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Taraldsen K, Polhemus A, Engdal M, Jansen CP, Becker C, Brenner N, Blain H, Johnsen LG, Vereijken B. Evaluation of mobility recovery after hip fracture: a scoping review of randomized controlled studies. Osteoporos Int 2024; 35:203-215. [PMID: 37801082 PMCID: PMC10837269 DOI: 10.1007/s00198-023-06922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
Few older adults regain their pre-fracture mobility after a hip fracture. Intervention studies evaluating effects on gait typically use short clinical tests or in-lab parameters that are often limited to gait speed only. Measurements of mobility in daily life settings exist and should be considered to a greater extent than today. Less than half of hip fracture patients regain their pre-fracture mobility. Mobility recovery is closely linked to health status and quality of life, but there is no comprehensive overview of how gait has been evaluated in intervention studies on hip fracture patients. The purpose was to identify what gait parameters have been used in randomized controlled trials to assess intervention effects on older people's mobility recovery after hip fracture. This scoping review is a secondary paper that identified relevant peer-reviewed and grey literature from 11 databases. After abstract and full-text screening, 24 papers from the original review and 8 from an updated search and manual screening were included. Records were eligible if they included gait parameters in RCTs on hip fracture patients. We included 32 papers from 29 trials (2754 unique participants). Gait parameters were primary endpoint in six studies only. Gait was predominantly evaluated as short walking, with gait speed being most frequently studied. Only five studies reported gait parameters from wearable sensors. Evidence on mobility improvement after interventions in hip fracture patients is largely limited to gait speed as assessed in a controlled setting. The transition from traditional clinical and in-lab to out-of-lab gait assessment is needed to assess effects of interventions on mobility recovery after hip fracture at higher granularity in all aspects of patients' lives, so that optimal care pathways can be defined.
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Affiliation(s)
- K Taraldsen
- Department of Rehabilitation Science and Health Technology, OsloMet, Oslo, Norway.
| | - A Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - M Engdal
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | - C-P Jansen
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - C Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - N Brenner
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - H Blain
- Department of Geriatrics, Montpellier University Hospital and Montpellier University MUSE, Montpellier, France
| | - L G Johnsen
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
- Department of Orthopaedic Surgery, St. Olav's Hospital HF, Trondheim, Norway
| | - B Vereijken
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
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Wisborg T, Dehli T, Eken T, Brattebø G, Johnsen LG. Forskjeller i mortalitet hos traumepasienter. Tidsskr Nor Laegeforen 2023; 143:23-0410. [PMID: 37668135 DOI: 10.4045/tidsskr.23.0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
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Dehli T, Wisborg T, Johnsen LG, Brattebø G, Eken T. Mortality after hospital admission for trauma in Norway: A retrospective observational national cohort study. Injury 2023; 54:110852. [PMID: 37302870 DOI: 10.1016/j.injury.2023.110852] [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: 12/13/2022] [Revised: 05/07/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND National quality data for trauma care in Norway have not previously been reported. We have therefore assessed crude and risk-adjusted 30-day mortality in trauma cases after primary hospital admission on national and regional levels for 36 acute care hospitals and four regional trauma centres. METHODS All patients in the Norwegian Trauma Registry in 2015-2018 were included. Crude and risk-adjusted 30-day mortality was assessed for the total cohort and for severe injuries (Injury Severity Score ≥16), and individual and combined effects of health region, hospital level, and hospital size were studied. RESULTS 28,415 trauma cases were included. Crude mortality was 3.1% for the total cohort and 14.5% for severe injuries, with no statistically significant difference between regions. Risk-adjusted survival was lower in acute care hospitals than in trauma centres (0.48 fewer excess survivors per 100 patients, P<0.0001), amongst severely injured patients in the Northern health region (4.80 fewer excess survivors per 100 patients, P = 0.004), and in hospitals with <100 trauma admissions per year (0.65 fewer excess survivors than in hospitals with ≥100 admissions, P = 0.01). However, the only statistically significant effects in a multivariable logistic case mix-adjusted descriptive model were hospital level and health region. Case-mix adjusted odds ratio for survival for severely injured patients directly admitted to a trauma centre vs. an acute care hospital was 2.04 (95% CI 1.04-4.00, P = 0.04), and if admitted in the Northern health region vs. all other health regions was 0.47 (95% CI 0.27-0.84, P = 0.01). The proportion of cases admitted directly to the regional trauma centre in the sparsely populated Northern health region was half of that in the other regions (18.4% vs. 37.6%, P<0.0001). CONCLUSION Differences in risk-adjusted survival for severe injuries can to a large extent be attributed to whether patients are directly admitted to a trauma centre. This should have implications for planning of transport capacity in remote areas.
