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Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S. Causal assessment of workplace manual handling or assisting patients and low back pain: results of a systematic review. Spine J 2010; 10:639-51. [PMID: 20537959 DOI: 10.1016/j.spinee.2010.04.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [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] [Received: 12/23/2009] [Revised: 02/24/2010] [Accepted: 04/14/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a common musculoskeletal disorder associated with a considerable social and economic burden within the working-age population. Despite an unclear etiology, numerous physical activities are suspected of leading to LBP. Declaring a causal relationship between occupational activities and LBP remains challenging and requires a methodologically rigorous approach. PURPOSE To conduct a systematic review focused on assessing the potentially causal relationship between workplace manual handling or assisting patients and LBP. STUDY DESIGN Systematic review of the literature. SAMPLES Studies reporting an association between workplace manual handling or assisting patients and LBP. OUTCOME MEASURES Numerical association between different levels of exposure to manual handling or assisting patients, and the presence or severity of LBP. METHODS A systematic review was conducted using Medline, EMBASE, CINAHL, Cochrane Library, and Occupational Safety and Health database, gray literature, hand-searching occupational health journals, reference lists of included studies, and content experts. The methodological quality of each study was assessed using a modified Newcastle-Ottawa Scale (NOS) for observational studies. The overall level of evidence supporting various Bradford-Hill criteria for causality for each category of manual handling or assisting patients and type of LBP was then evaluated. Studies were deemed of higher quality if they received a score of five or more on the modified NOS and used appropriate statistical analysis methods. RESULTS This search yielded 2,766 citations, and 32 studies met the eligibility criteria. Three high-quality studies reported on manual handling and LBP, including two prospective cohorts and one cross-sectional design. None demonstrated a significant association in most of their multivariate risk estimates. One study was able to assess dose-response and temporality, but its results did not support these criteria. Only one study discussed the biological plausibility of this association. Four high-quality studies evaluated assisting patients and LBP, including two case-controls, one cross-sectional, and one prospective cohort design. These studies were consistent in reporting no significant association. Two studies demonstrated a nonsignificant dose-response trend, and two studies discussed the biological plausibility of this association. No studies were able to demonstrate the temporality or experiment criteria. CONCLUSIONS The studies reviewed did not support a causal association between workplace manual handling or assisting patients and LBP in a Bradford-Hill framework. Conflicting evidence in specific subcategories of assisting patients was identified, suggesting that tasks such as assisting patients with ambulation may possibly contribute to LBP. It appears unlikely that workplace manual handling or assisting patients is independently causative of LBP in the populations of workers studied.
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Affiliation(s)
- Darren M Roffey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational carrying and low back pain: results of a systematic review. Spine J 2010; 10:628-38. [PMID: 20447872 DOI: 10.1016/j.spinee.2010.03.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [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] [Received: 12/01/2009] [Revised: 02/24/2010] [Accepted: 03/14/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Occupational low back pain (LBP) is a common musculoskeletal disorder that results in high healthcare use and a heavy societal burden from morbidity and medical costs. The etiology of LBP is unclear, although numerous physical activities in the workplace have been implicated in its development. Determining the causal relationship between LBP and specific occupational activities requires a rigorous methodological approach. PURPOSE To conduct a systematic review of the scientific literature focused on establishing a causal relationship between occupational carrying and LBP. STUDY DESIGN Systematic review of the literature was performed. SAMPLE Studies reporting an association between occupational carrying and LBP. OUTCOME MEASURES Numerical association between different levels of exposure to occupational carrying and the presence or severity of LBP. METHODS A systematic review was performed to identify, evaluate, and summarize the literature related to establishing a causal relationship between occupational carrying and LBP by using the commonly used Bradford-Hill framework. The literature was searched using Medline, Embase, CINAHL, Cochrane Library, the Occupational Safety and Health (OSH-ROM) database, gray literature (eg, studies not published in peer-reviewed journals), hand-searching occupational health journals, reference lists of included studies, and content experts. Study quality was evaluated using a modified version of the Newcastle-Ottawa Scale. Levels of evidence supporting specific Bradford-Hill criteria were evaluated for different categories of carrying and types of LBP outcomes. RESULTS This search yielded 2,766 citations. A total of nine high-quality studies reported on occupational carrying and LBP, including four case-control studies and five prospective cohort studies. These nine studies reported strong and consistent evidence against a statistical association between carrying and LBP. Three studies assessed dose-response, of which only one reported a dose-response trend that was not statistically significant. Five studies were able to assess temporality, but none reported results fulfilling this aspect of causality. The biological plausibility of carrying and LBP was not discussed in any of the nine studies. None of these studies attempted to evaluate the experiment criterion by devising studies in which the exposure to carrying and level of LBP could be measured before and after implementing a strategy aimed at reducing carrying in the workplace to determine its effect on LBP. CONCLUSIONS This review failed to identify high-quality studies that supported any of the Bradford-Hill criteria to establish causality between occupational carrying and LBP. Based on these results, it is unlikely that occupational carrying is independently causative of LBP in the populations of workers studied.
