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Michelson JD, Bernknopf JW, Charlson MD, Merena SJ, Stone LM. What Is the Efficacy of a Nonoperative Program Including a Specific Stretching Protocol for Flexor Hallucis Longus Tendonitis? Clin Orthop Relat Res 2021; 479:2667-2676. [PMID: 34170867 PMCID: PMC8726539 DOI: 10.1097/corr.0000000000001867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/28/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diagnosis and treatment of tendonitis/entrapment of the flexor hallucis longus (FHL) has been sporadically described in the evidence, primarily in the context of dancers and other athletes. Although various nonspecific nonoperative treatments have been described, it is not clear how often they achieve a satisfactory amount of symptom improvement. QUESTIONS/PURPOSES The present study was designed to address the following questions regarding the nonoperative treatment of FHL tendonitis: (1) In a population of patients where the default management option for FHL tendonitis is a comprehensive nonsurgical approach, what proportion of patients thus treated opted not to have surgery? (2) What factors were associated with a patient's decision to undergo surgery after a period of nonsurgical management? METHODS The 656 patients included were all those diagnosed with FHL tendonitis who were initially treated nonoperatively in the foot and ankle division between January 2009 and December 2018. Demographics, comorbidities, examination findings, imaging results, pain scores, treatment instituted, and final outcome were obtained from the electronic medical record. The primary outcome was the decision to have surgery due to unsatisfactory symptom improvement. We compared patients who opted for surgery with those who did not after nonoperative treatment with univariable and multivariable statistics using demographics, comorbidities, and clinical findings as potential risk factors, with p < 0.05. RESULTS Forty-four percent (180 of 409) of patients decided to forgo surgery after the institution of a specific FHL stretching program. Surgery was more likely in patients with clinical hallux rigidus (OR 2.4 [95% CI 1.16 to 4.97]; p = 0.02) or posteromedial ankle pain (OR 1.78 [95% CI 1.12 to 2.83]; p = 0.01) and less likely in those who completed an FHL stretching program (OR 0.15 [95% CI 0.08 to 0.27]; p < 0.001). CONCLUSION FHL tendonitis is more common than the previous evidence suggests and frequently occurs in nonathletes. Once it was diagnosed by detection of tenderness anywhere along the tendon, most frequently at the fibroosseous tunnel, nonoperative treatment focused on specific FHL stretching and immobilization in more severe cases reduced the symptoms to the extent that 44% of patients decided that surgery was unnecessary. The key to its diagnosis is awareness that this injury is possible because most patients treated in this study had been previously seen by orthopaedic providers who had not appreciated the presence of the condition, leading to a delay in diagnosis and treatment of more than a year in many patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- James D. Michelson
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jacob W. Bernknopf
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mark D. Charlson
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Stephen J. Merena
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Lara M. Stone
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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Affiliation(s)
- Seth S Leopold
- Editor-In-Chief, Clinical Orthopaedics and Related Research® , Philadelphia, PA, USA
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Joseph K, Udogwu UN, Manson TT, Ludwig SC, Banagan KE, Baker M, Yousaf IS, Yousaf O, Demyanovich H, Pollak AN, O'Toole RV, O'Hara NN. Patient Satisfaction After Discharge Is Discordant With Reported Inpatient Experience. Orthopedics 2021; 44:e427-e433. [PMID: 34039209 DOI: 10.3928/01477447-20210415-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patient satisfaction measures are commonly used to evaluate clinical performance. However, research on the correlation between patient satisfaction scores and actual patient experience is limited. This study aimed to determine the concordance between patient satisfaction reported as an inpatient and patient satisfaction reported after discharge. The study enrolled 231 adult orthopedic patients at least 48 hours after admission to an academic hospital. Study participants rated their overall inpatient experience on a scale of 0 to 10, followed by open-ended questions on their hospital experience. Participants were then randomized to a second survey by either phone or mail at 4 to 6 weeks after discharge. Statistical and qualitative techniques were used to assess concordance in satisfaction scores and the agreement and association between patient experiences and patient satisfaction scores. The median overall patient satisfaction scores were 9.5 as inpatients (interquartile range [IQR], 8-10) and 10 at follow-up (IQR, 8-10), with a poor concordance between the inpatient and follow-up satisfaction scores (ρc=0.28). This study raises concerns regarding the validity of patient satisfaction measures to accurately quantify inpatient experience and the limitations related to its modes of administration. The authors observed poor agreement between the reported experience as an inpatient and the recollection of the inpatient experience after discharge. [Orthopedics. 2021;44(3):e427-e433.].
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Pereira D, Lee DH. CORR Synthesis: What Is the Current Understanding of Overlapping Surgery in Orthopaedics, Particularly as it Relates to Patient Outcomes and Perceptions? Clin Orthop Relat Res 2021; 479:1208-1216. [PMID: 33239517 PMCID: PMC8133144 DOI: 10.1097/corr.0000000000001584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/03/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Daniel Pereira
- D. Pereira, D. H. Lee, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- D. H. Lee, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donald H Lee
- D. Pereira, D. H. Lee, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- D. H. Lee, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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O'Hara NN, Kringos DS, Slobogean GP, Degani Y, Klazinga NS. Patients Place More of an Emphasis on Physical Recovery Than Return to Work or Financial Recovery. Clin Orthop Relat Res 2021; 479:1333-1343. [PMID: 33239518 PMCID: PMC8133069 DOI: 10.1097/corr.0000000000001583] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/02/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Value-based healthcare models aim to incentivize healthcare providers to offer interventions that address determinants of health. Understanding patient priorities for physical and socioeconomic recovery after injury can help determine which services and resources are most useful to patients. QUESTIONS/PURPOSES (1) Do trauma patients consistently identify a specific aspect/domain of recovery as being most important at 6 weeks, 6 months, and 12 months after an injury? (2) Does the relative importance of those domains change within the first year after injury? (3) Are differences in priorities greater between patients than for a given patient over time? (4) Are different recovery priorities associated with identifiable biopsychosocial factors? METHODS Between June 2018 and December 2018, 504 adult patients with fractures of the extremities or pelvis were surgically treated at the study site. For this prospective longitudinal study, we purposefully sampled patients from 6 of the 12 orthopaedic attendings' postoperative clinics. The participating surgeons surgically treated 243 adult patients with fractures of the extremities or pelvis. Five percent (11 of 243) of patients met inclusion criteria but missed their appointments during the 6-week recruitment window and could not be consented. We excluded 4% (9 of 243) of patients with a traumatic brain injury, 1% (2) of patients with a spinal cord injury, and 5% (12) of non-English-speaking patients (4% Spanish speaking [10]; 1% other languages [2]). Eighty-six percent of eligible patients (209 of 243) were approached for consent, and 5% (11 of 209) of those patients refused to participate. All remaining 198 patients consented and completed the baseline survey; 83% (164 of 198 patients) completed at least 6 months of follow-up, and 68% (134 of 198 patients) completed the 12-month assessment. The study participants' mean age was 44 ± 17 years, and 63% (125 of 198) were men. The primary outcome was the patient's recovery priorities, assessed at 6 weeks, 6 months, and 12 months after fracture using a discrete choice experiment. Discrete choice experiments are a well-established method for eliciting decisional preferences. In this technique, respondents are presented with a series of hypothetical scenarios, described by a set of plausible attributes or outcomes, and asked to select their preferred scenario. We used hierarchical Bayesian modeling to calculate individual-level estimates of the relative importance of physical recovery, work-related recovery, and disability benefits, based on the discrete choice experiment responses. The hierarchical Bayesian model improves upon more commonly used regression techniques by accounting for the observed response patterns of individual patients and the sequence of scenarios presented in the discrete choice experiment when calculating the model estimates. We computed the coefficient of variation for the three recovery domains and compared the between-patient versus within-patient differences using asymptotic tests. Separate prognostic models were fit for each of the study's three recovery domains to assess marginal changes in the importance of the recovery domain based on patient characteristics and factors that remained constant over the study (such as sex or preinjury work status) and patient characteristics and factors that varied over the study (including current work status or patient-reported health status). We previously published the 6-week results. This paper expands upon the prior publication to evaluate longitudinal changes in patient recovery priorities. RESULTS Physical recovery was the respondents' main priority at all three timepoints, representing 60% ± 9% of their overall concern. Work-related recovery and access to disability benefits were of secondary importance and were associated with 27% ± 6% and 13% ± 7% of the patients' concern, respectively. The patients' concern for physical recovery was 6% (95% CrI 4% to 7%) higher at 12 months after fracture that at 6 weeks postfracture. The mean concern for work-related recovery increased by 7% (95% CrI 6% to 8%) from 6 weeks to 6 months after injury. The mean importance of disability benefits increased by 2% (95% CrI 1% to 4%) from 6 weeks to 6 months and remained 2% higher (95% CrI 0% to 3%) at 12 months after the injury. Differences in priorities were greater within a given patient over time than between patients as measured using the coefficient of variation (physical recovery [245% versus 7%; p < 0.001], work-related recovery [678% versus 12%; p < 0.001], and disability benefits [620% versus 33%; p < 0.001]. There was limited evidence that biopsychosocial factors were associated with variation in recovery priorities. Patients' concern for physical recovery was 2% higher for every 10-point increase in their Patient-reported Outcome Measure Information System (PROMIS) physical health status score (95% CrI 1% to 3%). A 10-point increase in the patient's PROMIS mental health status score was associated with a 1% increase in concern for work-related recovery (95% CrI 0% to 2%). CONCLUSION Work-related recovery and accessing disability benefits were a secondary concern compared with physical recovery in the 12 months after injury for patients with fractures. However, the importance of work-related recovery was elevated after the subacute phase. Priorities were highly variable within a given patient in the year after injury compared with between-patient differences. Given this variation, orthopaedic surgeons should consider assessing and reassessing the socioeconomic well-being of their patients throughout their continuum of care. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Nathan N O'Hara
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Dionne S Kringos
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Gerard P Slobogean
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Yasmin Degani
