The Popularity of Outcome Measures for Hip and Knee Arthroplasties.

BACKGROUND: The optimal methods of determining outcomes following hip and knee arthroplasty remain controversial. The objectives of this study were to determine the most frequently used outcome measures in randomized controlled trials (RCT) and study protocols registered with clinical trials registries (CTR) on hip and knee arthroplasty. METHODS: A systematic search strategy was undertaken to identify the outcome measures used in RCT and CTR following joint arthroplasty. Databases searched included Embase, Ovid MEDLINE (including In-Process), Cochrane Central Register of Controlled Trials, CINAHL Plus, clinicaltrials.gov, ISRCTN registry, and ANZCTR. Differences in the use of outcome measures between RCT and CTR were assessed using logistic regression. RESULTS: There were 291 RCT and 113 CTR on hip arthroplasty and 452 RCT and 184 CTR on knee arthroplasty that met the inclusion criteria. The most popular outcome measures were the Harris Hip Score and the Knee Society Score. Multiple outcome measures were used in greater than 50% of the included studies. The Oxford Hip Score, Oxford Knee Score, EuroQol-5D, and Knee Injury and Osteoarthritis Outcome Score (all P < .001) were used in significantly more CTR than RCT. CONCLUSION: There is a clear preference for the use of the Harris Hip Score and Knee Society Score, contrary to existing international guidelines and reviews on the topic. Both measures require clinician input, which potentially influences their validity and increases their overall administration cost. Some patient-reported outcome measures, such as the Oxford Hip and Knee Scores, EuroQol-5D, and KOOS, appear to be increasing in popularity.

Measuring Recovery After Ankle Fractures: A Systematic Review of the Psychometric Properties of Scoring Systems.

Recovery after ankle fractures places a considerable burden on patients both short and long term. Numerous tools called patient-reported outcome measures (PROMs) have been developed to measure the outcome of ankle fractures. They can assist clinicians to measure the effect, guide intervention, and assess the rate of recovery. We identified and evaluated the psychometric properties of PROMs used in the assessment of ankle fractures. In a systematic search, we examined 4 databases from inception to December 4, 2016. Search terms included ankle fracture, ankle pain, disability, gait, questionnaire, and PROMs. Reference lists were also examined. The inclusion criteria were English studies and adult populations. The psychometric properties of the identified PROMs were examined, including internal consistency, test-retest reliability, validity, floor-ceiling effects, and minimally important clinical differences. We identified 22 PROMs relating to ankle pain and disability. Only 5 were specifically used for ankle fractures. The 36-item short-form health survey and short musculoskeletal functional assessment reported floor-ceiling effects, and the lower extremity functional scale reported good responsiveness and content validity, although these are not tools specifically related to ankle fractures. The ankle-fracture outcome of rehabilitation measure (A-FORM) and the Olerud and Molander questionnaire were ankle fracture specific and assessed for internal consistency and validity. Clinicians should use the most appropriate PROM to evaluate patients' recovery from ankle fractures. The A-FORM currently has the most appropriate evidence supporting its use as a PROM for ankle fracture management and rehabilitation.

Impaired health-related quality of life, psychological distress, and productivity loss in younger people with persistent shoulder pain: a cross-sectional analysis.

PURPOSE: To investigate wellbeing and work impacts in younger people with persistent shoulder pain. MATERIALS AND METHODS: People aged 20-55 years with shoulder pain of >6 weeks' duration (excluding those with recent fracture or dislocation) were recruited from orthopaedic clinics at three major public hospitals. Health-related quality of life (HRQoL) and psychological distress were evaluated using the Assessment of Quality of Life (AQoL) and K10 instruments and compared to population norms. Shoulder-related absenteeism and presenteeism were quantified using the Work Productivity and Activity Impairment (WPAI) Questionnaire. RESULTS: Of the 81 participants (54% male), 69% had shoulder pain for over 12 months. Substantial HRQoL impairment was evident (mean reduction from population norms 0.33 AQoL units, 95% CI -0.38 to -0.27; minimal important difference 0.06 AQoL units). High or very high psychological distress was three times more prevalent among participants than the general population (relative risk 3.67, 95% CI 2.94 to 4.59). One-quarter of participants had ceased paid employment due to shoulder pain and 77% reported shoulder-related impairment at work. CONCLUSIONS: The broader impacts of painful shoulder conditions on younger people extend well beyond pain and upper limb functional limitations. In particular, the work-related impacts should form a routine part of patient assessment and rehabilitation.Implications for rehabilitationPersistent shoulder pain in younger people (aged 20-55 years) is associated with substantially reduced health-related quality of life and greater psychological distress, compared to population norms, as well as work participation and productivity impacts.As rotator cuff conditions, shoulder capsule pathology, and glenohumeral instability are relatively common, our data suggest that persistent shoulder pain is likely to have a high community impact among people of working age.Information resources that people with painful shoulder conditions can share with their families, employers, and colleagues may assist others to better understand the broader impacts of these conditions.Work-related challenges associated with shoulder pain should be considered within routine clinical care, and may require referral to an occupational health clinician or vocational rehabilitation service.