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Affiliation(s)
- Eugene K Wai
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational lifting and low back pain: results of a systematic review. Spine J 2010; 10:554-66. [PMID: 20494816 DOI: 10.1016/j.spinee.2010.03.033] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [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] [Received: 11/13/2009] [Revised: 02/08/2010] [Accepted: 03/29/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a disorder that commonly affects the working population, resulting in disability, health-care utilization, and a heavy socioeconomic burden. Although the etiology of LBP remains uncertain, occupational activities have been implicated. Evaluating these potentially causal relationships requires a methodologically rigorous approach. Occupational repetitive and/or heavy lifting is widely thought to be a risk factor for the development of LBP. PURPOSE To conduct a systematic review of the scientific literature to evaluate the causal relationship between occupational lifting and LBP. STUDY DESIGN Systematic review of the literature. SAMPLE Studies reporting an association between occupational lifting and LBP. OUTCOME MEASURES Numerical association between different levels of exposure to occupational lifting and the presence or severity of LBP. METHODS A search was conducted using Medline, EMBASE, CINAHL, Cochrane Library, OSH-ROM, gray literature (eg, reports not published in scientific journals), hand-searching occupational health journals, reference lists of included studies, and content experts. Evaluation of study quality was performed using a modified version of the Newcastle-Ottawa Scale. Levels of evidence were evaluated for specific Bradford-Hill criteria (association, dose-response, temporality, experiment, and biological plausibility). RESULTS This search yielded 2,766 citations, of which 35 studies met eligibility criteria and 9 were considered high methodological quality studies, including four case-controls and five prospective cohorts. Among the high-quality studies, there was conflicting evidence for association with four studies reporting significant associations and five studies reporting nonsignificant results. Two of the three studies that assessed dose-response demonstrated a nonsignificant trend. There were no significant risk estimates that demonstrated temporality. No studies were identified that satisfied the experiment criterion. Subgroup analyses identified certain types of lifting and LBP that had statistically significant results, but there were none that satisfied more than two of the Bradford-Hill criteria. CONCLUSIONS This review uncovered several high-quality studies examining a relationship between occupational lifting and LBP, but these studies did not consistently support any of the Bradford-Hill criteria for causality. There was moderate evidence of an association for specific types of lifting and LBP. Based on these results, it is unlikely that occupational lifting is independently causative of LBP in the populations of workers studied. Further research in specific subcategories of lifting would further clarify the presence or absence of a causal relationship.
