Force Required to Maintain Reduction of a Preexisting Scapholunate Dissociation.

PURPOSE: To determine the force required to maintain reduction of Geissler grade 4 scapholunate dissociations during physiological wrist motions. METHODS: Fresh-frozen cadaveric wrists with Geissler grade 4 scapholunate dissociations were identified by arthroscopy. Following reduction, a load cell was attached to measure the force across the scapholunate joint at a neutral position and during 4 different wrist motions re-created using a servohydraulic wrist simulator, including a large flexion-extension motion (FEM), small and large dart-thrower's motions (DTMs), and a large DTM with ulnar offset. RESULTS: Five wrists with isolated preexisting scapholunate interosseous ligament (SLIL) tears were analyzed. The force required to maintain reduction was significantly greater in extension than in flexion during the large FEM and large DTM with ulnar offset. The forces were significantly larger in this study of preexisting SLIL dissociations compared with results from a prior study of acutely sectioned SLILs. In addition, forces to maintain reduction during DTMs were significantly less than forces during FEMs. Finally, a set of 3 wrists with preexisting scapholunate and lunotriquetral interosseous ligament (LTIL) tears were identified and had significantly decreased forces to maintain reduction at maximum extension and had decreased maximal forces during a cycle of motion compared with the wrists with isolated SLIL tears. CONCLUSIONS: The forces required to maintain reduction of a Geissler grade 4 wrist are higher than forces after acutely sectioned SLIL. The forces are greater in extension than in flexion and less during the DTM compared with the FEM. Wrists with both SLIL and LTIL tears required less force to maintain reduction than those with isolated SLIL tears. CLINICAL RELEVANCE: This study helps determine the strength of reconstruction required to maintain reduction of a Geissler grade 4 scapholunate dissociation.

Development of a 5As-based technology-assisted weight management intervention for veterans in primary care.

BACKGROUND: Obesity is a worldwide epidemic, and its prevalence is higher among Veterans in the United States. Based on our prior research, primary care teams at a Veterans Affairs (VA) hospital do not feel well-equipped to deliver effective weight management counseling and often lack sufficient time. Further, effective and intensive lifestyle-based weight management programs (e.g. VA MOVE! program) are underutilized despite implementation of systematic screening and referral at all VA sites. The 5As behavior change model (Assess, Advise, Agree, Assist, Arrange) is endorsed by the United States Preventive Service Task Force for use in counseling patients about weight management in primary care and reimbursed by Medicare. In this paper, we describe the iterative development of a technology-assisted intervention designed to provide primary care-based 5As counseling within Patient-Centered Medical Homes without overburdening providers/healthcare teams. METHODS: Thematic analyses of prior formative work (focus groups with patients [n = 54] and key informant interviews with staff [n = 25]) helped to create a technology-assisted, health coaching intervention called Goals for Eating and Moving (GEM). To further develop the intervention, we then conducted two rounds of testing with previous formative study participants (n = 5 for Round 1, n = 5 for Round 2). Each session included usability testing of prototypes of the online GEM tool, pilot testing of 5As counseling by a Health Coach, and a post-session open-ended interview. RESULTS: Three main themes emerged from usability data analyses: participants' emotional responses, tool language, and health literacy. Findings from both rounds of usability testing, pilot testing, as well as the open-ended interview data, were used to finalize protocols for the full intervention in the clinic setting to be conducted with Version 3 of the GEM tool. CONCLUSIONS: The use of qualitative research methods and user-centered design approaches enabled timely detection of salient issues to make iterative improvements to the intervention. Future studies will determine whether this intervention can increase enrollment in intensive weight management programs and promote clinically meaningful weight loss in both Veterans and in other patient populations and health systems.