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Affiliation(s)
- T Dehli
- Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute for Clinical Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.
| | - T Wisborg
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Interprofessional Rural Research Team - Finnmark, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway; Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway
| | - L G Johnsen
- St. Olav's University Hospital, Department of Orthopaedic Trauma, Trondheim, Norway; Norwegian University of Science and Technology (NTNU), Department of Neuromedicine and Movement Science (INB), Trondheim, Norway
| | - G Brattebø
- Norwegian National Advisory Unit on Emergency Medical Communication, Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - T Eken
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Anaesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
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Dakhil S, Saltvedt I, Benth JŠ, Thingstad P, Watne LO, Bruun Wyller T, Helbostad JL, Frihagen F, Johnsen LG, Taraldsen K. Longitudinal trajectories of functional recovery after hip fracture. PLoS One 2023; 18:e0283551. [PMID: 36989248 PMCID: PMC10057789 DOI: 10.1371/journal.pone.0283551] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND There is limited evidence regarding predictors of functional trajectories after hip fracture. We aimed to identify groups with different trajectories of functional recovery the first year after hip fracture, and to determine predictors for belonging to such groups. METHODS This longitudinal study combined data from two large randomized controlled trials including patients with hip fracture. Participants were assessed at baseline, four and 12 months. We used the Nottingham Extended Activities of Daily Living (NEADL) as a measure of instrumental ADL (iADL) and Barthel Index for personal ADL (pADL). A growth mixture model was estimated to identify groups of patients following distinct trajectories of functioning. Baseline characteristics potentially predicting group-belonging were assessed by multiple nominal regression. RESULTS Among 726 participants (mean age 83.0; 74.7% women), we identified four groups of patients following distinct ADL trajectories. None of the groups regained their pre-fracture ADL. For one of the groups identified in both ADL outcomes, a steep decline in function was shown the first four months after surgery, and none of the groups showed functional recovery between four and 12 months after surgery. CONCLUSIONS No groups regained their pre-fracture ADL. Some of the patients with relatively high pre-fracture function, had a steep ADL decline. For this group there is a potential for recovery, but more knowledge and research is needed in this group. These findings could be useful in uncovering groups of patients with different functioning after a hip fracture, and aid in discharge planning.
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Affiliation(s)
- Shams Dakhil
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Saltvedt
- Department of Geriatric Medicine, St. Olav University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Leiv Otto Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Torgeir Bruun Wyller
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Frede Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Lars Gunnar Johnsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Orthopedic Trauma Unit, Department of Orthopedic Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, OsloMet, Oslo Metropolitan University, Oslo, Norway
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Garratt AM, Furunes H, Hellum C, Solberg T, Brox JI, Storheim K, Johnsen LG. Evaluation of the EQ-5D-3L and 5L versions in low back pain patients. Health Qual Life Outcomes 2021; 19:155. [PMID: 34049574 PMCID: PMC8160396 DOI: 10.1186/s12955-021-01792-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 01/19/2021] [Accepted: 05/19/2021] [Indexed: 12/16/2022] Open
Abstract
Background The EuroQol EQ-5D is one of the most widely researched and applied patient-reported outcome measures worldwide. The original EQ-5D-3L and more recent EQ-5D-5L include three and five response categories respectively. Evidence from healthy and sick populations shows that the additional two response categories improve measurement properties but there has not been a concurrent comparison of the two versions in patients with low back pain (LBP). Methods LBP patients taking part in a multicenter randomized controlled trial of lumbar total disc replacement and conservative treatment completed the EQ-5D-3L and 5L in an eight-year follow-up questionnaire. The 3L and 5L were assessed for aspects of data quality including missing data, floor and ceiling effects, response consistency, and based on a priori hypotheses, associations with the Oswestry Disability Index (ODI), Pain-Visual Analogue Scales and Hopkins Symptom Checklist (HSCL-25). Results At the eight-year follow-up, 151 (87%) patients were available and 146 completed both the 3L and 5L. Levels of missing data were the same for the two versions. Compared to the EQ-5D-5L, the 3L had significantly higher floor (pain discomfort) and ceiling effects (mobility, self-care, pain/discomfort, anxiety/depression). For these patients the EQ-5D-5L described 73 health states compared to 28 for the 3L. Shannon’s indices showed the 5L outperformed the 3L in tests of classification efficiency. Correlations with the ODI, Pain-VAS and HSCL-25 were largely as hypothesized, the 5L having slightly higher correlations than the 3L. Conclusion The EQ-5D assesses important aspect of health in LBP patients and the 5L improves upon the 3L in this respect. The EQ-5D-5L is recommended in preference to the 3L version, however, further testing in other back pain populations together with additional measurement properties, including responsiveness to change, is recommended. Trial registration: retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677.
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Affiliation(s)
- A M Garratt
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - H Furunes
- Department of Surgery, Innlandet Hospital Gjøvik, Gjøvik, Norway.,University of Oslo, Oslo, Norway
| | - C Hellum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - T Solberg
- Department of Neurosurgery and The Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway.,Institute for Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - J I Brox
- University of Oslo, Oslo, Norway.,Department for Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - K Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway.,Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - L G Johnsen
- Department of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway
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Dakhil S, Thingstad P, Frihagen F, Johnsen LG, Lydersen S, Skovlund E, Wyller TB, Sletvold O, Saltvedt I, Watne LO. Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials. BMC Geriatr 2021; 21:208. [PMID: 33765935 PMCID: PMC7992808 DOI: 10.1186/s12877-021-02152-7] [Citation(s) in RCA: 3] [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: 09/03/2020] [Accepted: 03/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL). Methods This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery. Results Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points. Conclusions Merged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.