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Affiliation(s)
- Eugene K Wai
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
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Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational standing or walking and low back pain: results of a systematic review. Spine J 2010; 10:262-72. [PMID: 20207335 DOI: 10.1016/j.spinee.2009.12.023] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [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] [Received: 08/04/2009] [Revised: 11/06/2009] [Accepted: 12/25/2009] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a widespread musculoskeletal condition that frequently occurs in the working-age population. Numerous occupational physical activities have been implicated in its etiology. PURPOSE To conduct a systematic review establishing a causal relationship between occupational standing or walking and LBP. STUDY DESIGN Systematic review of the literature. SAMPLE Studies reporting an association between occupational standing or walking and LBP. OUTCOME MEASURES Numerical association between exposure to standing or walking and the presence of LBP. METHODS A systematic review was performed to identify, evaluate, and summarize the literature related to establishing a causal relationship, according to Bradford-Hill criteria for causality, between occupational standing or walking and LBP. A search was conducted using MEDLINE, Embase, CINAHL, Cochrane Library, and Occupational Safety and Health database, gray literature, hand-searching occupational health journals, reference lists of included studies, and expert knowledge. Evaluation of methodological quality was performed using a modified Newcastle-Ottawa Scale. RESULTS This search yielded 2,766 citations. Eighteen studies met the inclusion criteria. Five were high-quality studies related to standing, and two were high-quality studies related to walking. For occupational standing and LBP, there was moderate to strong evidence against the association criterion, the only study examining dose response did not support this criterion, four studies examining temporality failed to support this criterion, and only one study discussed the biological plausibility criterion. For occupational walking and LBP, there was moderate evidence against a causal relationship with respect to the association, temporality, dose response, and biological plausibility criteria. No studies assessed the experiment criterion for these activities. CONCLUSIONS A summary of existing studies was not able to find any high-quality studies that satisfied more than two of the Bradford-Hill causation criteria for occupational standing or walking and LBP. Based on the evidence reviewed, it is unlikely that occupational standing or walking is independently causative of LBP in the populations of workers studied.
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Affiliation(s)
- Darren M Roffey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON K1Y 4E9, Canada
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Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S. Causal assessment of awkward occupational postures and low back pain: results of a systematic review. Spine J 2010; 10:89-99. [PMID: 19910263 DOI: 10.1016/j.spinee.2009.09.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [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] [Received: 07/10/2009] [Revised: 08/31/2009] [Accepted: 09/16/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a prevalent and costly musculoskeletal disorder that often occurs in the working-age population. Although numerous physical activities have been implicated in its complex etiology, determining causation remains challenging and requires a methodologically rigorous approach. PURPOSE To conduct a systematic review of the scientific literature focused on establishing a causal relationship between awkward occupational postures and LBP. STUDY DESIGN Systematic review of the literature using MEDLINE, EMBASE, CINAHL, Cochrane Library, and Occupational Safety and Health database, gray literature, hand-searching occupational health journals, reference lists of included studies, and experts. Evaluation of methodological quality using a modified Newcastle-Ottawa Scale for observational studies. Summary levels of evidence for each of the Bradford Hill criteria for causality for each category of awkward occupational posture and type of LBP. SAMPLE Studies reporting an association between awkward occupational postures and LBP. OUTCOME MEASURES Numerical association between different levels of exposure to awkward occupational postures and the presence or severity of LBP. METHODS A systematic review was performed to identify, evaluate, and summarize the literature related to establishing a causal relationship, according to Bradford Hill criteria, between awkward occupational postures and LBP. RESULTS This search yielded 2,766 citations. Eight high-quality studies reported on awkward occupational postures and LBP. Three were case-control studies, one was cross-sectional, and four were prospective cohort studies. There was strong evidence for consistency of no association between awkward occupational postures and LBP, with only two studies demonstrating significant associations in most of their risk estimates compared with six studies reported mainly nonsignificant associations. Two studies assessed dose response, with one study demonstrating a nonsignificant dose-response trend. Three studies were able to assess temporality, but all demonstrated nonsignificant risk estimates. Biological plausibility was discussed by two studies. There was no available evidence to assess the experiment criterion for causality. CONCLUSIONS There was strong evidence from six high-quality studies that there was no association between awkward postures and LBP. Similarly, there was strong evidence from three high-quality studies that there was no temporal relationship. Moreover, subgroup analyses identified only a handful of studies that demonstrated only weak associations and no evidence for other aspects of causality in certain specific subcategories. It is therefore unlikely that awkward occupational postures are independently causative of LBP in the populations of workers studied.
