Reported Outcomes and Outcome Measures in Proximal Interphalangeal Joint Arthroplasty: A Systematic Review.

Purpose: There is a lack of scientific consensus on the best arthroplasty implant option for proximal interphalangeal joint (PIPJ) arthritis, due to diversity in outcome reporting and measurement methods. The development of a standardized core outcome set (COS) and standard outcome measures could mitigate this issue. This study catalogs the reported outcomes and outcome measures found in PIPJ arthroplasty studies, which can be used in the first step of developing a COS. Methods: A database search of MEDLINE, EMBASE, and Web of Science (January 1, 2010, to March 10, 2021) was performed to retrieve studies that reported outcomes of the 3 most common primary PIPJ arthroplasty implants: silicone, pyrocarbon, and metal-polyethylene. The primary objectives of this study include reported outcomes and outcome measures. Secondary objectives include clinimetric properties of outcome measures, study design, and implant types. Results: Fifty articles met inclusion criteria. Of the included studies, 41 (82%) were case series, 8 (16%) were cohort studies, and 1 (2%) was a randomized control trial. Thirty-three unique outcomes were identified. Fifteen (46%) outcomes were clinician-reported and 26 (79%) were patient-reported. Eighteen unique outcome measures were identified. Of the outcome measures, 15 (83%) were patient-reported, 1 (6%) was clinician-reported, and 2 (11%) were reported by both patients and clinicians. Conclusions: Substantial heterogeneity was found in reported outcomes and outcome measures across studies evaluating PIPJ arthroplasty, impeding knowledge translation. The development of a COS for PIPJ arthroplasty is necessary to help compare and pool data across studies, and advance scientific knowledge.

Objectif: Il manque de consensus scientifique sur la meilleure option d'arthroplastie pour l'arthrite de l'articulation interphalangienne proximale (IPP) en raison de la diversité des résultats décrits et des méthodes de mesure. L'élaboration d'un ensemble standardisé de résultats de base et de mesures standardisées des résultats pourrait contribuer à limiter ce problème. Cette étude dresse un catalogue des résultats rapportés et des mesures de résultats trouvés dans les études sur l'arthroplastie des IPP; celui-ci peut servir de première étape à l'élaboration d'un ensemble standardisé de résultats de base. Méthodes: Une recherche a été menée dans les bases de données MEDLINE, EMBASE et Web of Science sur la période du 1er janvier 2010 au 10 mars 2021 pour extraire les études qui rapportaient des résultats avec les 3 implants pour arthroplastie des IPP les plus souvent utilisés : silicone, pyrocarbone et métal-polyéthylène. Les objectifs principaux de cette étude incluent les résultats rapportés et les mesures des résultats. Les objectifs secondaires sont, notamment, les propriétés clinimétriques des mesures des résultats, la conception des études et les types d'implants. Résultats: Cinquante articles satisfaisaient les critères d'inclusion. Parmi les études incluses, 41 (82%) étaient des séries de cas, 8 (16%) étaient des études de cohortes et 1 (2%) était un essai randomisé. Trente-trois résultats uniques ont été identifiés. Quinze résultats (46%) étaient rapportés par le clinicien et 26 (79%) ont été déclarés par les patients. Dix-huit mesures uniques de résultats ont été identifiées. Parmi les mesures de résultats, 15 (83%) ont été déclarées par les patients, 1 (6%) a été déclarée par un clinicien et 2 (11%) ont été déclarées à la fois par les patients et les cliniciens. Conclusions: Une hétérogénéité importante a été constatée dans les résultats rapportés et dans les mesures de résultats dans les études évaluant l'arthroplastie des IPP, entravant leur traduction en connaissances utiles. L'élaboration d'un ensemble standardisé de résultats de base s pour les IPP est nécessaire pour comparer et regrouper les données entre les études et donc pour faire avancer les connaissances scientifiques.

Immobilization of the Wrist After Dorsal Wrist Ganglion Excision: A Systematic Review and Survey of Current Practice.