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Affiliation(s)
- Shams Dakhil
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Frede Frihagen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lars Gunnar Johnsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Orthopedic Trauma Unit, Department of Orthopedic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Stian Lydersen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Sletvold
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Leiv Otto Watne
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Abstract
AIMS Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients. METHODS This study investigated time to surgery and 60-day post-admission death of patients 70 years and older admitted for acute hip fracture surgery in Norway between 2008 and 2016. The proportion of hospital capacity being occupied by newly admitted surgical patients was used as the exposure. Hip fracture patients admitted during periods of high proportion of recent admissions were compared with hip fracture patients admitted at the same hospital during the same month, on similar weekdays, and times of the day with fewer admissions. RESULTS Among 60,072 patients, mean age was 84.6 years (SD 6.8), 78% were females, and median time to surgery was 20 hours (IQR 11 to 29). Overall, 14% (8,464) were dead 60 days after admission. A high (75th percentile) proportion of recent surgical admission compared to a low (25th percentile) proportion resulted in 20% longer time to surgery (95% confidence interval (CI) 16 to 25) and 20% higher 60-day mortality (hazard ratio 1.2, 95% CI 1.1 to 1.4). CONCLUSION A high volume of recently admitted acute surgical patients, indicating probable competition for surgical resources, was associated with delayed surgery and increased 60-day mortality. Cite this article: Bone Joint J 2021;103-B(2):264-270.
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Affiliation(s)
- Sara Marie Nilsen
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Andreas Asheim
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Fredrik Carlsen
- Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjartan Sarheim Anthun
- Department of Health Research, SINTEF Digital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Gunnar Johnsen
- Department of Orthopaedic Surgery, St. Olav's Hospital HF, Trondheim, Norway.,Department of Neuromedicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Johan Vatten
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Naess HL, Vikane E, Wehling EI, Skouen JS, Bell RF, Johnsen LG. Effect of Early Interdisciplinary Rehabilitation for Trauma Patients: A Systematic Review. Arch Rehabil Res Clin Transl 2020; 2:100070. [PMID: 33543097 PMCID: PMC7853396 DOI: 10.1016/j.arrct.2020.100070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective To perform a systematic review to assess the current scientific evidence concerning the effect of EIR for trauma patients with or without an associated traumatic brain injury. Data Source We performed a systematic search of several electronic (Ovid MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, and SveMed+) and 2 clinical trial registers (clinicaltrials.gov and International Clinical Trials Registry Platform). In addition, we handsearched reference lists from relevant studies. Data Extraction Two review authors independently identified studies that were eligible for inclusion. The primary outcome measures were functional-related outcomes and return to work. The secondary outcome measures were length of stay in hospital, number of days on respirator, complication rate, physical and mental health measures, quality of life, and socioeconomic costs. Data Synthesis Four studies with a total number of 409 subjects, all with traumatic brain–associated injuries, were included in this review. The included trials varied considerably in study design, inclusion and exclusion criteria, and had small numbers of participants. All studies were judged to have at least 1 high risk of bias. We found the quality of evidence, for both our primary and secondary outcomes, low. Conclusions No studies that matched our inclusion criteria for EIR for trauma patients without traumatic brain injuries could be found. For traumatic brain injuries, there are a limited number of studies demonstrating that EIR has a positive effect on functional outcomes and socioeconomic costs. This review highlights the need for further research in trauma care regarding early phase interdisciplinary rehabilitation.
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Affiliation(s)
- Hanne Langseth Naess
- Regional Trauma Center, Haukeland University Hospital, Bergen, Norway.,Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Eirik Vikane
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Eike Ines Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.,Department of Biological and Medicine Psychology, University of Bergen, Bergen, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rae Frances Bell
- Regional Centre of Excellence in Palliative Care, Haukeland University Hospital, Bergen, Norway
| | - Lars Gunnar Johnsen
- Department of Neuromedicine and Movement Science, University of Trondheim, Trondheim, Norway.,Norwegian National Advisory Unit on Trauma, Oslo, Norway
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Nilsen SM, Bjørngaard JH, Carlsen F, Anthun KS, Johnsen LG, Vatten LJ, Asheim A. Hospitals´ Discharge Tendency and Risk of Death - An Analysis of 60,000 Norwegian Hip Fracture Patients. Clin Epidemiol 2020; 12:173-182. [PMID: 32110108 PMCID: PMC7036694 DOI: 10.2147/clep.s237060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose A reduction in the length of hospital stay may threaten patient safety. This study aimed to estimate the effect of organizational pressure to discharge on 60-day mortality among hip fracture patients. Patients and Methods In this cohort study, hip fracture patients were analyzed as if they were enrolled in a sequence of trials for discharge. A hospital’s discharge tendency was defined as the proportion of patients with other acute conditions who were discharged on a given day. Because the hospital’s tendency to discharge would affect hip fracture patients in an essentially random manner, this exposure could be regarded as analogous to being randomized to treatment in a clinical trial. The study population consisted of 59,971 Norwegian patients with hip fractures, hospitalized between 2008 and 2016, aged 70 years and older. To calculate the hospital discharge tendency for a given day, we used data from all 5,013,773 other acute hospitalizations in the study period. Results The probability of discharge among hip fracture patients increased by 5.5 percentage points (95% confidence interval (CI)=5.3–5.7) per 10 percentage points increase in hospital discharges of patients with other acute conditions. The increased risk of death that could be attributed to a discharge from organizational causes was estimated to 3.7 percentage points (95% CI=1.4–6.0). The results remained stable under different time adjustments, follow-up periods, and age cut-offs. Conclusion This study showed that discharges from organizational causes may increase the risk of death among hip fracture patients.