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Affiliation(s)
- Darren M Roffey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, ON K1Y 4E9, Canada
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Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational bending or twisting and low back pain: results of a systematic review. Spine J 2010; 10:76-88. [PMID: 19631589 DOI: 10.1016/j.spinee.2009.06.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [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] [Received: 05/28/2009] [Accepted: 06/12/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a common musculoskeletal disorder that often occurs in the working-age population. Although numerous physical activities have been implicated in its etiology, determining causation remains challenging and requires a methodologically rigorous approach. PURPOSE To conduct a systematic review focused on establishing a causal relationship between occupational bending or twisting and LBP. STUDY DESIGN A systematic review of the literature using Medline, Embase, CINAHL, Cochrane Library, and Occupational Safety and Health database, gray literature, hand-searching occupational health journals, reference lists of included studies, and experts. Evaluation of methodological quality using a modified Newcastle-Ottawa Scale for observational studies. Summary levels of evidence for each of the Bradford-Hill criteria for causality for each category of bending or twisting and type of LBP. SAMPLE Studies reporting an association between occupational bending or twisting and LBP. OUTCOME MEASURES Numerical association between different levels of exposure to bending or twisting and the presence or severity of LBP. METHODS A systematic review was performed to identify, evaluate, and summarize the literature related to establishing a causal relationship, according to Bradford-Hill criteria, between occupational bending or twisting and LBP. RESULTS This search yielded 2,766 citations. Ten high-quality studies reported on bending and LBP. Five were case-control studies and five were prospective cohort studies. There was conflicting evidence for association, with five studies demonstrating significant associations in the majority of their risk estimates, but no evidence for consistency. Seven studies assessed dose response, with four studies demonstrating a nonsignificant dose-response trend. Four studies were able to assess temporality, but only one demonstrated significant risk estimates. Biological plausibility was discussed by two studies. There was no available evidence for experiment. Seven high-quality studies reported on twisting and LBP. Two were case-control studies and five were prospective cohort studies. Three studies reported significant associations in the majority of their risk estimates, with no evidence for consistency. Three studies demonstrated a nonsignificant dose-response trend. Two studies were able to assess temporality, but only one study was able to demonstrate significant risk estimates. Two studies discussed biological plausibility. There was no available evidence for experiment. CONCLUSIONS A summary of existing studies was not able to find high-quality studies that satisfied more than three of the Bradford-Hill criteria for causation for either occupational bending or twisting and LBP. Conflicting evidence in multiple criteria was identified. This suggests that specific subcategories could contribute to LBP. However, the evidence suggests that occupational bending or twisting in general is unlikely to be independently causative of LBP.
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Affiliation(s)
- Eugene K Wai
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
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Roffey DM, Byrne NM, Hills AP. Effect of stage duration on physiological variables commonly used to determine maximum aerobic performance during cycle ergometry. J Sports Sci 2007; 25:1325-35. [PMID: 17786685 DOI: 10.1080/02640410601175428] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this study, we examined the effect of stage duration on physiological variables commonly used to determine maximum aerobic performance during cycle ergometry. Ten recreationally trained males (mean age 27.8 +/- 7.1 years; BMI 24.3 +/- 2.5 kg x m(-2); VO2max 52.5 +/- 5.9 ml x kg(-1) x min(-1)) performed three different stage duration protocols on two separate occasions. Each short stage (SS; 1-min stages), long stage (LS; 3-min stages), and constant load + short stage (CL + SS; 4-min constant load followed by 1-min stages) protocol started at 50 W with increments of 30 W. The physiological variables measured included: time to maximum, maximum workload, maximum oxygen consumption (VO2max), maximum heart rate, maximum rating of perceived exertion, maximum blood lactate concentration, and maximum respiratory exchange ratio. The ventilatory threshold was calculated for every trial of the three protocols. There was no difference in VO2max, but maximum heart rate was higher in the LS protocol (P<0.05). Maximum respiratory exchange ratio varied between the protocols (P<0.05), while maximum workload differed between the SS and LS protocols, and the LS and CL + SS protocols (P<0.0001). The physiological variables were comparable between trials for the SS and CL + SS protocols, but maximum workload and VO2max differed for the LS protocol (P<0.05). Workload at the ventilatory threshold was lower for the LS protocol (P<0.05). Heart rate at the ventilatory threshold was different between the LS and CL + SS protocols (P<0.05). Performing a test involving 1- or 3-min stage durations on a single occasion was appropriate for the determination of VO2max and the ventilatory threshold. However, the disparity in heart rate and workload could result in differences in mechanical and physiological work being undertaken. Consistent use of a protocol may alleviate errors during exercise prescription.