BACKGROUND: Postoperative care after dorsal wrist ganglion (DWG) excision is highly varied. The effect of immobilization of the wrist on patient outcomes has not yet been examined. METHODS: A systematic review of the literature was performed to determine whether wrist immobilization after DWG surgical excision is beneficial. A survey of hand surgeons in Canada was performed to sample existing practice variations in current immobilization protocols after DWG excision. RESULTS: A systematic review yielded 11 studies that rigidly immobilized the wrist (n = 5 open excision, n = 5 arthroscopic excision, n = 1 open or arthroscopic excision), 10 studies that used dressings to partially limit wrist motion (n = 5 open, n = 5 arthroscopic), 1 study (open) that did either of the above, and 2 studies (arthroscopic) that did not restrict wrist motion postoperatively. This ranged from 48 hours to 2 weeks in open DWG excision and 5 days to 3 weeks in arthroscopic DWG excision. The survey of Canadian hand surgeons had a similarly divided result of those who chose to immobilize the wrist fully (41%), partially (14%), or not at all (55%). Most surgeons surveyed who immobilized the wrist postoperatively did so for 1 to 2 weeks. CONCLUSION: The systematic review and survey of Canadian hand surgeons reveal that hand surgeons are divided regarding the need to immobilize the wrist after DWG excision. In terms of functional outcome, there is no compelling data to suggest 1 strategy is superior. The time frame for immobilization when undertaken was short at 2 weeks or less.The systematic review is registered in the PROSPERO database (PROSPERO 2016:CRD42016050877).

Obesity, Cancer, and Risk Reduction with Bariatric Surgery.

The prevalence of noncommunicable diseases has increased dramatically in North America and throughout the world and is expected to continue increasing in coming years. Obesity has been linked to several types of cancers and is associated with increased morbidity and mortality following cancer diagnosis. Bariatric surgery has emerged as the prominent model to evaluate the effects of intentional weight loss on cancer incidence and outcomes. Current literature, comprising prospective cohort investigations, indicates site-specific reductions in cancer risk with select bariatric procedures. Future research is required to establish evidence-based indications for bariatric surgery in the context of cancer prevention.

Reporting Outcomes and Outcome Measures in Digital Replantation: A Systematic Review.

Introduction There is a lack of consensus on what the critical outcomes in replantation are and how best to measure them. This review aims to identify all reported outcomes and respective outcome measures used in digital replantation. Materials and Methods Randomized controlled trials, cohort studies, and single-arm observational studies of adults undergoing replantation with at least one well-described outcome or outcome measure were identified. Primary outcomes were classified into six domains, and outcome measures were classified into eight domains. The clinimetric properties were identified and reported. A total of 56 observational studies met the inclusion criteria. Results In total, 29 continuous and 29 categorical outcomes were identified, and 87 scales and instruments were identified. The most frequently used outcomes were survival of replanted digit, sensation, and time in hospital. Outcomes and measures were most variable in domains of viability, quality of life, and motor function. Only eight measures used across these domains were validated and proven reliable. Conclusion Lack of consensus creates an obstacle to reporting, understanding, and comparing the effectiveness of various replantation strategies.

Reporting Outcomes and Outcome Measures in Cubital Tunnel Syndrome: A Systematic Review.

PURPOSE: Comparison between studies assessing outcomes after surgical treatment of cubital tunnel syndrome (CuTS) has proven to be difficult owing to variations in outcome reporting. This study aimed to identify outcomes and outcome measures used to evaluate postoperative results for CuTS. METHODS: We performed computerized database searches of MEDLINE and EMBASE. Studies with 20 or more patients aged 18 and older who were undergoing medial epicondylectomy, endoscopic decompression, open simple decompression, or decompression with subcutaneous, submuscular, or intramuscular transposition for ulnar neuropathy at the elbow were included. Outcomes and outcome measures were extracted and tabulated. RESULTS: Of the 101 studies included, 45 unique outcomes and 31 postoperative outcome measures were identified. These included 7 condition-specific, clinician-reported instruments; 4 condition-specific, clinician-reported instruments; 8 patient-reported, generic instruments; 11 clinician-generated instruments; and one utility measure. Outcome measures were divided into 6 unique domains. Overall, 60% of studies used condition-specific outcome measures. The frequency of any condition-specific outcome measure ranged from 1% to 37% of included studies. CONCLUSIONS: There is marked heterogeneity in outcomes and outcome measures used to assess CuTS. A standardized core outcome set is needed to compare results of various techniques of cubital tunnel decompression. CLINICAL RELEVANCE: This study builds on the existing literature to support the notion that there is marked heterogeneity in outcomes and outcome measures used to assess CuTS. The authors believe that a future standardized set of core outcomes is needed to limit heterogeneity among studies assessing postoperative outcomes in CuTS to compare these interventions more easily and pool results in the form of systematic reviews and meta-analyses.