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Affiliation(s)
- Sara Marie Nilsen
- Center for Health Care Improvement, Trondheim University Hospital, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Fredrik Carlsen
- Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjartan Sarheim Anthun
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Lars Gunnar Johnsen
- Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Johan Vatten
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Asheim
- Center for Health Care Improvement, Trondheim University Hospital, Trondheim, Norway.,Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Asheim A, Marie Nilsen S, Toch-Marquardt M, Sarheim Anthun K, Gunnar Johnsen L, Bjårngaard JH. Time of admission and mortality after hip fracture: a detailed look at the weekend effect in a nationwide study of 55,211 hip fracture patients in Norway. Acta Orthop 2018; 89:610-614. [PMID: 30398406 PMCID: PMC6319186 DOI: 10.1080/17453674.2018.1533769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 02/08/2023] Open
Abstract
Background and purpose - There are numerous studies on the weekend effect for hip fracture patients, with conflicting results. We analyzed time of admission and discharge, and the association with mortality and length of hospital stay in more detail. Patients and methods - We used data from 61,211 surgically treated hip fractures in 55,211 patients, admitted to Norwegian hospitals 2008-2014. All patients were aged 50 years or older. Data were analyzed with Cox and Poisson regression. Results - Mortality within 30 days did not differ substantially by day of admission, although admissions on Sundays and holidays had a slightly increased mortality. The hazard ratios were 1.1 (95% confidence interval [CI] 0.97-1.2) for Sundays, and 1.2 (CI 0.98-1.4) for holidays, relative to Mondays. For patients admitted between 6:00 am and 7:00 am the hazard ratio was 1.4 (CI 1.1-1.8) relative to patients admitted between 2:00 pm and 3:00 pm. Discharges during weekends and holidays were associated with a substantial higher mortality than weekday discharges. Patients admitted from Friday to Sunday generally stayed in hospital for a shorter time than patients admitted during other days. Interpretation - Our results indicate that the discussion on weekday versus weekend admission effects might have distracted attention from other important factors, such as time of day of admission, and day of discharge from hospital treatment.
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Affiliation(s)
- Andreas Asheim
- Center for Health Care Improvement, St Olav’s HospitalS, Trondheim, Norway;; ,Norwegian University of Science and Technology, Department of Mathematical Sciences, Trondheim, Norway;;
| | - Sara Marie Nilsen
- Center for Health Care Improvement, St Olav’s HospitalS, Trondheim, Norway;;
| | - Marlen Toch-Marquardt
- Norwegian University of Science and Technology, Department of Public Health and Nursing, Trondheim, Norway;;
| | - Kjartan Sarheim Anthun
- Norwegian University of Science and Technology, Department of Public Health and Nursing, Trondheim, Norway;; ,Department of Health Research, SINTEF Digital, Trondheim, Norway;
| | - Lars Gunnar Johnsen
- Department of Orthopaedic Surgery, St Olav’s Hospital, Trondheim, Norway;; ,Norwegian University of Science and Technology, Department of Neuromedicine, Trondheim, Norway
| | - Johan Håkon Bjårngaard
- Norwegian University of Science and Technology, Department of Public Health and Nursing, Trondheim, Norway;; ,Correspondence:
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Sales C, Portolés T, Johnsen LG, Danielsen M, Beltran J. Olive oil quality classification and measurement of its organoleptic attributes by untargeted GC-MS and multivariate statistical-based approach. Food Chem 2018; 271:488-496. [PMID: 30236707 DOI: 10.1016/j.foodchem.2018.07.200] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 02/03/2023]
Abstract
The capabilities of dynamic headspace entrainment followed by thermal desorption in combination with gas chromatography (GC) coupled to single quadrupole mass spectrometry (MS) have been tested for the determination of volatile components of olive oil. This technique has shown a great potential for olive oil quality classification by using an untargeted approach. The data processing strategy consisted of three different steps: component detection from GC-MS data using novel data treatment software PARADISe, a multivariate analysis using EZ-Info, and the creation of the statistical models. The great number of compounds determined enabled not only the development of a quality classification method as a complementary tool to the official established method "PANEL TEST" but also a correlation between these compounds and different types of defect. Classification method was finally validated using blind samples. An accuracy of 85% in oil classification was obtained, with 100% of extra virgin samples correctly classified.
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Affiliation(s)
- C Sales
- Research Institute for Pesticides and Water (IUPA), University Jaume I, Avda. Sos Baynat, E-12071 Castellón, Spain
| | - T Portolés
- Research Institute for Pesticides and Water (IUPA), University Jaume I, Avda. Sos Baynat, E-12071 Castellón, Spain.