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Affiliation(s)
- Darren M Roffey
- School of Human Movement Studies and ATN Centre for Metabolic Fitness, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
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Roffey DM, Byrne NM, Hills AP. Day-to-day variance in measurement of resting metabolic rate using ventilated-hood and mouthpiece & nose-clip indirect calorimetry systems. JPEN J Parenter Enteral Nutr 2006; 30:426-32. [PMID: 16931612 DOI: 10.1177/0148607106030005426] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To know if the magnitude of change in resting metabolic rate (RMR) observed during an intervention is meaningful, it is imperative to first identify the variability that occurs within individuals from day to day under normal conditions. The 2 most common systems used to measure RMR involve a ventilated hood or a mouthpiece & nose clip to collect expired gases. The variation in measurement using these 2 approaches has not been systematically compared. METHODS RMR was measured in 10 healthy adults during 5 separate testing sessions within a 2-week period where usual diet and physical activity were maintained. Each testing session consisted of one measurement of RMR using a ventilated hood system, followed by another using a mouthpiece & nose-clip system. RESULTS No significant difference in RMR was evident between measurement sessions using either indirect calorimeter. Oxygen consumption and RMR were significantly higher using the mouthpiece & nose-clip system. Average within-individual coefficient of variation for RMR was significantly lower for the ventilated-hood system. RMR measures were consistently lower using the ventilated-hood system by an average of 94.5 +/- 63.3 kcal. Day-to-day variance was between 2% and 4% for both systems. CONCLUSIONS The use of either system is appropriate for assessing RMR in clinical and research settings, but alternating between systems should be undertaken with caution. A change in RMR must be greater than approximately 6% (96 kcal/d; 1.2 kcal/kg/d) or approximately 8% (135 kcal/d; 1.7 kcal/kg/d) when using a ventilated-hood system or a mouthpiece & nose-clip system, respectively, to observe any meaningful intervention-related differences within individuals.
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Affiliation(s)
- Darren M Roffey
- School of Human Movement Studies, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Roffey DM, Luscombe ND, Byrne NM, Hills AP, Bellon M, Tsopelas C, Kirkwood ID, Wittert GA. Use of [14C]-sodium bicarbonate/urea to measure physical activity induced increases in total energy expenditure in free-living healthy males. Asia Pac J Clin Nutr 2005; 14:83-90. [PMID: 15734713] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The aim of this study was to evaluate the utility of the [(14)C]-sodium bicarbonate/urea technique to detect physical activity-induced increases in total energy expenditure in free-living healthy men. Thirteen healthy males aged 34.1 +/- 11.7 yrs with body mass index 24.1 +/- 3.1 kg/m(2) were studied on three separate occasions, during which [(14)C]-bicarbonate was infused over 48-hours and urine was collected during the second 24-hours. On three separate occasions and in random order, subjects either remained sedentary, or performed a bout of physical activity on an electro-magnetically braked cycle ergometer sufficient to increase energy expenditure by 7% or 11% above predicted sedentary total energy expenditure. Urine samples were analyzed to evaluate the amount of [(14)C]-bicarbonate incorporated into urinary urea, thereby reflecting the amount of CO(2) produced per day, and upon conversion, the number of kilojoules of energy expended in 24-hours. All 13 subjects successfully completed the two physical activity treatments and there were no adverse events. As measured by the [(14)C]-urea assay, mean total energy expenditure values were not significantly different between sedentary activity (17902 +/- 905 kJ/day), the physical activity treatment designed to increase TEE by 7% (17701 +/- 594 kJ/day) and the physical activity treatment designed to increase TEE by 11% (18538 +/- 485 kJ/day) (P=0.668). In conclusion, although the [(14)C]-sodium bicarbonate/urea technique was well tolerated and did not interfere with normal daily activities, it was not able to accurately measure physical activity-induced increases in EE in the range of 7-11% above predicted sedentary total energy expenditure.
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Affiliation(s)
- Darren M Roffey
- Department of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia
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