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Niek S Klazinga
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Bernstein DN, Gruber JS, Merchan N, Garcia J, Harper CM, Rozental TD. What Factors Are Associated with Increased Financial Burden and High Financial Worry For Patients Undergoing Common Hand Procedures? Clin Orthop Relat Res 2021; 479:1227-1234. [PMID: 33394757 PMCID: PMC8133202 DOI: 10.1097/corr.0000000000001616] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have examined whether orthopaedic surgery, including hand surgery, is associated with patients' financial health. We sought to understand the level of financial burden and worry for patients undergoing two common hand procedures-carpal tunnel release and open reduction and internal fixation for a distal radius fracture-as well as to determine factors associated with a higher financial burden and worry. QUESTIONS/PURPOSES In patients undergoing operative treatment for isolated carpal tunnel syndrome with carpal tunnel release or open reduction and internal fixation for a distal radius fracture, we used validated financial burden and worry questionnaires to ask: (1) What percentage of patients report some level of financial burden, and what is the median financial burden composite score? (2) What percentage of patients report some level of financial worry, and what percentage of patients report a high level of financial worry? (3) When accounting for other assessed factors, what patient- and condition-related factors are associated with financial burden? (4) When accounting for other assessed factors, what patient- and condition-related factors are associated with high financial worry? METHODS In this cross-sectional survey study, a hand and upper extremity database at a single tertiary academic medical center was reviewed for patients 18 years or older undergoing operative treatment in our hand and upper extremity division for an isolated distal radius fracture between October 2017 and October 2019. We then selected all patients undergoing carpal tunnel release during the first half of that time period (given the frequency of carpal tunnel syndrome, a 1-year period was sufficient to ensure comparable patient groups). A total of 645 patients were identified (carpal tunnel release: 60% [384 of 645 patients]; open reduction and internal fixation for a distal radius fracture: 40% [261 of 645 patients). Of the patients who underwent carpal tunnel release, 6% (24 of 384) were excluded because of associated injuries. Of the patients undergoing open reduction and internal fixation for a distal radius fracture, 4% (10 of 261) were excluded because of associated injuries. All remaining 611 patients were approached. Thirty-six percent (223 of 611; carpal tunnel release: 36% [128 of 360]; open reduction and internal fixation: 38% [95 of 251]) of patients ultimately completed two validated financial health surveys: the financial burden composite and financial worry questionnaires. Descriptive statistics were calculated to report the percentage of patients who had some level of financial burden and worry. Further, the median financial burden composite score was determined. The percentage of patients who reported a high level of financial worry was calculated. A forward stepwise regression model approach was used; thus, variables with p values < 0.10 in bivariate analysis were included in the final regression analyses to determine which patient- and condition-related factors were associated with financial burden or high financial worry, accounting for all other measured variables. RESULTS The median financial burden composite score was 0 (range 0 [lowest possible financial burden] to 6 [highest possible financial burden]), and 13% of patients (30 of 223) reported a high level of financial worry. After controlling for potentially confounding variables like age, insurance type, and self-reported race, the number of dependents (regression coefficient 0.15 [95% CI 0.008 to 0.29]; p = 0.04) was associated with higher levels of financial burden, while retired employment status (regression coefficient -1.24 [95% CI -1.88 to -0.60]; p < 0.001) was associated with lower levels of financial burden. In addition, the number of dependents (odds ratio 1.77 [95% CI 1.21 to 2.61]; p = 0.004) and unable to work or disabled employment status (OR 3.76 [95% CI 1.25 to 11.28]; p = 0.02) were associated with increased odds of high financial worry. CONCLUSION A notable number of patients undergoing operative hand care for two common conditions reported some degree of financial burden and worry. Patients at higher risk of financial burden and/or worry may benefit from increased resources during their hand care journey, including social work consultation and financial counselors. This is especially true given the association between number of dependents and work status on financial burden and high financial worry. However, future research is needed to determine the return on investment of this resource utilization on patient clinical outcomes, overall quality of life, and well-being. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- David N Bernstein
- D. N. Bernstein, J. S. Gruber, N. Merchan, J. Garcia, C. M. Harper, T. D. Rozental, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Lichstein PM, He JK, Estok D, Prather JC, Dyer GS, Ponce BA. What Is the Prevalence of Burnout, Depression, and Substance Use Among Orthopaedic Surgery Residents and What Are the Risk Factors? A Collaborative Orthopaedic Educational Research Group Survey Study. Clin Orthop Relat Res 2020; 478:1709-1718. [PMID: 32732555 PMCID: PMC7371097 DOI: 10.1097/corr.0000000000001310] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/23/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Burnout and depression among healthcare professionals and trainees remain alarmingly common. In 2009, 56% of orthopaedic surgery residents reported burnout. Alcohol and illicit drug use are potential exacerbating factors of burnout and depression; however, these have been scarcely studied in residency populations. QUESTIONS/PURPOSES (1) What proportion of orthopaedic residents report symptoms of burnout and depression? (2) What factors are independently associated with an orthopaedic resident reporting emotional exhaustion, depersonalization, low personal accomplishment, and depression? (3) What proportion of orthopaedic residents report hazardous alcohol or drug use? (4) What factors are independently associated with an orthopaedic resident reporting hazardous alcohol or drug use? METHODS We asked 164 orthopaedic surgery programs to have their residents participate in a 34-question internet-based, anonymous survey, 28% of which (46 of 164) agreed. The survey was distributed to all 1147 residents from these programs, and 58% (661 of 1147) of these completed the survey. The respondents were evenly distributed among training years. Eighty-three percent (551 of 661) were men, 15% (101 of 661) were women, and 1% (nine of 661) preferred not to provide their gender. The survey asked about demographics, educational debt, sleep and work habits, perceived peer or program support, and substance use, and validated instruments were used to assess burnout (abbreviated Maslach Burnout Inventory), depression (Patient Health Questionnaire-2), and hazardous alcohol use (Alcohol Use Disorder Identification Test-Consumption). The main outcome measures included overall burnout, emotional exhaustion, depersonalization, low personal accomplishment, depression, and hazardous alcohol and drug use. Using the variables gathered in the survey, we performed an exploratory analysis to identify significant associations for each of the outcomes, followed by a multivariable analysis. RESULTS Burnout was reported by 52% (342 of 661) of residents. Thirteen percent of residents (83 of 656) had positive screening results for depression. Factors independently associated with high emotional exhaustion scores included early training year (odds ratio 1.15; 95% confidence interval, 1.01-1.32; p = 0.03) unmanageable work volume (OR 3.13; 95% CI, 1.45-6.67; p < 0.01), inability to attend health maintenance appointments (OR 3.23; 95% CI, 1.69-6.25; p < 0.01), lack of exercise (OR 1.69; 95% CI, 1.08-2.70; p = 0.02), and lack of program support (OR 3.33; 95% CI, 2.00-5.56; p < 0.01). Factors independently associated with depersonalization included early training year (OR 1.27; 95% CI, 1.12-1.41; p < 0.01), inability to attend health maintenance appointments (OR 2.70; 95% CI, 1.67-4.35; p < 0.01), and lack of co-resident support (OR 2.52; 95% CI, 1.52-4.18; p < 0.01). Low personal accomplishment was associated with a lack of co-resident support (OR 2.85; 95% CI, 1.54-5.28; p < 0.01) and lack of program support (OR 2.33; 95% CI, 1.32-4.00; p < 0.01). Factors associated with depression included exceeding duty hour restrictions (OR 2.50; 95% CI, 1.43-4.35; p < 0.01) and lack of program support (OR 3.85; 95% CI, 2.08-7.14; p < 0.01). Sixty-one percent of residents (403 of 656) met the criteria for hazardous alcohol use. Seven percent of residents (48 of 656) reported using recreational drugs in the previous year. Factors independently associated with hazardous alcohol use included being a man (OR 100; 95% CI, 35-289; p < 0.01), being Asian (OR 0.31; 95% CI, 0.17-0.56; p < 0.01), single or divorced marital status (OR 2.33; 95% CI, 1.47-3.68; p < 0.01), and more sleep per night (OR 1.92; 95% CI, 1.21-3.06; p < 0.01). Finally, single or divorced marital status was associated with drug use in the past year (OR 2.30; 95% CI, 1.26-4.18; p < 0.01). CONCLUSIONS The lack of wellness among orthopaedic surgery residents is troubling, especially because most of the associated risk factors are potentially modifiable. Programs should capitalize on the modifiable elements to combat burnout and improve overall wellbeing. Programs should also educate residents on burnout, focus on work volume, protect access to health maintenance, nurture those in the early years of training, and remain acutely aware of the risk of substance abuse. Orthopaedic surgery trainees should strive to encourage peer support, cultivate personal responsibility, and advocate for themselves or peers when faced with challenges. At a minimum, programs and educational leaders should foster an environment in which admitting symptoms of burnout is not seen as a weakness or failure. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Paul M Lichstein
- P. M. Lichstein, D. Estok, G. S. Dyer, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jun Kit He
- J. K. He, J. C. Prather, B. A. Ponce, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel Estok
- P. M. Lichstein, D. Estok, G. S. Dyer, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John C Prather
- J. K. He, J. C. Prather, B. A. Ponce, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George S Dyer
- P. M. Lichstein, D. Estok, G. S. Dyer, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brent A Ponce
- J. K. He, J. C. Prather, B. A. Ponce, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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E Lindsay S, Alokozai A, Eppler SL, Fox P, Curtin C, Gardner M, Avedian R, Palanca A, Abrams GD, Cheng I, Kamal RN. Patient Preferences for Shared Decision Making: Not All Decisions Should Be Shared. J Am Acad Orthop Surg 2020; 28:419-426. [PMID: 31567900 PMCID: PMC8080702 DOI: 10.5435/jaaos-d-19-00146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION To assess bounds of shared decision making in orthopaedic surgery, we conducted an exploratory study to examine the extent to which patients want to be involved in decision making in the management of a musculoskeletal condition. METHODS One hundred fifteen patients at an orthopaedic surgery clinic were asked to rate preferred level of involvement in 25 common theoretical clinical decisions (passive [0], semipassive [1 to 4], equally shared involvement between patient and surgeon [5], semiactive [6 to 9], active [10]). RESULTS Patients preferred semipassive roles in 92% of decisions assessed. Patients wanted to be most involved in scheduling surgical treatments (4.75 ± 2.65) and least involved in determining incision sizes (1.13 ± 1.98). No difference exists in desired decision-making responsibility between patients who had undergone orthopaedic surgery previously and those who had not. Younger and educated patients preferred more decision-making responsibility. Those with Medicare desired more passive roles. DISCUSSION Despite the importance of shared decision making on delivering patient-centered care, our results suggest that patients do not prefer to share all decisions.
