Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty.

BACKGROUND: COVID-19 has caused unprecedented delays in elective orthopedic surgery. Understanding patients' perceptions of the disruptions in care and their willingness to reengage the healthcare system are crucial to planning the resumption of elective care. QUESTIONS/PURPOSES: The purpose of this study was to elicit patient perceptions about delays in total joint arthroplasty during the COVID-19 pandemic. METHODS: We identified a consecutive series of patients who experienced COVID-19-driven delays to scheduled total hip or knee arthroplasty at an urban, academic medical center in the Southeastern United States. A 20-item survey was administered via telephone. Answers were recorded and descriptive statistics were performed. A post hoc χ-square analysis compared characteristics and outlooks of patients who did and did not immediately desire surgery. RESULTS: Of 111 patients (64% of those identified) who met inclusion criteria and completed the survey, 96% said they felt that they were treated fairly and 90% said that the surgical delay was in their best interest; 68% reported emotional distress from the delay, but 45% reported a desire to wait longer for the pandemic to subside. Lower joint-function scores, higher pain levels, higher pain catastrophizing scores, and longer latency from personally deciding to pursue surgery were associated with the reported need for immediate surgery. CONCLUSION: Overall, patients reported that they understood the need for elective surgical delays during the COVID-19 pandemic. However, the psychological implications they reported were not negligible. Patient preference for immediate reengagement with the healthcare system was dichotomous, with many patients favoring precautionarily furthering the delay. Understanding these preferences will help optimize elective orthopedic care during unprecedented times.

Measuring ambulation with wrist-based and hip-based activity trackers for children with cerebral palsy.

AIM: To assess the accuracy of consumer available wrist-based and hip-based activity trackers in quantitatively measuring ambulation in children with cerebral palsy (CP). METHOD: Thirty-nine children (23 males, 16 females; mean age [SD] 9y 7mo [3y 5mo]; range 4-15y) with CP were fitted with trackers both on their wrist and hip. Each participant stood for 3 minutes, ambulated in a hallway, and sat for 3 minutes. The number of steps and distance were recorded on trackers and compared to manually counted steps and distance. Pearson correlation coefficients were determined for the number of steps during ambulation from each tracker and a manual count. Mean absolute error (MAE) and range of errors were calculated for steps during ambulation for each tracker and a manual count and for distance for each tracker and hallway distance. RESULTS: For the number of steps, a weak inverse relationship (r=-0.033) was found for the wrist-based tracker and a strong positive relationship (r=0.991) for the hip-based tracker. The MAE was 88 steps for the wrist-based and seven steps for the hip-based tracker. The MAE for distance was 0.06 miles for the wrist-based and 0.07 miles for the hip-based tracker. INTERPRETATION: Only the hip-based tracker provided an accurate step count; neither tracker was accurate for distance. Thus, ambulation of children with CP can be accurately quantified with readily available trackers. WHAT THIS PAPER ADDS: Consumer available activity trackers accurately measure ambulation in children with cerebral palsy (CP). The hip-based tracker is more accurate than the wrist-based tracker for children with CP. The hip-based Fitbit activity tracker accurately measures step counts of children with CP during ambulation.

MEDICIÓN DE LA AMBULACIÓN CON RASTREADORES DE ACTIVIDAD DE MUÑECA Y CADERA PARA NIÑOS CON PARÁLISIS CEREBRAL: OBJETIVO: Evaluar la precisión de los rastreadores de actividad basados ​​en la muñeca y en la cadera disponibles para el consumidor en la medición cuantitativa de la ambulación en niños con parálisis cerebral (PC) METODO: Treinta y nueve niños (23 varones, 16 mujeres; edad media [DS] 9 años y 7 meses [3 años y 5 meses]; rango 4-15 años) con PC fueron equipados con rastreadores en su muñeca y cadera. Cada participante se paró durante 3 minutos, caminó por un pasillo y se sentó durante 3 minutos. La cantidad de pasos y la distancia se registraron en los rastreadores y se compararon con los pasos y la distancia contados manualmente. Los coeficientes de correlación de Pearson se determinaron para el número de pasos durante la ambulación de cada rastreador y un conteo manual. El error absoluto medio (MAE) y el rango de errores se calcularon para los pasos durante la ambulación y la distancia del pasillo para cada rastreador y para el conteo manual. RESULTADOS: Para el número de pasos, se encontró una relación inversa débil (r = -0.033) para el rastreador ubicado en la muñeca y una relación positiva fuerte (r = 0.991) para el rastreador ubicado en la cadera. El MAE fue de 88 pasos para la muñeca y siete pasos para el rastreador de la cadera. El MAE para la distancia fue de 0.06 millas para la muñeca y 0.07 millas para el rastreador ubicado en la cadera. INTERPRETACIÓN: Solo el rastreador ubicado en la cadera proporcionó un conteo de pasos preciso; ninguno de los rastreadores era preciso para la distancia. Por lo tanto, la deambulación de los niños con PC se puede cuantificar con precisión con rastreadores fácilmente disponibles.