Quantifying the lumbar spine movements of surgeons during surgical lists in a teaching hospital.

BACKGROUND: Low back pain (LBP) is a common occupational musculoskeletal complaint among health professionals. No research has quantified lumbar movement patterns in the surgical workplace, identifying 'at risk' behaviours with objective measures. This project aimed to identify lumbar movement patterns and change in LBP of surgeons and surgical trainees during a surgical list. METHODS: Surgeons or surgical trainees were recruited in a tertiary metropolitan hospital. Low back movements were quantified in real time via a monitoring system. This measured three-dimensional movement, velocity, acceleration and orientation to gravity during a typical theatre session. Pre- and post-surgery LBP, or low back injury measures of functional disability were quantified using the Oswestry disability index. Mean (standard deviation) and median (interquartile range) low back movement patterns were described. A Wilcoxon signed-rank test determined differences in LBP recorded from beginning to end of recording periods. RESULTS: Participants (n = 28) recorded data for a mean (standard deviation) of 6.1 (2.2) h. On average, 27.7 lumbar flexion events were recorded per monitoring session, with flexion movements held for >30 s an average of 5.6 times. Many of the flexion events were considered low range (between 20° and 40°) with an average of 19.1 events per session. Orthopaedic trainees recorded the highest average of lumbar and sustained lumbar flexions per hour (4.13 times). LBP significantly increased over the work day (z = -2.53, P = 0.012). CONCLUSION: This study provides a base for the understanding of low back movement patterns during surgery. This data may be useful in helping surgeons to identify their 'high risk' movements and prevent low back symptoms.

Two and a half years on: data and experiences establishing a 'Virtual Clinic' for joint replacement follow up.

BACKGROUND: We use a 'Virtual Clinic' for follow up of hip and knee replacement patients. The aim of this study was to investigate patient compliance, pain and function, revision rates and surgeon experience using this system. METHODS: All hip and knee replacements conducted from 2000 onwards were suitable for 'Virtual Clinic' review. Between July 2014 and December 2016, all patients due for follow up (at 1, 5 and 7 years post-operatively, or biennially thereafter) were mailed an Oxford Hip or Knee Score and a request for a radiograph. A surgeon reviewed the questionnaire and radiograph and decided whether face-to-face review was necessary. We calculated compliance as the percentage of eligible patients who completed the 'Virtual Clinic'. We used retrospective review of medical records for all clinic participants to analyse Oxford scores, disposition following appointment, and revision rates. We reviewed all clinic participants in December 2017 to identify any further revisions. Surgeon feedback was assessed by emailed survey. RESULTS: A total of 2076 patients were due for follow up. 1405 patients were contactable, and 710 completed the process. We calculated a 36% compliance rate. Surgeons decided 162 (23%) patients with a mean Oxford score of 24.2 required face-to-face assessment. This identified 13 patients needing revision. One other patient was revised for loosening which developed between 'Virtual Clinic' appointments. Surgeon feedback indicated the inclusion of a 'comment' section on the questionnaire as particularly useful. DISCUSSION: We describe our adoption of a 'Virtual Clinic' for joint replacement follow up. We recommend this system as a practical method of following up patients.

Why do surgeons receive more complaints than their physician peers?