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Affiliation(s)
- Sarah E Lindsay
- From the Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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Rowland C, Walsh L, Harrop R, Roy B, Skevington SM. What Do U.K. Orthopedic Surgery Patients Think About PROMs? Evaluating the Evaluation and Explaining Missing Data. Qual Health Res 2019; 29:2057-2069. [PMID: 31154898 DOI: 10.1177/1049732319848698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The NHS routinely evaluates the quality of life of patients receiving hip or knee replacement surgery using patient-reported outcome measures (PROMs), but some hospital completion rates are only 30%, restricting data usefulness. Statistics limit insights into how and why data are missing, so qualitative methods were used to explore this issue. Observation periods preceded semistructured interviews with 34 preoperative patients attending an orthopedic outpatient clinic. Interview themes covered: completion time/timing, orientation, setting, measures, and practicalities. Triangulated against observations, pragmatic barriers, and facilitators were considered. Refined themes included completion conditions, patient support, and national delivery. Simple improvements (e.g., quiet zone) could improve completion rates and reducing missing data. Reorganizing preoperative leaflets and their systematic distribution via standardized procedures could reassure patients, enhancing PROMs acceptance, while reducing inquiries and subsequent staff burden. Findings have implications for interpreting national statistics. They indicate that further debate about mandating preoperative PROMs is due.
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Affiliation(s)
| | - Lauren Walsh
- The University of Manchester, Manchester, United Kingdom
| | - Rebecca Harrop
- The University of Manchester, Manchester, United Kingdom
| | - Bibhas Roy
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Mandarelli G, Parmigiani G, Carabellese F, Codella S, Roma P, Brancadoro D, Ferretti A, Alessandro L, Pinto G, Ferracuti S. Decisional capacity to consent to treatment and anaesthesia in patients over the age of 60 undergoing major orthopaedic surgery. Med Sci Law 2019; 59:247-254. [PMID: 31366276 DOI: 10.1177/0025802419865854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite growing attention to the ability of patients to provide informed consent to treatment in different medical settings, few studies have dealt with the issue of informed consent to major orthopaedic surgery in those over the age of 60. This population is at risk of impaired decision-making capacity (DMC) because older age is often associated with a decline in cognitive function, and they often present with anxiety and depressive symptoms, which could also affect their capacity to consent to treatment. Consent to major orthopaedic surgery requires the patient to understand, retain and reason about complex procedures. This study was undertaken to extend the literature on decisional capacity to consent to surgery and anaesthesia of patients over the age of 60 undergoing major orthopaedic surgery. Recruited patients ( N=83) were evaluated using the Aid to Capacity Evaluation, the Beck Depression Inventory, the State–Trait Anxiety Inventory Y, the Mini-Mental State Examination and a visual analogue scale for measuring pain symptomatology. Impairment of medical DMC was common in the overall sample, with about 50% of the recruited patients showing a doubtful ability, or overt inability, to provide informed consent. Poor cognitive functioning was associated with reduced medical DMC, although no association was found between decisional capacity and depressive, anxiety and pain symptoms. These findings underline the need of an in-depth assessment of capacity in older patients undergoing major orthopaedic surgery.
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Affiliation(s)
| | | | - Felice Carabellese
- Section of Criminology and Forensic Psychiatry, Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Silvia Codella
- Anesthesiology Department, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Paolo Roma
- Department of Human Neurosciences, 'Sapienza' University of Rome, Italy
| | - Domitilla Brancadoro
- Anesthesiology Department, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Andrea Ferretti
- Orthopaedic Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | | | - Giovanni Pinto
- Anesthesiology Department, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, 'Sapienza' University of Rome, Italy
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11
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Abstract
Background: Multiple studies have concluded that patients are more likely to understand and trust physicians who dress in more formal attire (shirt and tie) as opposed to casual attire (t-shirts and jeans). The white coat has repeatedly been reported as a major source of trust and confidence in a patient's eyes. Methods: This study explores the effect an orthopedic hand surgeon's attire has on a patient's perception of their surgeon's clinical values. All patients 18 years of age and older who visited our orthopedic hand surgeon's suburban outpatient practice were asked to participate in our survey-based study. Results: Ninety-seven surveys were completed and included. A majority of our responders are female (n = 59, 60.8%), Caucasian (n = 83, 85.6%) between the ages of 55 and 74 years (n = 40, 41.2%), currently employed (n = 59, 60.8%) with private health insurance (n = 69, 71.1%), and married (n = 64, 66.0%). Patients rated male and female hand surgeons wearing a white coat highest using the Likert scale and when asked about their perceived clinical qualities. Patients consistently poorly rated their surgeons wearing casual attire. Patients did note that the white coat, or any specific attire, was not necessary during the initial encounter to build a strong patient-surgeon relationship. Finally, goatees and beards do not positively or negatively impact a surgeon's patient-constructed image. Conclusions: Combining strong clinical skills with appropriate clinical attire highlighted by the physician wearing a white coat appears to be an effective way to enhance patient satisfaction while ultimately gaining the trust and respect needed to properly care for patients.
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Affiliation(s)
- Vince W. Lands
- St. Luke’s University Health Network,
Bethlehem, PA, USA
| | - Ajith Malige
- St. Luke’s University Health Network,
Bethlehem, PA, USA
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13
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Abstract
Objective The aim of this retrospective study was to find out whether a cut off value existed for elbow flexion and extension after open surgical release of elbow contracture that would correlate with subjective patient satisfaction. Methods The study enrolled 77 patients (53 males and 24 females with a mean age of 35.1 (18–77) years at the time of operation) with elbow contracture who attended regular follow-up appointments for more than 12 months. The mean follow up period was 44.2 months (12–186). The preoperative and postoperative modified MAYO elbow scores, objective parameters of increase in both flexion and extension end point measurements and improvement in total ROM were compared in order to determine the cut off degree of ROM in both flexion and extension that significantly correlated with patient satisfaction. Results Of the 77 participating patients, 26 patients had an extrinsic (33.8%) and 51 patients had an intrinsic elbow contracture (66.2%). Surgeries performed involved 40 cases of lateral release and 37 cases of both lateral and medial (progressive) release. The median preoperative total flexion-extension arch (ROM) was 45° (20°–65°). The median postoperative total flexion-extension arch (ROM) was 110° (97.5°–125°). The modified MAYO elbow score improved from 60 to 85 points postoperatively. The postoperative flexion cut off value was 115° for an excellent or good postoperative modified MAYO elbow score. Conclusion Post-operative flexion cut off value was 115° and had a positive effect on the postoperative patient satisfaction. The cut off value for postoperative extension was 20° but it was not a significant variable on patient satisfaction as was the total increase in ROM. Level of significance Level IV Therapeutic Study.
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Affiliation(s)
| | | | - Umit Gok
- Kocaeli University, Kocaeli, Turkey
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14
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Abstract
The aim of this study was to understand experiences of wait time among patients awaiting scheduled orthopaedic or cardiac surgery. Using a qualitative approach, 32 patients completed two interviews each regarding their wait time experiences, including effects of waiting. Patient experiences of wait time varied regardless of actual wait time and included reports of restriction, uncertainty, resignation, coping and opportunity. Participants' waiting experiences indicate a complex relationship between greater symptom severity and less tolerance for wait time. We suggest healthcare resources focus on alleviating the deleterious effects of waiting for certain patients rather than reducing absolute wait times.