| | | | | | - J Beltran
- Research Institute for Pesticides and Water (IUPA), University Jaume I, Avda. Sos Baynat, E-12071 Castellón, Spain
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Furunes H, Storheim K, Brox JI, Johnsen LG, Skouen JS, Franssen E, Solberg TK, Sandvik L, Hellum C. Total disc replacement versus multidisciplinary rehabilitation in patients with chronic low back pain and degenerative discs: 8-year follow-up of a randomized controlled multicenter trial. Spine J 2017; 17:1480-1488. [PMID: 28583869 DOI: 10.1016/j.spinee.2017.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/14/2017] [Revised: 04/01/2017] [Accepted: 05/08/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar total disc replacement (TDR) is a treatment option for selected patients with chronic low back pain (LBP) that is non-responsive to conservative treatment. The long-term results of disc replacement compared with multidisciplinary rehabilitation (MDR) have not been reported previously. PURPOSE We aimed to assess the long-term relative efficacy of lumbar TDR compared with MDR. DESIGN We undertook a multicenter randomized controlled trial at five university hospitals in Norway. PATIENT SAMPLE The sample consisted of 173 patients aged 25-55 years with chronic LBP and localized degenerative changes in the lumbar intervertebral discs. OUTCOME MEASURES The primary outcome was self-reported physical function (Oswestry Disability Index [ODI]) at 8-year follow-up in the intention-to-treat population. Secondary outcomes included self-reported LBP (visual analogue scale [VAS]), quality of life (EuroQol [EQ-5D]), emotional distress (Hopkins Symptom Checklist [HSCL-25]), occupational status, patient satisfaction, drug use, complications, and additional back surgery. METHODS Patients were randomly assigned to lumbar TDR or MDR. Self-reported outcome measures were collected 8 years after treatment. The study was powered to detect a difference of 10 ODI points between the groups. The study has not been funded by the industry. RESULTS A total of 605 patients were screened for eligibility, of whom 173 were randomly assigned treatment. Seventy-seven patients (90%) randomized to surgery and 74 patients (85%) randomized to rehabilitation responded at 8-year follow-up. Mean improvement in the ODI was 20.0 points (95% confidence interval [CI] 16.4-23.6, p≤.0001) in the surgery group and 14.4 points (95% CI 10.7-18.1, p≤.0001) in the rehabilitation group. Mean difference between the groups at 8-year follow-up was 6.1 points (95% CI 1.2-11.0, p=.02). Mean difference in favor of surgery on secondary outcomes were 9.9 points on VAS (95% CI 0.6-19.2, p=.04) and 0.16 points on HSCL-25 (95% CI 0.01-0.32, p=.04). There were 18 patients (24%) in the surgery group and 4 patients (6%) in the rehabilitation group who reported full recovery (p=.002). There were no significant differences between the groups in EQ-5D, occupational status, satisfaction with care, or drug use. In the per protocol analysis, the mean difference between groups was 8.1 ODI points (95% CI 2.3-13.9, p=.01) in favor of surgery. Forty-three of 61 patients (70%) in the surgery group and 26 of 52 patients (50%) in the rehabilitation group had a clinically important improvement (15 ODI points or more) from baseline (p=.03). The proportion of patients with a clinically important deterioration (six ODI points or more) was not significantly different between the groups. Twenty-one patients (24%) randomized to rehabilitation had crossed over and had undergone back surgery since inclusion, whereas 12 patients (14%) randomized to surgery had undergone additional back surgery. One serious adverse event after disc replacement is registered (<1%). CONCLUSIONS Substantial long-term improvement can be expected after both disc replacement and MDR. The difference between groups is statistically significant in favor of surgery, but smaller than the prespecified clinically important difference of 10 ODI points that the study was designed to detect. Future research should aim to improve selection criteria for disc replacement and MDR.
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Affiliation(s)
- Håvard Furunes
- Innlandet Hospital Gjøvik, Department of Surgery, Innlandet Hospital Gjøvik, Kyrre Grepps gate 11, 2819 Gjøvik, Norway; University of Oslo, Postbox 1072 Blindern, 0316 Oslo, Norway; Oslo University Hospital Ullevål, FORMI, Building 37B, Postbox 4950 Nydalen, 0424 Oslo, Norway.
| | - Kjersti Storheim
- University of Oslo, Postbox 1072 Blindern, 0316 Oslo, Norway; Oslo University Hospital Ullevål, FORMI, Building 37B, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Jens Ivar Brox
- University of Oslo, Postbox 1072 Blindern, 0316 Oslo, Norway; Department for Physical Medicine and Rehabilitation, Oslo University Hospital, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Lars Gunnar Johnsen
- Department of Orthopaedic Surgery, St. Olav's University Hospital, Prinsesse Kristinas gate 3, 7030 Trondheim, Norway; Department of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, Høgskoleringen 1, 7491 Trondheim, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, The Outpatient Spine Clinic, Haukeland University Hospital, Postbox 1400, 5021 Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5007 Bergen, Norway
| | - Eric Franssen
- Orthopaedic Department, Stavanger University Hospital, Gerd Ragna Bloch Thorsens gate, 4011 Stavanger, Norway
| | - Tore K Solberg
- Department of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Hansine Hansens veg 18, 9019 Tromsø, Norway; The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, University Hospital of Northern Norway, Sykehusvegen 38, 9019 Tromsø, Norway; Department of Neurosurgery, University Hospital of Northern Norway, Sykehusvegen 38, 9019 Tromsø, Norway
| | - Leiv Sandvik
- University of Oslo, Postbox 1072 Blindern, 0316 Oslo, Norway
| | - Christian Hellum
- University of Oslo, Postbox 1072 Blindern, 0316 Oslo, Norway; Division of Orthopaedic Surgery, Oslo University Hospital, Postbox 4950 Nydalen, 0424 Oslo, Norway
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Gjerde AM, Aa E, Sund JK, Stenumgard P, Johnsen LG. Medication reconciliation of patients with hip fracture by clinical pharmacists. Eur J Hosp Pharm 2015; 23:166-170. [PMID: 31156840 DOI: 10.1136/ejhpharm-2015-000741] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/29/2015] [Revised: 10/07/2015] [Accepted: 10/12/2015] [Indexed: 11/04/2022] Open
Abstract
