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1.
Bone Joint J ; 102-B(1): 42-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888361

RESUMO

AIMS: Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture. METHODS: A total of 744 adults with an isolated fracture of the proximal humerus, elbow, or distal radius completed PROMs. Due to multicollinearity of patient engagement and psychosocial variables, we generated a single variable combining measures of engagement and psychosocial factors using factor analysis. We then performed multivariable analysis with p < 0.10 on bivariate analysis. RESULTS: Patient engagement and psychosocial factors combined to form a single factor (factor 1) accounting for 20% (QuickDASH, semi-partial R2 = 0.20) and 14% (PROMIS UE PF, semi-partial R2 = 0.14) of the variation in limitations six to nine months after fracture. Factor 1 also accounted for 17% (NRS-C, semi-partial R2 = 0.17) of variation in satisfaction with care, and 21% (NRS-S, semi-partial R2 = 0.21) of variation in satisfaction with services. Demographic factors (age, sex, work status) and measures of greater pathophysiology (type of fracture, high-energy injury, post-surgical complications), accounted for much less variation. CONCLUSION: Patients who actively manage their health and demonstrate effective emotional and social functioning share a common underlying trait. They have fewer limitations and greater satisfaction with care during recovery from upper limb fractures. Future efforts should focus on evaluating initiatives that optimize patient engagement, such as patient education, coaching, and a communication strategy for healthcare professionals. Cite this article: Bone Joint J 2020;102-B(1):42-47.


Assuntos
Articulação do Cotovelo/lesões , Comportamentos Relacionados com a Saúde , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Participação do Paciente , Fraturas do Rádio/cirurgia , Atividades Cotidianas , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Ósseas , Promoção da Saúde , Humanos , Fraturas do Úmero/psicologia , Fraturas Intra-Articulares/psicologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Estudos Prospectivos , Fraturas do Rádio/psicologia , Autoeficácia , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
2.
N C Med J ; 78(5): 318-321, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28963267

RESUMO

The increase in the number of active and independent older adults has, unfortunately, led to an epidemic of musculoskeletal injuries in this population. Chronic pain and functional decline are common sequelae from these injuries and have a major impact on quality of life. Optimizing care for these patients will likely require educating patients about analgesic risks and benefits, promoting physical activity, identifying and addressing the psychological impacts of the injury, and coordinating care between emergency physicians, orthopedists, and primary providers. Active management of acute musculoskeletal pain has the potential to prevent the transition to chronic pain and disability in this vulnerable population.


Assuntos
Atitude Frente a Saúde , Dor Crônica , Sistema Musculoesquelético/lesões , Recuperação de Função Fisiológica , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Dor Crônica/prevenção & controle , Avaliação da Deficiência , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/psicologia , Fraturas do Úmero/reabilitação , Fraturas do Úmero/terapia , Masculino , Modalidades de Fisioterapia
3.
Injury ; 46(4): 693-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25697858

RESUMO

PURPOSE: The aim of this study was to determine patient variables that are independent predictors of validated functional outcome scores after humeral diaphyseal fractures. METHODS: Adult patients with humeral shaft fractures were retrospectively recruited from a level 1 trauma centre over an 8-year period. Basic demographic information was obtained along with Disabilities of the Arm, Shoulder and Hand (DASH), Simple Shoulder Test (SST) and Short Form 12 (SF-12) physical component summary (PCS) and mental component summary (MCS). Regression analysis was performed to identify patient factors associated with satisfactory outcomes, defined as DASH<21; SST≥10; PCS≥40; and MCS≥40. Of 95 eligible patients, 77 were recruited. Participants had an average age of 47±20 years. Forty-five patients were treated with surgery and 32 healed non-operatively. The average follow-up was 48±29 months. RESULTS: Satisfactory DASH scores decreased with increase in age (odds ratio (OR) 0.95; P=0.023). Satisfactory SST scores were more likely in patients without a history of psychiatric illness (OR 6.3; P=0.01). Satisfactory SF-12 PCS scores were more likely with no psychiatric history (OR 12; P=0.007) and in patients with private insurance (OR 11.4; P=0.03), but these scores decreased with rising Charlson comorbidity index (CCI; OR 0.50; P=0.023). Satisfactory SF-12 MCS scores increased in the absence of psychiatric history (OR 39; P=0.003), and decreased with rising CCI score (OR 0.54; P=0.035). Analysis of patients younger than 50 years of age (n=38) revealed that the absence of psychiatric history increased the odds of satisfactory DASH scores (OR 10.4; P=0.04). Patients aged ≥50 (n=39) had worse DASH scores with increasing age (OR 0.89; P=0.037), better SST scores with middle-third fractures compared to proximal (OR 7.8; P=0.039), better SF-12 PCS with no psychiatric history (OR 16.1; P=0.018) and worse scores with rising CCI (OR 0.50; P=0.036), while rising CCI decreased the odds of satisfactory SF-12 MCS scores (OR 0.47; P=0.046). Treatment modality, associated fractures and classification as "high energy" mechanism were not associated with outcome. CONCLUSION: Patient age, history of psychiatric illness, insurance type, fracture location and Charlson comorbidity index scores had a statistically significant effect on patient-reported functional outcomes following treatment of humeral shaft fractures, regardless of treatment modality, injury mechanism and associated fractures. The impact of these variables may be age dependent.