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15
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Affiliation(s)
- David Ring
- />Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- />Clinical Orthopaedics and Related Research, Philadelphia, PA 19103 USA
| | - Seth S. Leopold
- />Clinical Orthopaedics and Related Research, Philadelphia, PA 19103 USA
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16
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Wallensten R, Gustafson P. [Macho orthopedist = patient risk]. Lakartidningen 2015; 112:DLZX. [PMID: 26348054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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17
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Affiliation(s)
- James H Herndon
- William H. and Johanna A. Harris Professor of Orthopaedic Surgery, Harvard Medical School, 55 Fruit Street - GRB 624, Boston, MA, 01970, USA,
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18
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Abstract
BACKGROUND So-called "hazardous attitudes" (macho, impulsive, antiauthority, resignation, invulnerable, and confident) were identified by the Federal Aviation Administration and the Canadian Air Transport Administration as contributing to road traffic incidents among college-aged drivers and felt to be useful for the prevention of aviation accidents. The concept of hazardous attitudes may also be useful in understanding adverse events in surgery, but it has not been widely studied. QUESTIONS/PURPOSES We surveyed a cohort of orthopaedic surgeons to determine the following: (1) What is the prevalence of hazardous attitudes in a large cohort of orthopaedic surgeons? (2) Do practice setting and/or demographics influence variation in hazardous attitudes in our cohort of surgeons? (3) Do surgeons feel they work in a climate that promotes patient safety? METHODS We asked the members of the Science of Variation Group-fully trained, practicing orthopaedic and trauma surgeons from around the world-to complete a questionnaire validated in college-aged drivers measuring six attitudes associated with a greater likelihood of collision and used by pilots to assess and teach aviation safety. We accepted this validation as applicable to surgeons and modified the questionnaire accordingly. We also asked them to complete the Modified Safety Climate Questionnaire, a questionnaire assessing the absence of a safety climate that is based on the patient safety cultures in healthcare organizations instrument. Three hundred sixty-four orthopaedic surgeons participated, representing a 47% response rate of those with correct email addresses who were invited. RESULTS Thirty-eight percent (137 of 364 surgeons) had at least one score that would have been considered dangerously high in pilots (> 20), including 102 with dangerous levels of macho (28%) and 41 with dangerous levels of self-confidence (11%). After accounting for possible confounding variables, the variables most closely associated with a macho attitude deemed hazardous in pilots were supervision of surgical trainees in the operating room (p = 0.003); location of practice in Canada (p = 0.059), Europe (p = 0.021), and the United States (p = 0.005); and being an orthopaedic trauma surgeon (p = 0.046) (when compared with general orthopaedic surgeons), but accounted for only 5.3% of the variance (p < 0.001). On average, 19% of surgeon responses to the Modified Safety Climate Questionnaire implied absence of a safety climate. CONCLUSIONS Hazardous attitudes are common among orthopaedic surgeons and relate in small part to demographics and practice setting. Future studies should further validate the measure of hazardous attitudes among surgeons and determine if they are associated with preventable adverse events. We agree with aviation safety experts that awareness of amelioration of such attitudes might improve safety in all complex, high-risk endeavors, including surgery-a line of thinking that merits additional research.
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Affiliation(s)
- Wendy E. Bruinsma
- />Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Stéphanie J. E. Becker
- />Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA USA
| | - Thierry G. Guitton
- />Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - David Ring
- />Orthopaedic Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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19
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Harris JD, Staheli G, LeClere L, Andersone D, McCormick F. What effects have resident work-hour changes had on education, quality of life, and safety? A systematic review. Clin Orthop Relat Res 2015; 473:1600-8. [PMID: 25269530 PMCID: PMC4385350 DOI: 10.1007/s11999-014-3968-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [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: 01/31/2023]
Abstract
BACKGROUND More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents' duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics. QUESTIONS/PURPOSES We performed a systematic review to determine whether work-hour restrictions have measurably influenced quality-of-life measures, operative and technical skill development, resident surgical education, patient care outcomes (including mortality, morbidity, adverse events, sentinel events, complications), and surgeon and resident attitudes (such as perceived effect on learning and training experiences, personal benefit, direct clinical experience, clinical preparedness). METHODS We performed a systematic review of PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were any English language peer-reviewed articles that analyzed the effect(s) of orthopaedic surgery resident work-hour restrictions on patient safety, resident education, resident/surgeon quality of life, resident technical operative skill development, and resident surgeon attitudes toward work-hour restrictions. Eleven studies met study inclusion criteria. One study was a prospective analysis, whereas 10 studies were of level IV evidence (review of surgical case logs) or survey results. RESULTS Within our identified studies, there was some support for improved resident quality of life, improved resident sleep and less fatigue, a perceived negative impact on surgical operative and technical skill, and conflicting evidence on the topic of resident education, patient outcomes, and variable attitudes toward the work-hour changes. CONCLUSIONS There is a paucity of high-level or clear evidence evaluating the effect of the changes to resident work hours. Future research in this area should focus on objective measures that include patient safety as a primary outcome.
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Affiliation(s)
- Joshua D. Harris
- />Department of Orthopedic Surgery, The Methodist Hospital, Houston, TX USA
| | - Greg Staheli
- />Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA USA
| | - Lance LeClere
- />Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA USA
| | - Diana Andersone
- />Holy Cross Orthopedic Institute, 5597 N Dixie Highway, Fort Lauderdale, FL 33334 USA
| | - Frank McCormick
- />Holy Cross Orthopedic Institute, 5597 N Dixie Highway, Fort Lauderdale, FL 33334 USA
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20
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Hess L. [Sissi therapy apparently helps with back pain]. MMW Fortschr Med 2014; 156 Spec no 2:14. [PMID: 25551999 DOI: 10.1007/s15006-014-3671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Howard JS, Mattacola CG, Mullineaux DR, English RA, Lattermann C. Influence of response shift on early patient-reported outcomes following autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc 2014; 22:2163-71. [PMID: 24061717 PMCID: PMC3947741 DOI: 10.1007/s00167-013-2654-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 08/24/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE Response shift is the phenomenon by which an individual's standards for evaluation change over time. The purpose of this study was to determine whether patients undergoing autologous chondrocyte implantation (ACI) experience response shift. METHODS Forty-eight patients undergoing ACI participated. The "then-test" method was used to evaluate response shift in commonly used patient-reported outcome measures (PROMs)-the SF-36 Physical Component Scale (SF-36 PCS), WOMAC, IKDC, and Lysholm. Each PROM was completed pre- and 6 and 12 months post-surgery. At 6 and 12 months, an additional "then" version of each form was also completed. The "then" version was identical to the original except that patients were instructed to assess how they were prior to ACI. Traditional change, response shift adjusted change, and response shift magnitude were calculated at 6 and 12 months. T tests (p < 0.05) were used to compare traditional change to response-shift-adjusted change, and response shift magnitude values to previously established minimal detectable change. RESULTS There were no differences between traditional change and response-shift-adjusted change for any of the PROMs. The mean response shift magnitude value of the WOMAC at 6 months (15 ± 14, p = 0.047) was greater than the previously established minimal detectable change (10.9). The mean response shift magnitude value for the SF-36 PCS at 12 months (9.4 ± 6.8, p = 0.017) also exceeded the previously established minimal detectable change (6.6). CONCLUSIONS There was no evidence of a group-level effect for response shift. These results support the validity of pre-test/post-test research designs in evaluating treatment effects. However, there is evidence that response shifts may occur on a patient-by-patient basis, and scores on the WOMAC and SF-36 in particular may be influenced by response shift. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jennifer S Howard
- Department of Rehabilitation Sciences, University of Kentucky, Lexington KY, Wethington Building, Room 206B, 900 South Limestone, Lexington, KY, 40536-0200, USA,
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22
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Ayers DC, Franklin PD, Ring DC. The role of emotional health in functional outcomes after orthopaedic surgery: extending the biopsychosocial model to orthopaedics: AOA critical issues. J Bone Joint Surg Am 2013; 95:e165. [PMID: 24196477 PMCID: PMC3808180 DOI: 10.2106/jbjs.l.00799] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- David C. Ayers
- The Arthritis and Joint Replacement Center, Department of
Orthopaedics and Physical Rehabilitation, UMass Memorial Medical Center, 119 Belmont
Street, Worcester, MA 01605
| | - Patricia D. Franklin
- Department of Orthopedics and Physical Rehabilitation,
University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA
01655
| | - David C. Ring
- Department of Orthopaedic Surgery, MGH Orthopaedic Hand
& Upper Extremity Service, Massachusetts General Hospital, Yawkey Center 2100,
55 Fruit Street, Boston, MA 02114. E-mail address:
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23
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Kato S, Murakami H, Demura S, Yoshioka K, Ota T, Shinmura K, Yokogawa N, Kawahara N, Tomita K, Tsuchiya H. Patient and family satisfaction with en bloc total resection as a treatment for solitary spinal metastasis. Orthopedics 2013; 36:e1424-30. [PMID: 24200448 DOI: 10.3928/01477447-20131021-27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Many studies have evaluated patient satisfaction surgeries for primary cancers. No studies have evaluated patient satisfaction in metastasectomies. The authors examined patient and family satisfaction with en bloc total resection of solitary spinal metastases and evaluated the factors that correlated with dissatisfaction. From 1998 to 2010, total en bloc spondylectomy (TES) was performed in 110 patients with solitary spinal metastases at the authors' institution. Questionnaires were sent by mail to 110 patients and their families in January 2012. Questionnaire included a subjective assessment of the results of surgery and the following questions: (1) Would you have the surgery again if you were returned to your presurgery status? and (2) Do you feel that you are a patient without cancer? To identify factors for dissatisfaction with the outcomes of TES, univariate and multivariate analyses were performed. Questionnaires were successfully delivered to 104 patients and their families. Responses were collected from 47 patients and 61 family members. Forty-five patients were very satisfied or satisfied with the outcomes of TES, and the other 2 were neutral. Fifty-four family members were very satisfied or satisfied, 5 were neutral, and 2 were dissatisfied. Forty-five patients indicated they would have the surgeries again. Thirteen patients indicated that they felt like patients without cancer. In multivariate analysis, patient death less than 2 years postoperatively and major postoperative complications were associated significantly with dissatisfaction.