Objective Medication reconciliation is a strategy for reducing medication discrepancies and improving patient safety. Transitions through different levels of care contribute to medication discrepancies caused by lack of communication. In October 2011, St Olav's Hospital initiated a fast-track model for patients with hip fractures, where clinical pharmacists (CPs) are a part of a multidisciplinary team. The purpose of this study was to examine discrepancies discovered in medication lists by CPs at the orthopaedic ward and consider their clinical relevance. Method This prospective study was conducted at an orthopaedic ward at St Olav's Hospital in the period October 2011-August 2012. Medication reconciliation by CPs was done for all patients with a hip fracture using a systematic method. Information was obtained by the CP by interview with the patient and additional sources, for example, medication list from general practitioner and nursing home. An independent expert group consisting of a geriatrician, an orthopaedist and a CP considered level of clinical relevance of the discrepancies found in the collected data. Results A total of 410 discrepancies were registered for all 317 patients, Discrepancies were found in 159 (50%) patients with an average of 2.6 per patient affected. Of the total amount of discrepancies, the expert group evaluated 68% and 19% as potentially moderate and severe, respectively, if they were unattended during hospitalisation and after discharge. Conclusions By using CPs in medication reconciliation at orthopaedic wards, discrepancies that can lead to serious discomfort or clinical deterioration of patients can be avoided.
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Affiliation(s)
| | | | - Janne Kutschera Sund
- Central Norway Hospital Pharmacy Trust, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pal Stenumgard
- Department of Geriatrics, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Lars Gunnar Johnsen
- Department of Orthopaedic Surgery, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway.,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
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Johnsen LG, Watne LO, Frihagen F, Helbostad JL, Prestmo A, Saltvedt I, Sletvold O, Wyller TB. Hvorfor ortogeriatri? Tidsskriftet 2015; 135:523-4. [DOI: 10.4045/tidsskr.15.0188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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15
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Lønne G, Ødegård B, Johnsen LG, Solberg TK, Kvistad KA, Nygaard ØP. MRI evaluation of lumbar spinal stenosis: is a rapid visual assessment as good as area measurement? Eur Spine J 2014; 23:1320-4. [PMID: 24573778 DOI: 10.1007/s00586-014-3248-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/13/2014] [Accepted: 02/16/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) is commonly assessed on MRI by measuring dural sac cross-sectional area (DSCA). A new method, morphological grading A-D, has recently been introduced as an alternative method. OBJECTIVE The aim of this study is to compare these two different methods for assessing LSS on MRI and study their reliability and intercorrelation. METHODS On pretreatment MRI of 84 patients, two experienced radiologists independently classified level L2/L3, L3/L4 and L4/L5 as no, relative or significant stenosis using both methods. Agreement was analyzed by weighted Kappa. The correlation between the two methods was analysed using Spearman correlation, and visualized in a box plot. RESULTS The interobserver agreement (95 % CI) was 0.69 (0.61-0.77) and 0.65 (0.56-0.74), respectively. The intraobserver agreements for DSCA were 0.77 (0.60-0.74) and 0.80 (0.66-0.93). On morphological grading A-D it was 0.78 (0.65-0.92) and 0.81 (0.68-0.94). The correlation coefficient between the two methods was 0.85 (p < 0.001). Grades C and D were under the limit value for significant stenosis using the DSCA. CONCLUSIONS The study shows that the inter- and intraobserver agreements of DSCA and morphological grading A-D were acceptable and their intercorrelation is strong. Both methods may be used in the MRI evaluation of LSS.
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Affiliation(s)
- Greger Lønne
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Anders Sandvigsgt 17, 2609, Lillehammer, Norway,
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16
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Johnsen LG. Kirurgi med skiveprotese i ryggen eller tverrfaglig rehabilitering? Tidsskriftet 2014. [DOI: 10.4045/tidsskr.14.0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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17
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Solberg T, Johnsen LG, Nygaard ØP, Grotle M. Can we define success criteria for lumbar disc surgery? : estimates for a substantial amount of improvement in core outcome measures. Acta Orthop 2013; 84:196-201. [PMID: 23506164 PMCID: PMC3639342 DOI: 10.3109/17453674.2013.786634] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [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: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE A successful outcome after lumbar discectomy indicates a substantial improvement. To use the cutoffs for minimal clinically important difference (MCID) as success criteria has a large potential bias, simply because it is difficult to classify patients who report that they are "moderately improved". We propose that the criteria for success should be defined by those who report that they are "completely recovered" or "much better". METHODS A cohort of 692 patients were operated for lumbar disc herniation and followed for one year in the Norwegian Registry for Spine Surgery. The global perceived scale of change was used as an external criterion, and success was defined as those who reported that they were "completely recovered" or "much better". Criteria for success for each of (1) the Oswestry disability index (ODI; score range 0-100 where 0 = no disability), (2) the numerical pain scale (NRS; range 0-10 where 0 = no pain) for back and leg pain, and (3) the Euroqol (EQ-5D; -0.6 to 1 where 1 = perfect health) were estimated by defining the optimal cutoff point on receiver operating characteristic curves. RESULTS The cutoff values for success for the mean change scores were 20 (ODI), 2.5 (NRS back), 3.5 (NRS leg), and 0.30 (EQ-5D). According to the cutoff estimates, the proportions of successful outcomes were 66% for the ODI and 67% for the NRS leg pain scale. INTERPRETATION The sensitivity/specificity values for the ODI and leg pain were acceptable, whereas they were very low for the EQ-5D. The cutoffs for success can be used as benchmarks when comparing data from different surgical units.