MEDINDO A DEAMBULAÇÃO COM RASTREADOR DE ATIVIDADE POSICIONADO NO PUNHO E QUADRIL COMERCIALMENTE DISPONÍVEL EM CRIANÇAS COM PARALISIA CEREBRAL: OBJETIVO: Avaliar a precisão de rastreadores de atividade posicionados no punho e quadril, disponíveis para o consumidor, para mensurar qualitativamente a deambulação em crianças com paralisia cerebral (PC). MÉTODO: Trinta e nove crianças (23 meninos, 16 meninas; média da idade [DP] 9 anos e 7 meses [3 anos e 5 meses]; amplitude 4-15 anos) com PC foram equipados com rastreadores em punho e quadril. Cada participante permaneceu em pé durante 3 minutos, andando em um corredor, e sentado por 3 minutos. O número de passos e distância foram registrados nos rastreadores e comparados com os passos e distância medidos manualmente. Coeficientes de correlação de Pearson foram determinados para o número de passos durante a deambulação para cada rastreador e a contagem manual. O Erro Médio Absoluto (EMA) e variância de erros foram calculados para os passos durante a deambulação para cada rastreador e a contagem manual e para a distância de cada rastreador e a distância do corredor. RESULTADOS: Para o número de passos, uma relação inversa fraca (r=-0,033) foi encontrada entre o rastreador do punho e uma relação positiva forte (r=0,991) para o reastreador do quadril. A EMA foi de 88 passos para o rastreador do punho e sete passos para o rastreador do quadril. A EMA para a distância foi de 0,06 milhas (9,66km) para o rastreador do punho e 0,07 milhas (11,26km) para o rastreador do quadril. INTERPRETAÇÃO: Somente o rastreador do quadril forneceu a contagem precisa dos passos; nenhum rastreador foi preciso para a distância. Assim, a deambulação em crianças com PC pode ser quantificada com precisão com os rastreadores atualmente disponíveis.

Perfusion is Not Measurably Decreased in Idiopathic Clubfoot.

BACKGROUND: Vascular aberration has been accepted as a potential etiology of clubfoot, and abnormal vasculature has been observed in as high as 85% of children with severe clubfoot. The perfusion index (PI) corresponds to the ratio of pulsatile to nonpulsatile blood flow at a monitoring site and can be used to quantify perfusion of the extremities. The purpose of this study was to use PI to compare the perfusion of clubfeet to controls in order to further assess the role of abnormal vasculature in clubfoot. METHODS: A Masimo Radical 7 Pulse Oximeter (Masimo Corporation, Irvine, California) was used to measure the PI and oxygen saturation (SpO2) of the feet of children 5 years of age and younger with and without clubfoot. The sensor was placed on the great toe. Patients with clubfoot undergoing non-operative treatment and control patients undergoing treatment in a clinic for orthopedic concerns not involving the foot and with no known vascular issues were assessed. The PI and SpO2 for the following three groups were compared: 1. affected feet of patients with bilateral or unilateral clubfoot, 2. unaffected feet of patients with unilateral clubfoot, and 3. control feet. RESULTS: One hundred and twenty-eight patients were enrolled, 64 with clubfoot (31 bilateral and 33 unilateral) and 64 controls. No significant differences in PI or SpO2 were found between: 64 clubfeet and 64 feet of controls (PI of 2.9 vs. 2.9, p = 0.984; SpO2 of 97.1 vs. 98.1, p = 0.192); unaffected feet of 30 patients with unilateral clubfoot and 64 controls (PI of 3.0 vs.2.9, p = 0.907; SpO2 of 96.9 vs. 98.1, p = 0.224); and affected and unaffected feet of 30 patients with unilateral clubfoot (PI of 3.3 vs.3.0, p = 0.500; SpO2 of 97.4 vs. 96.9, p = 0.527). CONCLUSIONS: No difference was observed in the PI or SpO2 when comparing affected clubfoot limbs with unaffected limbs, suggesting that vascular anomalies cannot fully explain the development of clubfoot.