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24
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Pouli N, Das Nair R, Lincoln NB, Walsh D. The experience of living with knee osteoarthritis: exploring illness and treatment beliefs through thematic analysis. Disabil Rehabil 2013; 36:600-7. [PMID: 23789746 PMCID: PMC4002631 DOI: 10.3109/09638288.2013.805257] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 05/08/2013] [Accepted: 05/10/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Knee osteoarthritis (OA) is a major cause of disability in older adults. However, there is limited research on the daily experience of living with knee OA. We aimed to offer insight into the beliefs of patients with knee OA about their illness and treatment. METHOD Twenty-four semi-structured interviews were conducted with 17 women and 7 men with physician-diagnosed knee OA, aged between 48 and 84 years (mean = 62, SD = 7). The audio-taped interviews lasted from 30 min to 1 h, and were transcribed verbatim. The data were subjected to thematic analysis. The transcripts were independently coded by two researchers to increase reliability of coding. RESULTS Six themes were developed and two of these are examined in further detail: (i) Illness representation and (ii) Beliefs about the medical and surgical control of pain. Illness representation comprised beliefs about people's understanding of OA and their pain experience, as well as expectations about the course of illness. The second theme presented experiences of limited pain relief and concerns about the use of drugs and surgery. CONCLUSION Exploring illness representations and beliefs about medical and surgical control of pain may provide the basis for initiating psychological interventions for people with knee OA. IMPLICATIONS FOR REHABILITATION People with knee OA place pain at the core of their living, and hold beliefs about knee OA being an incurable disease of a progressive nature, linked to specific causal factors. People with OA have concerns and worries about use of medication to control pain, and are ambivalent towards relying on medical or surgical interventions. Exploring and addressing patient illness beliefs and treatment expectations may help improve concordance with and outcomes from intervention.
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Affiliation(s)
- Nektaria Pouli
- Arthritis Research UK Pain Centre, University of NottinghamNottinghamUK
| | - Roshan Das Nair
- Arthritis Research UK Pain Centre, University of NottinghamNottinghamUK
| | | | - David Walsh
- Arthritis Research UK Pain Centre, University of NottinghamNottinghamUK
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25
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Hudak PL, Clark SJ, Raymond G. The omni-relevance of surgery: how medical specialization shapes orthopedic surgeons' treatment recommendations. Health Commun 2012; 28:533-545. [PMID: 22889378 DOI: 10.1080/10410236.2012.702642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article examines treatment recommendations in orthopedic surgery consultations and shows how surgery is treated as "omni-relevant" within this activity, providing a context within which the broad range of treatment recommendations proposed by surgeons is offered. Using conversation analysis to analyse audiotaped encounters between orthopedic surgeons and patients, we highlight how surgeons treat surgery as having a special, privileged status relative to other treatment options by (1) invoking surgery (whether or not it is actually being recommended) and (2) presenting surgery as the "last best resort" (in relation to which other treatment options are calibrated, described and considered). This privileged status surfaces in the design and delivery of recommendations as a clear asymmetry: Recommendations for surgery are proposed early, in relatively simple and unmitigated form. In contrast, recommendations not for surgery tend to be delayed and involve significantly more interactional work in their delivery. Possible implications of these findings, including how surgeons' structuring of recommendations may shape patient expectations (whether for surgery or some alternative), and potentially influence the distribution of orthopedic surgery procedures arising from these consultations, are considered.
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26
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Heikkinen K, Salanterä S, Leppänen T, Vahlberg T, Leino-Kilpi H. Ambulatory orthopaedic surgery patients' emotions when using different patient education methods. J Perioper Pract 2012; 22:226-231. [PMID: 22919767 DOI: 10.1177/175045891202200703] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 06/01/2023]
Abstract
A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.
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Affiliation(s)
- Katja Heikkinen
- University of Turku, Department of Nursing Science, FIN-20014 Turku, Finland.
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27
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Abstract
BACKGROUND Limb preservation surgery for extremity sarcomas offers the promise of improved function and cosmesis over amputation. Application of limb salvage surgery for pediatric patients with expandable metallic endoprostheses is gaining acceptance. The few studies reporting these devices have focused on functional outcomes; one has addressed quality of life. QUESTIONS/PURPOSES We asked the following questions: (1) how happy are these patients; (2) how do these patients perceive their bodies; (3) do these children have difficulty with social interactions; and (4) how satisfied are patients and their parents with their outcomes? METHODS We retrospectively identified and contacted 26 living patients who underwent limb salvage with an expandable device. The Pediatric Outcomes Data Collection Instrument was administered to 15 of the 26 families. Attention was paid to the happiness domain of the Pediatric Outcomes Data Collection Instrument and specific answers within this domain were reported. RESULTS Children who received limb salvage with an expandable endoprosthesis showed high emotional satisfaction with their outcome. Overall patients reported excellent perceptions of body image and physical attractiveness. Most patients reported frequent social interactions with their peers and no difficulty with making new friends. CONCLUSIONS Although this study has a limited number of subjects and no control group, the data correlate with previously scores and indicate a high degree of emotional acceptance after limb salvage with an expandable endoprosthesis in a pediatric population.
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Affiliation(s)
- Eric R Henderson
- Department of Orthopaedics and Sports Medicine, University of South Florida, 13220 USF Laurel Drive, Tampa, FL 33612, USA.
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28
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Goebel S, Baumann B, Steinert A, Reppenhagen S, Faller H. [Elevated postoperative pain levels following orthopedic surgery. Depression as a strong predictor]. Schmerz 2010; 24:54-61. [PMID: 20143100 DOI: 10.1007/s00482-009-0883-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 01/04/2023]
Abstract
The aim of this study was to examine whether depression is a strong predictor of elevated postoperative pain levels following orthopedic surgery and whether the implementation of standardized pain management is more beneficial for patients with depression. We performed a non-randomized, prospective study with two different groups of patients who underwent orthopedic surgery. Group 1 (n=249) received non-standardized pain therapy whereas group 2 (n = 243) was treated with a standardized pain management concept. Effects of the treatment were monitored with a VAS-based pain assessment protocol. Depression was measured preoperatively with the self-reported Patient Health Questionnaire (PHQ-9). Patients with the probable diagnosis of a current episode of major depression showed significantly higher postoperative pain than patients without a depressive episode. On the other hand, patients with depression benefited from the implementation of standardized pain management. Our data suggest a predictive value of depression for severe postoperative pain. Patients with depression benefited from standardized postoperative pain therapy, but were still suffering from significantly higher postoperative pain.
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Affiliation(s)
- S Goebel
- Orthopädische Klinik König-Ludwig-Haus, Universität Würzburg, Brettreichstr. 11, 97074, Würzburg.
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29
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Hampel P, Graef T, Krohn-Grimberghe B, Tlach L. Effects of gender and cognitive-behavioral management of depressive symptoms on rehabilitation outcome among inpatient orthopedic patients with chronic low back pain: a 1 year longitudinal study. Eur Spine J 2009; 18:1867-80. [PMID: 19562387 DOI: 10.1007/s00586-009-1080-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 06/01/2009] [Accepted: 06/14/2009] [Indexed: 11/25/2022]
Abstract
Psychological factors have been found to be of major importance for the transition from acute to chronic low back pain (CLBP). Although some evidence has been provided that depressive symptoms occur secondarily to CLBP, psychological treatment modules that specifically address depressive symptoms are not yet included in German inpatient rehabilitation programs. In this study, a standard rehabilitation program for patients with CLBP and depressive symptoms was compared to a standard rehabilitation, into which a cognitive-behavioral management training of depressive symptoms was integrated. Moreover, treatment effects of this multidisciplinary standard rehabilitation program delivered to patients with either no or only mild depressive symptoms were investigated. As a further aim of the present study, gender effects on rehabilitation outcomes were examined. Short-, mid-, and long-term effects on individual global improvement as well as pain-related, psychological, and work-related measures were evaluated among N = 199 consecutively admitted patients with CLBP, aged from 24 to 62 years. The standard rehabilitation program had no persisting effects on psychological outcomes among patients with no and mild depressive symptoms. Patients with moderate and severe depressive symptoms in the standard rehabilitation program did not benefit with clinical importance at the 6- and 12-month follow-up assessments, but did show clinically significant improvements in psychological outcome measures at the 6-month follow-up assessment when the supplemental psychological component was applied. Additionally, days of sick leave decreased in the intervention group in the mid-term when compared to the baseline. Females benefited more in mental health than males. However, due to regression effects at the 12-month follow-up assessment, booster sessions are highly recommended. The results presented here support the notion that a more adequately tailored rehabilitation program seems to improve rehabilitation success and prevent further development of CLBP among this high-risk subpopulation.