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Affiliation(s)
- Tore Solberg
- Department of Neurosurgery, University Hospital of Northern Norway (UNN),The Norwegian Registry for Spine Surgery (NORspine), Centre of Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø
| | - Lars Gunnar Johnsen
- National Centre for Spinal Disorders, University Hospital of St. Olav, Trondheim,Faculty of Medicine, Norwegian University of Technology and Science (NTNU), Trondheim
| | - Øystein P Nygaard
- The Norwegian Registry for Spine Surgery (NORspine), Centre of Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø,National Centre for Spinal Disorders, University Hospital of St. Olav, Trondheim,Faculty of Medicine, Norwegian University of Technology and Science (NTNU), Trondheim
| | - Margreth Grotle
- FORMI, Communication Unit for Musculoskeletal Disorders, Oslo University Hospital, Ullevaal,Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
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Saltvedt I, Prestmo A, Einarsen E, Johnsen LG, Helbostad JL, Sletvold O. Development and delivery of patient treatment in the Trondheim Hip Fracture Trial. A new geriatric in-hospital pathway for elderly patients with hip fracture. BMC Res Notes 2012; 5:355. [PMID: 22800378 PMCID: PMC3463430 DOI: 10.1186/1756-0500-5-355] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/27/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip fractures are common among frail elderly persons and often have serious consequences on function, mobility and mortality. Traditional treatment of these patients is performed in orthopedic departments without additional geriatric assessment. However, studies have shown that interdisciplinary geriatric treatment may be beneficial compared to traditional treatment. The aim of the present study is to investigate whether treatment of these patients in a Department of Geriatrics (DG) during the entire hospital stay gives additional benefits as compared to conventional treatment in a Department of Orthopaedic Surgery (DOS). FINDINGS A new clinical pathway for in-hospital treatment of hip fracture patients was developed. In this pathway patients were treated pre-and postoperatively in DG. Comprehensive geriatric assessment was performed as an interdisciplinary, multidimensional, systematic assessment of all patients focusing on each patient's capabilities and limitations as recommended in guidelines and systematic reviews. Identification and treatment of co-morbidities, pain relief, hydration, oxygenation, nutrition, elimination, prevention and management of delirium, assessment of falls and osteoporosis were emphasized. Discharge planning started as early as possible. Initiation of rehabilitation with focus on early mobilisation and development of individual plans was initiated in hospital and continued after discharge from hospital. Fracture specific treatment was based upon standard treatment for the hospital, expert opinions and a review of the literature. CONCLUSION A new treatment program for old hip fracture patients was developed, introduced and run in the DG, the potential benefits of which being compared with traditional care of hip fracture patients in the DOS in a randomised clinical trial.
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Affiliation(s)
- Ingvild Saltvedt
- Department of Geriatrics, St, Olav Hospital, University Hospital of Trondheim, Trondheim, Norway.
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Hellum C, Johnsen LG, Gjertsen Ø, Berg L, Neckelmann G, Grundnes O, Rossvoll I, Skouen JS, Brox JI, Storheim K. Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up. Eur Spine J 2012; 21:681-90. [PMID: 22246644 DOI: 10.1007/s00586-011-2145-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 12/15/2011] [Accepted: 12/31/2011] [Indexed: 01/24/2023]
Abstract
PURPOSE A prospective study to evaluate whether certain baseline characteristics can predict outcome in patients treated with disc prosthesis or multidisciplinary rehabilitation. METHODS Secondary analysis of 154 patients with chronic low back pain (LBP) for at least 1 year and degenerative discs originally recruited for a randomized trial. Outcome measures were Oswestry Disability Index (ODI) dichotomized to < or ≥15 points improvement and whether subjects were working at 2-year follow-up. A multiple logistic regression analysis was used. RESULTS In patients treated with disc prosthesis, long duration of LBP and high Fear-Avoidance Beliefs for work (FABQ-W) predicted worse ODI outcome [odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.2-3.2 and OR = 1.7, CI 1.2-2.4 for every 5 years or 5 points]. Modic type I or II predicted better ODI outcome (OR = 5.3, CI 1.1-25.3). In patients treated with rehabilitation, a high ODI, low emotional distress (HSCL-25), and no daily narcotics predicted better outcome for ODI (OR = 2.5, CI 1.4-4.5 for every 5 ODI points, OR = 2.1, CI 1.1-5.1 for every 0.5 HSCL points and OR = 23.6, CI 2.1-266.8 for no daily narcotics). Low FABQ-W and working at baseline predicted working at 2-year follow-up after both treatments (OR = 1.3, CI 1.0-1.5 for every 5 points and OR = 4.1, CI 1.2-13.2, respectively). CONCLUSIONS Shorter duration of LBP, Modic type I or II changes and low FABQ-W were the best predictors of success after treatment with disc prosthesis, while high ODI, low distress and not using narcotics daily predicted better outcome of rehabilitation. Low FABQ-W and working predicted working at follow-up.