BACKGROUND: Compared with other doctors, surgeons are at an increased risk of medicolegal events, including patient complaints and negligence claims. This retrospective study aimed to describe the frequency and nature of complaints involving surgeons compared with physicians. METHODS: We assembled a national data set of complaints about surgeons and physicians lodged with medical regulators in Australia from 2011 to 2016. We classified the complaints into 19 issues across four domains: treatment and procedures, other performance, professional conduct and health. We assessed differences in complaint risk using incidence rate ratios (IRRs). Finally, we used a multivariate model to identify predictors of complaints among surgeons. RESULTS: The rate of complaints was 2.3 times higher for surgeons than physicians (112 compared with 48 complaints per 1000 practice years, P < 0.001). Two-fifths (41%) of the higher rate of complaints among surgeons was attributable to issues other than treatments and procedures, including fees (IRR = 2.68), substance use (IRR = 2.10), communication (IRR = 1.98) and interpersonal behaviour (IRR = 1.92). Male surgeons were at a higher risk of complaints, as were specialists in orthopaedics, plastic surgery and neurosurgery. DISCUSSION: Surgeons are more than twice as likely to attract complaints as their physician peers. This elevated risk arises partly from involvement in surgical procedures and treatments, but also reflects wider concerns about interpersonal skills, professional ethics and substance use. Improved understanding of these patterns may assist efforts to reduce harm and support safe practise.

Exploring the personal burden of shoulder pain among younger people in Australia: protocol for a multicentre cohort study.

INTRODUCTION: Persistent musculoskeletal conditions can impact profoundly on younger people's quality of life, psychological distress and capacity to work, as shown by previous research involving younger people with osteoarthritis. The personal impacts, in particular, work and parenting impacts, of other musculoskeletal conditions (such as persistent shoulder pain) on younger patient groups remain poorly understood. Furthermore, the personal financial burden associated with managing musculoskeletal conditions is rarely documented. This study aims to investigate well-being, work participation and productivity, shoulder-related parenting disability and out-of-pocket healthcare expenditure among younger people with shoulder pain and evaluate changes over 12 months. METHODS AND ANALYSIS: One hundred and fifty people aged 20-55 years with shoulder pain of more than 6 weeks' duration (excluding those with recent history of fracture or dislocation) will be recruited for this cohort study. Participants will be recruited from three major public hospitals in Victoria, Australia, following screening of orthopaedic outpatient clinics lists and referrals. Participants will be asked to complete a baseline questionnaire and 2-week healthcare costs diary, with follow-up data collected at 12 months. Patient-reported outcomes will be collected, including health-related quality of life (HRQoL), shoulder pain and function, psychological distress, shoulder-related parenting disability and work productivity. Information on sociodemographics, employment, health services utilisation and shoulder-related healthcare expenditure will also be collected. Descriptive analysis of baseline data will provide a comprehensive snapshot of the personal burden of shoulder pain. Baseline HRQoL and psychological distress data will be compared with Australian population norms to provide context around well-being. Associations between sociodemographic factors and patient-reported outcomes will be evaluated using univariate and multivariate analyses. Changes in patient-reported outcomes from baseline to 12 months will be analysed using paired t-tests. ETHICS AND DISSEMINATION: Ethics approval has been obtained. The study findings will be submitted to peer-reviewed journals and presented at relevant scientific meetings.

Preferences for Disease-Related Education and Support Among Younger People With Hip or Knee Osteoarthritis.

OBJECTIVE: To explore the usefulness and accessibility of different delivery modes of disease-related education and support, as perceived by younger people with osteoarthritis (OA). METHODS: People ages 20-55 years with hip or knee OA were recruited from 3 major Australian public hospitals and the community (n = 147). Data were collected on use of disease-related education and support services, as well as perceived usefulness and accessibility of delivery modes including group-based programs, online resources, telephone helplines, mailed information, social media, and mobile applications (rated on visual analog scales from 1-10; higher scores indicate greater usefulness or accessibility). RESULTS: Very few participants had used social media (5%), group self-management programs (3%), or telephone helplines (2%) to obtain OA information. Mailed information packs and online education programs were considered the most useful (median usefulness scores 8.0 and 7.0, respectively) and accessible methods (median accessibility scores 10.0 and 9.0, respectively) for providing OA education and support. Social media was perceived as least useful (median usefulness score 2.0) and least accessible; 45% of participants considered it "not at all useful," while 35% reported it would be "very difficult" to access OA education and support by this means. Less educational attainment was associated with greater perceived difficulty in accessing online/electronic delivery modes, while people in paid work perceived easier access. CONCLUSION: These data highlight the value of mailed information and online education to younger people with OA and can be used to develop targeted resources for individuals of working age. Social media was not a highly valued source of disease-related education and support.