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Affiliation(s)
- Petra Hampel
- Center of Clinical Psychology and Rehabilitation, University of Bremen, Grazer Str. 6, 28359, Bremen, Germany.
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van Til JA, Stiggelbout AM, Ijzerman MJ. The effect of information on preferences stated in a choice-based conjoint analysis. Patient Educ Couns 2009; 74:264-271. [PMID: 18954956 DOI: 10.1016/j.pec.2008.08.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 08/29/2008] [Accepted: 08/30/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The objective of the study was to investigate the effect of a priori information on preferences for treatment elicited in a discrete choice experiment. METHODS A convenience sample of 100 subjects was randomly split into two groups. The groups received minimal or extensive information on the treatment of ankle and foot impairment in stroke. Then, they participated in a discrete choice experiment. Possible treatment was described using eight decision criteria with two to four levels each. Part-worth utility coefficients for the criteria levels, criteria importance and overall treatment preference were estimated. It was tested whether the amount of information that was received influenced the outcome of the discrete choice experiment. RESULTS In the extensively informed group fewer reversals in the expected order of part-worth utilities were found. Criteria importance for four of the eight criteria and criteria importance ranking between the minimally and extensively informed subject groups were significantly different. The difference in part-worth utility of the levels had a minor effect on the predicted utility of the available treatments. CONCLUSION The lower number of level rank reversals in the extensively informed subjects indicates a better understanding of outcome desirability and thus a better understanding of the decision task. The effect of more extensive information on predicted treatment preference was minimal. PRACTICE IMPLICATIONS While interpreting the results of a discrete choice experiment, the effect of prior knowledge on the decision problem has to be taken into account. Although information seems to increase the understanding of the decision task, outcomes valuation can also be directed by information and more extensive information increases the cognitive burden which is placed on the subjects. Future research should focus on the exact nature and size of the effects and the results of this study should be clinically validated.
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Affiliation(s)
- J A van Til
- University of Twente, Enschede, The Netherlands.
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Martínez-Pérez J. [Consolidating the medical model of disability: on poliomyelitis and constitution of orthopedic surgery and orthopaedics as a speciality in Spain (1930-1950)]. Asclepio 2009; 61:117-142. [PMID: 19753686 DOI: 10.3989/asclepio.2009.v61.i1.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
At the beginning of the 1930s, various factors made it necessary to transform one of the institutions which was renowned for its work regarding the social reinsertion of the disabled, that is, the Instituto de Reeducación Profesional de Inválidos del Trabajo (Institute for Occupational Retraining of Invalids of Work). The economic crisis of 1929 and the legislative reform aimed at regulating occupational accidents highlighted the failings of this institution to fulfill its objectives. After a time of uncertainty, the centre was renamed the Instituto Nacional de Reeducación de Inválidos (National Institute for Retraining of Invalids). This was done to take advantage of its work in championing the recovery of all people with disabilities.This work aims to study the role played in this process by the poliomyelitis epidemics in Spain at this time. It aims to highlight how this disease justified the need to continue the work of a group of professionals and how it helped to reorient the previous programme to re-educate the "invalids." Thus we shall see the way in which, from 1930 to 1950, a specific medical technology helped to consolidate an "individual model" of disability and how a certain cultural stereotype of those affected developed as a result. Lastly, this work discusses the way in which all this took place in the midst of a process of professional development of orthopaedic surgeons.
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Janzen JA, Hadjistavropoulos HD. Examination of negative affective responses to waiting for surgery. Can J Nurs Res 2008; 40:72-91. [PMID: 19186786] [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: 05/27/2023] Open
Abstract
Long surgical waiting times are associated with many negative consequences. Although depression and anxiety have been studied among patients waiting for surgery, fundamental anxieties, such as anxiety sensitivity and health anxiety, have not been examined. Furthermore, research into patients' perspectives on coping while waiting is limited. The purpose of this study was to examine the extent of anxiety sensitivity, health anxiety, depression, and anxiety and their influence on coping, concern about waiting, and anxiety about surgery in individuals waiting for surgery. Individuals waiting for surgery completed measures assessing these constructs. Results revealed a high degree of health anxiety and anxiety sensitivity. Regression analysis showed that health anxiety and depression are unique predictors of coping and together help to predict concern about waiting. Anxiety sensitivity and anxiety did not add to the prediction of these variables. Overall, the results suggest that further attention should be given to interventions that address psychological distress during the wait for surgery.
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Affiliation(s)
- Jennifer A Janzen
- Department of Psychology, University of Regina, Saskatchewan, Canada
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Abstract
BACKGROUND As the U.S. population ages, orthopaedic surgeons will increasingly be required to counsel older patients about major surgical procedures. Understanding patient concerns or worries about surgery could help orthopaedic surgeons to assist their patients in making these decisions. The objectives of this study were to explore the nature of patient concerns regarding orthopaedic surgery and to describe how patients raise concerns during visits with orthopaedic surgeons and how orthopaedic surgeons respond. METHODS As part of a study involving audiotaping of 886 visits between patients and orthopaedic surgeons, fifty-nine patients sixty years of age or older who were considering surgery were recruited to participate in semistructured telephone interviews at five to seven days and one month after the visit. Patients were asked about their perceptions of the visit and how they made their decision about surgery. These interviews were analyzed to identify patients' concerns with the use of qualitative content analysis and then compared with the audiotaped visits to determine whether these concerns were actually raised during the visit and, if so, how well the orthopaedic surgeons responded. Analyses based on patient race (black or white) were also performed. RESULTS One hundred and sixty-four concerns pertaining to (1) the surgery (anticipated quality of life after the surgery, the care facility, the timing of the operation, and the patient's capacity to meet the demands of the surgery) and (2) the surgeons (their competency, communication, and professional practices) were identified. Patients raised only 53% of their concerns with the orthopaedic surgeons and were selective in what they disclosed; concerns about the timing of the operation and about the care facility were frequently raised, but concerns about their capacity to meet the demands of the surgery and about the orthopaedic surgeons were not. Orthopaedic surgeons responded positively to 66% of the concerns raised by the patients. Only two concerns were raised in response to direct surgeon inquiry. CONCLUSIONS Patients raised only half their concerns regarding surgery with orthopaedic surgeons. Orthopaedic surgeons are encouraged to fully address how patients' capacity to meet the demands of the surgery, defined by their resources (such as social support, transportation, and finances) and obligations (to family members, employers, and religion), may impinge on their willingness to accept recommended surgery.
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Affiliation(s)
- Pamela L Hudak
- The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
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Kaur S, Miller MD, Halbert J, Giles LC, Crotty M. Nutritional status of adults participating in ambulatory rehabilitation. Asia Pac J Clin Nutr 2008; 17:199-207. [PMID: 18586637] [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: 05/26/2023]
Abstract
AIMS To assess the overall nutritional status of older adults participating in ambulatory rehabilitation and determine its association with relevant outcomes including physical function and quality of life. DESIGN Cross-sectional. SETTING Ambulatory rehabilitation service in the Southern region of Adelaide, Australia. SUBJECTS A total of 229 participants recruited as part of a RCT between June 2005 and June 2006, stroke (n=83), elective orthopedic procedure (n=44) and other medical condition (n=102). METHODS Nutritional status was measured using Mini Nutritional Assessment (MNA), Simplified Nutrition Appetite Questionnaire (SNAQ) and Body Mass Index. Functional performance was assessed using the Modified Barthel Index (MBI) and quality of life was measured using the Short Form-36 (SF-36). RESULTS Sixty-three percent of participants were malnourished or at risk of malnutrition according to the MNA and a third had a risk of >or= 5% weight loss in the subsequent six months, according to the SNAQ. Participants with a diagnosis other than stroke or elective orthopedic procedure were the most vulnerable, with 53% (n=74/140) classified as at risk of malnutrition or malnourished and a longer length of stay in hospital. Functional performance was no different for participants assessed as at risk of malnutrition or malnourished compared to the well nourished, but the SF-36 mental component score was significantly higher for those who were well nourished (p=0.003). CONCLUSION Findings emphasise the magnitude of the malnutrition problem in ambulatory rehabilitation settings. Further research is required to evaluate the resource implications against expected benefits of providing nutrition interventions at this point.