A systematic review identifying outcomes and outcome measures in Dupuytren's disease research.

This systematic review summarizes the outcome reporting standards in Dupuytren's disease treatment research. A search of Ovid Medline, Ovid Embase, and CINAHL was conducted. Randomized controlled trials, cohort studies, and case series published between 1997 and 2017, investigating treatment of Dupuytren's disease with fasciectomy, fasciotomy, or collagenase, were eligible for inclusion. Range of motion was the most commonly reported outcome, appearing in 77% of included studies. Outcomes, such as range of motion, recurrence, and clinical success, were frequently defined, however many different definitions were used. We identified 37 unique measurement methods for range of motion, 28 for recurrence, and 25 for clinical success. Most outcomes were assessed at multiple time points, and only a few studies reported results according to established clinical significance thresholds. Development of a core outcome set will help standardize outcome reporting, and ensure future research in this field is relevant, interpretable, and amenable to systematic review and/or meta-analysis.

Outcomes and Outcome Measures in Breast Reduction Mammaplasty: A Systematic Review.

BACKGROUND: Reduction mammaplasty remains critical to the treatment of breast hypertrophy. No technique has been shown to be superior; however, comparison between studies is difficult due to variation in outcome reporting. OBJECTIVES: The authors sought to identify a comprehensive list of outcomes and outcome measures in reduction mammaplasty. METHODS: A comprehensive computerized search was performed. Included studies were randomized or nonrandomized controlled trials involving at least 100 cases of female breast hypertrophy and patients of all ages who underwent 1 or more defined reduction mammaplasty technique. Outcomes and outcome measures were extracted and tabulated. RESULTS: A total 106 articles were eligible for inclusion; 57 unique outcomes and 16 outcome measures were identified. Frequency of patient-reported and author-reported outcomes were 44% and 88%, respectively. Postoperative complications were the most frequently reported outcome (82.2%). Quality-of-life outcomes were accounted for in 37.7% of studies. Outcome measures were either condition-specific or generic; frequencies were as low as 1% and as high as 5.6%. Five scales were formally assessed in the breast reduction populations. Clinical measures were defined in 15.1% of studies. CONCLUSIONS: There is marked heterogeneity in reporting of outcomes and outcome measures in the literature. A standardized outcome set is needed to compare outcomes of various reduction mammaplasty techniques.

Reporting Time Horizons in Randomized Controlled Trials in Plastic Surgery: A Systematic Review.

BACKGROUND: Current guidelines for randomized controlled trial reporting do not require authors to justify their choice of time horizon. This is concerning, as the time horizon when an outcome is assessed has important implications for the interpretation of study results, and resources allocated to an investigation. Therefore, this study seeks to examine the standards of time horizon reporting in the plastic surgery literature. METHODS: This is a systematic review of plastic surgery randomized controlled trials published within the past 4 years. The MEDLINE database was searched to yield relevant studies. All studies included were English language, prospective, nonpharmaceutical randomized controlled trials, comparing two plastic surgical interventions. Studies were classified into plastic surgery domains, and information regarding study population, time horizon reporting, and justification of chosen time horizon, was extracted. RESULTS: The search retrieved 720 articles, of which 103 were eligible for inclusion. Time horizons were reported as either a standardized time point at which all patients were assessed, or a follow-up duration range, or were not reported at all. Although most studies (85.4 percent) reported a standardized time horizon, the majority (85.4 percent) failed to provide a valid justification to support their selection of time horizon. CONCLUSIONS: Clinical investigators failed to justify their choice of time horizon in the majority of published randomized controlled trials. To limit heterogeneity, time horizons for given interventions should be standardized to improve validity of outcome assessments, enable future pooling of results, and increase research efficiency.

