The Short Musculoskeletal Function Assessment: a study of the reliability, construct validity and responsiveness in patients sustaining trauma.

OBJECTIVE: To assess test-retest reliability, construct validity and responsiveness of the Dutch Short Musculoskeletal Function Assessment (SMFA-NL) in patients who sustained acute physical trauma. DESIGN: A longitudinal cohort study. SETTING: A level 1 trauma center in The Netherlands. SUBJECTS: Patients who required hospital admission after sustaining an acute physical trauma. INTERVENTION: Patients completed the SMFA-NL at six weeks, eight weeks and six months post-injury. MAIN MEASURE: The measures used were The Dutch Short Musculoskeletal Function Assessment. Test-retest reliability (between six and eight weeks post-injury) using intraclass correlation coefficients, the smallest detectable change and Bland and Altman plots. Construct validity (six weeks post-injury) and responsiveness (between six weeks and six months post-injury) were evaluated using the hypothesis testing method. RESULTS: A total of 248 patients (mean age: 46.5, SD: 13.4) participated, 145 patients completed the retest questionnaires (eight weeks) and 160 patients completed the responsiveness questionnaires (six months). The intraclass correlation coefficients indicated good to excellent reliability on all subscales (0.80 to 0.98). The smallest detectable change was 17.4 for the Upper Extremity Dysfunction subscale, 11.0 for the Lower Extremity Dysfunction subscales, 13.9 for the Problems with Daily Activities subscale and 16.5 for the Mental and Emotional Problems subscale. At group level, the smallest detectable change ranged from 1.48 to 1.96. A total of 86% of the construct validity hypotheses and 79% of the responsiveness hypotheses were confirmed. CONCLUSION: This study showed that the SMFA-NL has good to excellent reliability, sufficient construct validity and is able to detect change in physical function over time.

The influence of computer-assisted surgery on rotational, coronal and sagittal alignment in revision total knee arthroplasty.

BACKGROUND: Despite good results of primary total knee arthroplasty (TKA), the number of revision total knee arthroplasties (rTKAs) is rising. Proper implant position is essential, since malposition leads to worse clinical outcome. In rTKA most anatomical landmarks have disappeared because of extensive bone loss, making it more difficult to adequately implant the knee prosthesis. In primary TKA, computer-assisted surgery (CAS) leads to better prosthetic alignment than mechanical navigation guides. Literature about the use of CAS in rTKA is scarce though, and the effect on rotational prosthetic alignment has not been investigated yet. Hence the primary objective of this study is to compare rotational prosthetic alignment when using CAS in rTKA compared to a mechanical navigation guide. Secondary objectives are to compare prosthetic alignment in the coronal and sagittal planes. It is hypothesized that CAS leads to better rotational, coronal and sagittal prosthetic alignment when used during rTKA. METHODS/DESIGN: A prospective clinical intervention study with use of a historical control group will be conducted. Forty-four patients with a minimum age of 18 to be admitted for CAS-rTKA between September 2012 and September 2015 will be included in the intervention group. Forty-four patients with a minimum age of 18 who underwent rTKA with the use of a mechanical navigation guide between January 2002 and April 2012 will form the historical control group. Both groups will be matched according to gender and type of revision prosthesis. Rotational prosthesis alignment will be evaluated using a CT-scan of the knee joint. DISCUSSION: Proper implant position is essential, since malposition leads to worse clinical outcome. Several studies show a significantly positive influence of CAS on prosthetic alignment in primary TKA, but literature about the use of CAS in rTKA is limited. The purpose of this study is thus to investigate the influence of CAS during rTKA on postoperative prosthetic alignment, compared to mechanical navigation guides. TRIAL REGISTRATION: Netherlands National Trial Register NTR3512.

Psychological Factors Change During the Rehabilitation of an Achilles Tendon Rupture: A Multicenter Prospective Cohort Study.

OBJECTIVE: The authors sought to gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR. METHODS: Fifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire); kinesiophobia (Tampa Scale for Kinesiophobia); expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score); and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR. RESULTS: Psychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation, and performance. CONCLUSION: Psychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified. IMPACT: According to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population. LAY SUMMARY: With Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement can affect rehabilitation outcome. A physical therapist can help recognize these factors.

Pseudotumours, cobalt and clinical outcome in small head metal-on-metal versus conventional metal-on-polyethylene total hip arthroplasty.

BACKGROUND: Metal-on-metal total hip arthroplasty (MoM THA) is associated with the formation of pseudotumours. Studies mainly concern pseudotumour formation in large head MoM THA. We performed a long-term follow-up study, comparing pseudotumour incidence in small head metal-on-metal (SHMoM) THA with conventional metal-on-polyethylene (MoP) THA. Predisposing factors to pseudotumour formation were assessed. METHODS: From a previous randomised controlled trial comparing SHMoM (28 mm) cemented THA with conventional MoP cemented THA, patients were screened using a standardised CT protocol for the presence of pseudotumours. Serum cobalt levels and functional outcome were assessed. RESULTS: 56 patients (33 MoP and 23 MoM) were recruited after mean follow-up of 13.4 years (SD 0.5). The incidence of pseudotumours was 1 (5%) in the SHMoM THA cohort and 3 (9%) in the MoP THA cohort. Prosthesis survival was 96% for both SHMoM and MoP THAs. Serum cobalt levels did not exceed acceptable clinical values (<5 µg/L) whereas no differences in cobalt levels were detected at follow-up between both groups. Oxford and Harris Hip Scores were good and did not differ between SHMoM and MoP THA. CONCLUSIONS: This long-term follow-up study shows a low incidence of pseudotumour formation and good functional outcome in cemented head-taper matched SHMoM and MoP THA.