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Affiliation(s)
- Supreet Kaur
- Flinders University, Department of Nutrition and Dietetics G4, FMC Flats, Flinders Drive, Bedford Park South Australia 5042 Australia
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Bhandari M. Re: Choices. J Urol 2007; 177:1957. [PMID: 17437860 DOI: 10.1016/j.juro.2007.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Indexed: 11/18/2022]
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Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr 2007; 19:197-214. [PMID: 16973101 DOI: 10.1017/s104161020600425x] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 07/05/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to perform a systematic review and meta-analysis of the literature regarding the incidence of delirium following orthopedic surgery. METHODS Relevant papers were sourced from online databases and gray literature. Included studies used a validated diagnostic method to measure the incidence of delirium in a prospective sample of adult/elderly orthopedic patients. Data were subject to meta-analysis after stratification by type of surgery (elective v. emergency) and inclusion/exclusion of pre-existing cognitive impairment. A funnel plot assessed for publication bias. RESULTS 26 publications reported an incidence of postoperative delirium of 4-53.3% in hip fracture samples and 3.6-28.3% in elective samples. Significant heterogeneity was evident, and this persisted despite stratification. Hip fracture was associated with a higher risk of delirium than elective surgery both when the cognitively impaired were included in the sample (random effects pooled estimate = 21.7% [95% CI = 14.6-28.8] vs. 12.1% [95% CI = 9.6-14.6]), and when the cognitively impaired were excluded (random effects pooled estimate = 25% [95% CI = 15.7-34.7] vs. 8.8% [95% CI = 4.1-13.6]). The funnel plot showed a deficit of small studies showing low risk and large studies showing high risk. In eight hip fracture studies, the proportion of delirium cases with a preoperative onset ranged from 34 to 92%. CONCLUSIONS Delirium occurs more commonly with hip fracture than elective surgery, and frequently has a preoperative onset when associated with trauma. Recommendations are made with the aim of standardizing future research in order to further explore and reduce the heterogeneity and possible publication bias observed.
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Sinikallio S, Aalto T, Airaksinen O, Herno A, Kröger H, Savolainen S, Turunen V, Viinamäki H. Depression is associated with poorer outcome of lumbar spinal stenosis surgery. Eur Spine J 2007; 16:905-12. [PMID: 17394027 PMCID: PMC2219645 DOI: 10.1007/s00586-007-0349-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 02/09/2007] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
Abstract
The objective of this observational prospective study was to investigate the effect of depression on short-term outcome after lumbar spinal stenosis (LSS) surgery. Surgery was performed on 99 patients with clinically and radiologically defined LSS, representing ordinary LSS patients treated at the secondary care level. They completed questionnaires before surgery and 3 months postoperatively. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with Oswestry disability index, Stucki Questionnaire, self-reported walking ability, visual analogue scale (VAS) and pain drawing. Preoperatively, 20% of the patients had depression. In logistic regression analyses, significant associations were seen between preoperative depression and postoperative high Oswestry disability and Stucki severity scores and high intensity of pain (VAS score). In subsequent analyses, the patients with continuous depression, measured with BDI (60% of the patients who had preoperative depression), showed fewer improvements in symptom severity, disability score, pain intensity and walking capacity than the patients who did not experience depression at any phase. In those patients who recovered from depression, according to BDI-scores (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. In the surgical treatment of LSS, we recommend that the clinical practice should include an assessment of depression.
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Affiliation(s)
- Sanna Sinikallio
- Department of Rehabilitation (2981), Kuopio University Hospital, Tarinan sairaala, 71800 Siilinjärvi, Finland.
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Johansson AC, Cornefjord M, Bergkvist L, Ohrvik J, Linton SJ. Psychosocial stress factors among patients with lumbar disc herniation, scheduled for disc surgery in comparison with patients scheduled for arthroscopic knee surgery. Eur Spine J 2007; 16:961-70. [PMID: 17347823 PMCID: PMC2219662 DOI: 10.1007/s00586-007-0319-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 11/21/2006] [Accepted: 01/14/2007] [Indexed: 11/29/2022]
Abstract
Returning to work after disc surgery appears to be more heavily influenced by psychological aspects of work than by MR-identified morphological alterations. It is still not known whether psychosocial factors of importance for outcome after disc surgery are present preoperatively or develop in the postoperative phase. The aim of this study was to investigate the presence of work-related stress, life satisfaction and demanding life events, among patients undergoing first-time surgery for lumbar disc herniation in comparison with patients scheduled for arthroscopic knee surgery. Sixty-nine patients with disc herniation and 162 patients awaiting arthroscopy were included in the study, during the time period March 2003 to May 2005. Sixty-two percent of the disc patients had been on sick leave for an average of 7.8 months and 14 percent of the knee patients had been on sick leave for an average of 4.2 months. The psychosocial factors were investigated preoperatively using a questionnaire, which was a combination of the questionnaire of quality of work competence (QWC), life satisfaction (LiSat9) and life events as a modification of the social readjustment scale. There were no significant differences between the two groups in terms of work-related stress or the occurrence of demanding life events. The disc patients were significantly less satisfied with functions highly inter-related to pain and discomfort, such as present work situation, leisure-time, activities of daily living (ADL) function and sleep. Patients with disc herniation on sick leave were significantly less satisfied with their present work situation than knee patients on sick leave; this sub-group of patients with disc herniation also reported significantly higher expectations in relation to future job satisfaction than knee patients. The results indicate that psychosocial stress is not more pronounced preoperatively in this selected group of disc patients, without co-morbidity waiting for first-time disc surgery, than among knee patients awaiting arthroscopy. It was notable that the disc patients had high expectations in terms of improved job satisfaction after treatment by surgery.
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Affiliation(s)
- Ann-Christin Johansson
- Department of Orthopaedics/Centre for Clinical Research, Uppsala University, Central Hospital, 72189 Västerås, Sweden.
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Abstract
OBJECTIVE To assess the quality of life before and after hallux valgus surgery. METHODS A longitudinal study with 94 consecutive patients undergoing hallux valgus surgery. Assessments were made preoperatively and at 12 month postoperatively. Measures used were the quality of life (QoL) according to SF-36, a disease specific score (the American Orthopaedic Foot and Ankle Society's clinical rating system for the hallux), the severity of the deformity, the possibility of wearing the preferred choice of shoes and satisfaction with the treatment. The pre- and postoperative QoL scores were compared with the score in the general population. RESULTS QoL outcomes improved significantly postoperatively regarding bodily pain, vitality, mental health and the mental component summary. The correction of the deformity did not affect the QoL. Regardless of the extent of correction, the choice of shoeware and the degree of satisfaction with surgery were associated with a better QoL. CONCLUSIONS Hallux valgus patients have worse pain than the general population. Surgery produces a significant improvement in the quality of life. The severity of the deformity did not influence the QoL, however; the free choice of shoeware and the degree of satisfaction with the surgery had a positive effect on the QoL outcome. SF-36 is a relevant tool for evaluating outcome in hallux valgus surgery.
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Affiliation(s)
- Carlos Saro
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopaedics, Karolinska Institute at Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.
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Abstract
STUDY DESIGN Patient surveys to determine preferences in surgical decision making. OBJECTIVE To evaluate spine patient preferences regarding physician and patient roles in surgical decision making and to discuss the ethical considerations that arise. SUMMARY OF BACKGROUND DATA Since the 1980s, there has been a push toward increasing patient autonomy and self-determination, and away from the paternalism of the past. Commensurate with this shift, patients have been encouraged to take the primary active role in surgical decision making. To date, there is little empirical evidence regarding how deeply patients want to be involved in this decision-making process. METHODS A total of 200 consecutive patients seen at our academic spine center were administered 1 of 2 questionnaires (previously validated) aimed at determining patient preferences about how clinical decision making should take place. RESULTS Patients felt strongly that complete risk information be provided. The majority of patients felt that the physician, rather than the patient, should make the basic treatment decision, and the great majority felt that the physician should make the technical decisions regarding treatment. CONCLUSIONS Spine surgical patients often prefer to defer surgical decision making to their surgeons. In clinical scenarios where there is little controversy and the evidence is clear, this results in little consequence, assuming that the surgeon aims to provide evidence-based care. In scenarios with greater controversy and less clear evidence, the choice of treatment offered by the surgeon may be based on factors outside of the available science, and, accordingly, efforts should be made to educate fully the patient and to help the patient make his/her own decision based on personal values regarding outcomes.
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Affiliation(s)
- Bradley K Weiner
- Division of Spine Surgery, The Methodist Hospital/Texas Medical Center, Houston, TX 77030, USA.
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Abstract
STUDY DESIGN Review article of preoperative evaluation of surgical patients as relates to adult spine patients. OBJECTIVE To determine which patients should undergo preoperative evaluation and review options for improved preoperative preparation for these patients. SUMMARY OF BACKGROUND DATA There is increasing attention paid to preoperative preparation for surgical patients to decrease perioperative morbidity. Better preoperative evaluation may lead to decreased complication rates and may improve outcomes. METHODS The literature to date, including surgical, hospitalist, and critical care, was reviewed and combined with the authors' experience. RESULTS Suggestions for preoperative screening questions are summarized. CONCLUSION Better recognition of preoperative risk factors may help spine surgeons improve preoperative preparation in their patients, leading to decreased complication rates.
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Affiliation(s)
- Serena S Hu
- Department of Orthopedic Surgery, University of California-San Francisco, San Francisco, CA 94143-0728, USA.