Introducing Knowledge Translation to Plastic Surgery: Turning Evidence into Practice.

Best evidence has no bearing on quality of life if it is not implemented in clinical practice. The authors introduce knowledge translation as a theoretical framework for closing the gap between evidence and practice in plastic surgery. The current state of published evidence in plastic surgery is reviewed and evaluated, with the recommendation to use the EQUATOR Network's guidelines for reporting clinical research findings. Tools and strategies are offered for the reader to understand and integrate evidence at the bedside. Systemic solutions are also proposed for the dissemination of best evidence to facilitate its translation into practice.

Involvement of the Interosseous and Lumbrical Muscle-Tendon Units in the Lateral and Spiral Cords in Dupuytren's Disease of the Middle Fingers.

BACKGROUND: The nature of intrinsic muscle involvement in Dupuytren's disease of the middle fingers (long and ring) remains poorly characterized. Over the years, the authors have observed that both the spiral and lateral digital cords in the middle fingers receive contribution from intrinsic muscle-tendon units. This report describes the anatomical characteristics and frequency of intrinsic muscle-tendon unit involvement in Dupuytren's disease of the middle fingers. METHODS: Intrinsic muscle involvement in the middle digits was recorded in the operative reports of patients undergoing Dupuytren's surgery between October of 2013 and February of 2016. The anatomical variations of diseased fascia were delineated and classified. RESULTS: Of the 113 digits with Dupuytren's contracture operated on during this period, 52 involved the middle fingers (12 long and 40 ring fingers). Intrinsic muscles were found to be involved in the contracture of 14 of these digits. Two unique contracture patterns were identified: type I contracture, which involves a lateral digital cord originating from intrinsic muscle-tendon units and contracting only the proximal interphalangeal joint; and type II contracture, which involves a spiral cord receiving contribution from intrinsic muscle-tendon units and contracting both the metacarpophalangeal and proximal interphalangeal joints. The frequency of type I and type II contractures was 6 percent and 12 percent, respectively. CONCLUSION: Intrinsic hand muscles may contribute to Dupuytren's disease in the middle digits, and the authors suggest resecting cords as close as possible to their musculotendinous origin to improve postoperative outcomes.

Effect of Gonadal Hormones on Neurotransmitters Implicated in the Pathophysiology of Obsessive-Compulsive Disorder: A Critical Review.

Obsessive-compulsive disorder (OCD) is a relatively common neuropsychiatric disorder affecting between 1.6 and 3.2% of the population. A number of studies have previously reported increased incidence of OCD, or exacerbation of preexisting symptoms in females during reproductive events. Since these periods are known to involve fluctuating levels of gonadal hormones, these steroids have been suggested to be involved in modulating the course of the disorder. However, to date, only a few studies have measured hormone levels and obsessive-compulsive (OC) symptoms concurrently; thus, direct evidence for this relationship is limited. In turn, investigations into neurotransmission in OC individuals have been more extensive, and have implicated the serotonergic, dopaminergic, and glutamatergic neurotransmitter systems in OCD pathology. There is evidence suggesting that reproductive hormones estrogens and progesterone can modulate neurotransmission in the aforementioned signaling pathways by regulating the expression of receptors and channels, as well as the synthesis and release of the neurotransmitter itself. Overall, estrogen and progesterone appear to enhance serotonin signaling, which has been associated with improved OC symptoms. The effect of the gonadal hormones in dopaminergic and glutamatergic signaling is much more variable, highlighting the need for further research in this field. The existing evidence shows that gonadal hormones can have profound impacts on neurotransmission in the brain, leading to the conclusion that the hormonal fluctuations during reproductive events are a plausible factor contributing to the change in OCD course during these times.