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Affiliation(s)
- Christian Hellum
- Department of Orthopaedics, Oslo University Hospital, University of Oslo, Kirkevn 166, 0407, Oslo, Norway.
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Hellum C, Johnsen LG, Storheim K, Nygaard OP, Brox JI, Rossvoll I, Rø M, Sandvik L, Grundnes O. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study. BMJ 2011; 342:d2786. [PMID: 21596740 PMCID: PMC3100911 DOI: 10.1136/bmj.d2786] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare the efficacy of surgery with disc prosthesis versus non-surgical treatment for patients with chronic low back pain. DESIGN A prospective randomised multicentre study. SETTING Five university hospitals in Norway. PARTICIPANTS 173 patients with a history of low back pain for at least one year, Oswestry disability index of at least 30 points, and degenerative changes in one or two lower lumbar spine levels (86 patients randomised to surgery). Patients were treated from April 2004 to September 2007. INTERVENTIONS Surgery with disc prosthesis or outpatient multidisciplinary rehabilitation for 12-15 days. MAIN OUTCOME MEASURES The primary outcome measure was the score on the Oswestry disability index after two years. Secondary outcome measures were low back pain, satisfaction with life (SF-36 and EuroQol EQ-5D), Hopkins symptom check list (HSCL-25), fear avoidance beliefs (FABQ), self efficacy beliefs for pain, work status, and patients' satisfaction and drug use. A blinded independent observer evaluated scores on the back performance scale and Prolo scale at two year follow-up. RESULTS The study was powered to detect a difference of 10 points on the Oswestry disability index between the groups at two years. At two years there was a mean difference of -8.4 points (95% confidence interval -13.2 to -3.6) in favour of surgery. In the analysis of prespecified secondary outcomes, there were significant differences in favour of surgery for low back pain (mean difference -12.2, -21.3 to -3.1), patients' satisfaction (63% (n = 46) v 39% (n = 26)), SF-36 physical component score (mean difference 5.8, 2.5 to 9.1), self efficacy for pain (mean difference 1.0, 0.2 to 1.9), and the Prolo scale (mean difference 0.9, 0.1 to 1.6). There were no significant differences in return to work, SF-36 mental component score, EQ-5D, fear avoidance beliefs, Hopkins symptom check list, drug use, and the back performance scale. One serious complication of leg amputation occurred during surgical revision of a polyethylene dislodgement. The drop-out rate was 20% (34) and the crossover rate was 6% (5). CONCLUSIONS Surgical intervention with disc prosthesis for chronic low back pain resulted in a significantly greater improvement in the Oswestry score compared with rehabilitation, but this improvement did not clearly exceed the prespecified minimally important clinical difference between groups of 10 points, and the data are consistent with a wide range of differences between the groups, including values well below 10 points. The potential risks of surgery and the substantial amount of improvement experienced by a sizeable proportion of the rehabilitation group also have to be incorporated into overall decision making. Trial registration NCT 00394732.
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Affiliation(s)
- Christian Hellum
- Department of Orthopaedics, Oslo University Hospital and University of Oslo, Kirkevn 166, 0407 Oslo, Norway.
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Bjerkeset T, Johnsen LG, Kibsgaard L, Fuglesang P. [Surgical treatment of degenerative lumbar diseases]. Tidsskr Nor Laegeforen 2005; 125:1817-9. [PMID: 16012549] [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: 05/03/2023] Open
Abstract
BACKGROUND The diagnosis and treatment of painful degenerative spinal diseases remains controversial in the literature, and surgical treatment differs greatly between centres and surgeons. We have evaluated our results over a nine-year period. MATERIAL AND METHODS 237 patients referred with chronic degenerative spinal diseases could be evaluated, 132 women and 105 men, median age 48 (17 - 85). Median symptom duration was 10 years (1.5 - 50 years). The patient files were retrospectively studied independently by two surgeons. Out of the patients, 83 (35 %) had previously had lumbar spine operations, mainly discectomies. All patients were controlled as outpatients with clinical examination and an X-ray taken of the lower spine columna at least once. The final evaluation of patient satisfaction with the operation, pain and walking and working capacity was based on a questionnaire. RESULTS Out of these patients, 64 were treated with decompression only, 173 had additional posterolateral fusion with bone or instrument. Fusion rate was 90 %, with no significant difference between type of fusion (p = 0.07). After a median observation time of 5.2 years (0.5 - 10.5 years) 75 % of the patients were very satisfied or satisfied with the outcome; 48 % were back at work. Factors significantly related to poor results were little preoperative pain (p < 0.001), previous back operations (p = 0.003) and long preoperative sick leave (p = 0.015). INTERPRETATION Our results are comparable with most published studies. One should be restrictive with surgery on patients with little pain, long sick leave, preoperative inactivity, and previous multiple spinal operations.
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Johnsen LG. [Environmental health protection]. Tidsskr Nor Laegeforen 1994; 114:470-1. [PMID: 8009490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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