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Kasai Y, Kawakita E, Uchida A. Suicide during hospitalization in patients with spinal disease. Spine (Phila Pa 1976) 2006; 31:1981-2. [PMID: 16924217 DOI: 10.1097/01.brs.0000229227.02509.2f] [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: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To examine the frequency and current status of the incidence of deaths by suicide of patients with spinal diseases during hospitalization. SUMMARY OF BACKGROUND DATA It was reported that most cases of deaths by suicide during hospitalization were patients admitted to the psychiatric ward. There were no reports to the incidence of death by suicide during hospitalization in patients with spinal diseases. METHODS Of 69,861 patients admitted to the Department of Orthopedics of 28 affiliated hospitals of our university between September 1997 and August 2002, 14,987 patients with spinal diseases were targeted for this study. We examined the number of deaths by suicide during hospitalization. RESULTS Of the 14,987 patients with spinal diseases, there were 5 deaths (0.03%) by suicide during hospitalization. There were no deaths by suicide in 54,874 patients with orthopedic diseases other than spinal diseases. CONCLUSION In the treatment of patients with spinal diseases, it seemed important for spinal surgeons to provide comprehensive treatment for the whole patient by paying attention to the relationship between a patient and a physician, in particular, by carefully observing the psychologic status of a patient.
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Affiliation(s)
- Yuichi Kasai
- Department of Orthopaedic Surgery, Mie University Faculty of Medicine, Tsu city, Mie, Japan.
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Musial N. ["Oskar and Lucy in the Aschau Pediatric Orthopedic Clinic"--a picture book for preparing young patients for hospital treatment]. Kinderkrankenschwester 2006; 25:197-8. [PMID: 16736828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Nina Musial
- Orthopädischen Kinderklinik des BZ Aschau, Aschau im Chiemgau.
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Sinikallio S, Aalto T, Airaksinen O, Herno A, Kröger H, Savolainen S, Turunen V, Viinamäki H. Somatic comorbidity and younger age are associated with life dissatisfaction among patients with lumbar spinal stenosis before surgical treatment. Eur Spine J 2006; 16:857-64. [PMID: 16538522 PMCID: PMC2219643 DOI: 10.1007/s00586-006-0080-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 11/26/2005] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
The objective of the study was to examine self-reported life satisfaction and associated factors in patients (n=100) with lumbar spinal stenosis (LSS) in secondary care level, selected for surgical treatment. Life satisfaction was assessed with the four-item Life Satisfaction scale. Depression was assessed with a 21-item Beck Depression Inventory (BDI). Psychological well-being was assessed with Toronto Alexithymia Scale and Sense of Coherence Scale. LSS related physical functioning and pain were assessed with Oswestry disability index, Stucki questionnaire, Visual Analogue Scale and pain drawings. All questionnaires were administered before surgical treatment of LSS. Results showed that 25% of the patients with LSS were found to be dissatisfied with life. In a univariate analysis, smoking, elevated subjective disability scores and extensive markings in the pain drawings were more common in the dissatisfied patients. The dissatisfied patients also showed lower coping resources, elevated alexithymia and depression scores, and were more often depressed. In multiple logistic regression analyses, only younger age and somatic comorbidity were associated with life dissatisfaction. This association remained significant even when the BDI score was added into the model. No other significant associations emerged. In conclusion, life dissatisfaction was rather common among preoperative LSS patients. Pain and constraints on everyday functioning were important correlates of life dissatisfaction. However, only younger age and somatic comorbidity were independently associated with life dissatisfaction. These results emphasize the importance of recognizing and assessing the effect of coexisting medical conditions and they need to be addressed in any treatment program.
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Affiliation(s)
- Sanna Sinikallio
- Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland.
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Abstract
AIM The aim of this study was to examine how older patients who had undergone hip surgery described their experience of pain. BACKGROUND A verbal report of pain is considered to be the single most reliable indicator of a person's pain experience. When assessing pain, healthcare professionals must be able to interpret the content of pain reports in order to understand older patient's pain experiences. METHODS The study was carried out in two orthopaedic and two elder care wards in a large university hospital in Sweden in 2000. Altogether, 38 patients with hip replacement (mean age = 75) and 22 patients with hip fracture (mean age = 81) took part. A face-to-face interview was conducted with each patient on the second day after operation. Data were transcribed and analysed using descriptive qualitative content analysis. FINDINGS Participants expressed their pain in a nuanced and detailed way in everyday language. Four main themes with sub-themes emerged: (a) objectification (localizing; quantifying; characterizing; temporalizing); (b) compensating (substitution; picturing); (c) explaining (functionalizing pain and its relief; externalizing pain and its relief); (d) existentializing (present pain orientation; future pain orientation). CONCLUSIONS Exploring the ways older patients talk about pain is expected to result in a better understanding of the older patient's need of empathic individualized care and in the optimization of pain management.
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Affiliation(s)
- Ingrid Bergh
- School of Life Sciences, University of Skövde, Sweden.
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Abstract
PURPOSE Although the comparative efficacy of open and arthroscopic Bankart repair remains a matter of debate, little data exist on relative costs. We analyzed the patient outcomes, cost, and resource utilization of both procedures to determine if differences exist between open versus arthroscopic Bankart repair. TYPE OF STUDY Retrospective case-control study. METHODS We compared 22 patients who had open Bankart repair with 20 patients who had arthroscopic Bankart repair. Total operating times and all charges were obtained from records. Patients were evaluated using the American Shoulder and Elbow Surgeons (ASES) shoulder score, and any recurrence of dislocation was noted at minimum 24-month follow-up. RESULTS For arthroscopic Bankart repairs, operating times were shorter, but operating room equipment charges were greater. Overall charges were greater for open repairs as all open repair patients were admitted postoperatively. ASES shoulder scores were not significantly different between treatment groups. Four of 17 evaluable patients with open Bankart repair (including 1 shoulder in a patient who underwent bilateral repairs) had recurrent dislocation. One of the 18 evaluable patients with arthroscopic Bankart repair had recurrent dislocation. CONCLUSIONS Arthroscopic Bankart repair as same-day surgery has lower overall charges than open repair, although this difference would be negligible if all patients went home immediately after surgery. LEVEL OF EVIDENCE Level III, therapeutic, retrospective cohort study.
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Affiliation(s)
- Conrad Wang
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Van Blerk D. Evaluating an intermittent compression system for thromboembolism prophylaxis. Prof Nurse 2004; 20:48-9. [PMID: 15624623] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Patients undergoing orthopaedic or trauma surgery are at high risk of venous thromboembolism, which can lead to deep-vein thrombosis and other complications. However, it is well known that incidence can be greatly reduced with prophylaxis. This article reports on the trial of a new intermittent pneumatic compression device.
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Abergel A, Gil Z, Spektor S, Khafif A, Fliss DM. [Quality of life following anterior skull base surgery]. Harefuah 2004; 143:489-93, 550, 549. [PMID: 15669422] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Surgery for craniofacial resections is continuously improving, enabling the extirpation of tumors once considered unresectable. Nevertheless, the physical and psychological sequelae of these procedures and their affect on patients' everyday lives have not been systematically evaluated. The purpose of this study was to estimate the impact of anterior skull base surgery on the long-term quality of life (QOL) and on the family relations of patients with anterior skull base tumors. Demographic, medical and outcome data on 69 patients undergoing subcranial surgery for extirpation of tumors were retrospectively analyzed. Within this group, 35 patients and their lay caregiver successfully completed a disease-specific questionnaire. We did not find significant differences in QOL estimation between patients and their caregivers. Malignancy had the most significant impact on QOL, leading to a significant decrease in the overall score. Radiotherapy significantly decreased the scores in the specific symptoms and influence upon emotions domains. Age and comorbidity reduced the scores in the role of performance and physical function domains. A better correlation was found between the scores of married couples than between patients and lay caregivers who weren't married. Eighty three percent of the married couple's replies noted that the disease and surgery did not influence their relations. We conclude that malignancy, radiotherapy, comorbidity and age over 60, significantly impair quality of life in patients undergoing anterior skull base surgery. We suggest that a rehabilitation program should be implemented in these patients in order to improve their overall QOL.
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Affiliation(s)
- Avraham Abergel
- Department of Otolaryngology, Head and Neck Surgery and the Skull Base Surgery Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Edwards C, Staniszweska S, Crichton N. Investigation of the ways in which patients' reports of their satisfaction with healthcare are constructed. Sociol Health Illn 2004; 26:159-183. [PMID: 15027983 DOI: 10.1111/j.1467-9566.2004.00385.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A characteristic feature of patient satisfaction research is the consistently high level of satisfaction recorded. More reliable and relevant inquiry tools are constantly being developed, but underlying psychological and social pressures that could promote such a consistent and undiscriminating response have been little investigated. Williams et al. (1998) explored the phenomenon and concluded that, by considering issues of duty and culpability, patients could make allowances for poor care, and avoid evaluating it negatively. Their study was in community mental health. This study follows up their work within elective orthopaedic surgery, and investigates the pressures promoting such apparent transformation of opinion. Using a longitudinal design, and in-depth qualitative interviews, the patient's process of reflection was explored. Three psycho-social pressures were identified that appear to work together to make the transformation of opinion almost the default process. They are: the relative dependency of patients within the healthcare system; their need to maintain constructive working relationships with those providing their care; and their general preference for holding a positive outlook. It is suggested that, while it is the patient's prerogative to re-interpret the quality of their care positively, it is not the prerogative of the inquirer to accept this re-interpretation as representative of the patient's experience. Methods of inquiry are needed which access something of patients' development of opinion, and thereby something of their initial, often more negative, untransformed responses to their healthcare experiences.
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Affiliation(s)
- Carol Edwards
- Royal College of Nursing Institute, Radcliffe Infirmary, Oxford.
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