Assuntos
Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas do Úmero/cirurgia , Transtornos Mentais/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Adulto , Fatores Etários , Feminino , Fixação Interna de Fraturas/psicologia , Humanos , Fraturas do Úmero/epidemiologia , Fraturas do Úmero/psicologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
4.
Injury ; 41(12): 1277-83, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20696426

RESUMO

Minimal invasive plate osteosynthesis (MIPO) not only meets the criteria of a "biological" osteosynthesis by minimising invasivity as well as iatrogenic soft tissue damage, but can also provide adequate stability for fracture healing and early functional aftertreatment. Up to date, only few publications report on MIPO of humeral shaft fractures mainly using the anterolateral deltopectoral approach for proximal plate insertion. Objective of the present study was to assess the feasibility and clinical outcome of MIPO for metadiaphyseal fractures of the proximal humerus through a lateral approach using angular stable long PHILOS(®)-plates. We retrospectively evaluated 29 patients (mean age 77 years, range 48-95 years) with displaced metadiaphyseal fractures of the proximal humerus treated with MIPO technique. For the first time, an angular stable long PHILOS(®)-plate through a lateral deltoid-split approach proximally and a brachialis/brachioradialis intermuscular approach with exposure of the radial nerve distally, were used. There were no infections and no iatrogenic injuries to the axillary and radial nerve. One patient showed subacromial impingement and one patient had to be reoperated for redislocation of the distal fragment with screw breakage, which was most likely due to incorrect screw placement. This patient was successfully operated using the same method and implant. Besides one patient who refused further follow-up, 28 patients could be followed up to a mean of 8 months (range 3-12 months) each with an entirely healed fracture. Furthermore, patient's quality of life was documented using the SF-36 questionnaire. Comparison with published United States normative data showed no significant deficits in the physical as well as in the mental domains 8 months after MIPO. Minimal invasive long PHILOS(®)-plate osteosynthesis using a combined lateral deltoid-split and brachialis/brachioradialis intermuscular approach proved to be a safe procedure for the treatment of metadiaphyseal fractures of the proximal humerus with low morbidity and full restoration of quality of life in these elderly patients.


Assuntos
Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas do Úmero/cirurgia , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Estudos de Viabilidade , Feminino , Fixação Intramedular de Fraturas/psicologia , Humanos , Fraturas do Úmero/psicologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/psicologia , Qualidade de Vida/psicologia , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
5.
Alcohol Alcohol ; 38(4): 357-9, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12814904

RESUMO

AIMS: To investigate whether there are extractable conclusions for limb fracture management in dependent alcoholics. METHODS: We discuss four cases of dependent alcoholics who presented in our department over a 12-month period, and who developed significant complications owing to non-compliance with treatment. RESULTS: Initial treatment, although appropriate, failed because of non-compliance. This led to further admissions, wound infections and surgery to enable cure. CONCLUSIONS: Our case reports indicate that for upper limb fractures of the middle third of the humerus, non-operative treatment or internal fixation with out-patient detoxification is appropriate. Lower limb fractures, on the other hand, should be dealt with by external fixation and in-patient detoxification. It is imperative that the alcohol dependence is addressed if we are to decrease non-compliance.


Assuntos
Alcoolismo/psicologia , Alcoolismo/terapia , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Recusa do Paciente ao Tratamento/psicologia , Adulto , Idoso , Alcoolismo/complicações , Traumatismos do Tornozelo/etiologia , Traumatismos do Tornozelo/psicologia , Traumatismos do Tornozelo/terapia , Gerenciamento Clínico , Fraturas Ósseas/psicologia , Humanos , Fraturas do Úmero/etiologia , Fraturas do Úmero/psicologia , Fraturas do Úmero/terapia , Masculino , Pessoa de Meia-Idade
6.
Scand J Rehabil Med ; 28(2): 63-70, 1996 May.
Artigo em Inglês | MEDLINE | ID: mdl-8815990

RESUMO

This article deals with reliability aspects of standardized, active motor tests ("functional tests") when applied to patients with painful shoulder disorders. Motor performance was rated independently by the same two examiners in a standardized way in three different manoeuvres: the Hand in Neck, Hand in Back, and Pour out of a Pot tests. Pain experienced during these tests was rated by the patients on a verbal scale. A method of general applicability is presented for the analysis of reliability of standardized, active motor tests when applied to painful shoulder joint disorders. The importance of differential motivation is stressed, as is the importance of using reliability measures that are adapted to the specific purpose of a particular clinical investigation.


Assuntos
Fraturas do Úmero/reabilitação , Medição da Dor , Amplitude de Movimento Articular , Síndrome de Colisão do Ombro/reabilitação , Adulto , Idoso , Feminino , Humanos , Fraturas do Úmero/psicologia , Masculino , Pessoa de Meia-Idade , Motivação , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Síndrome de Colisão do Ombro/psicologia
7.
Ital J Orthop Traumatol ; 15(3): 353-60, 1989 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-2599855

RESUMO

Seventy-one patients treated for fracture of the surgical neck of the humerus by osteosynthesis with Kirschner wires inserted percutaneously were followed up. The method is described in detail, and its indications and limitations are discussed. The clinical and radiographic results were extremely positive, with minimal complications and a much reduced work load on the part of the surgical team.


Assuntos
Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Dispositivos de Fixação Ortopédica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Comportamento do Consumidor , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/normas , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/psicologia , Masculino , Pessoa de Meia-Idade , Radiografia
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