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1.
Orthop Clin North Am ; 51(1): 109-120, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739874

RESUMO

Reconstruction of the flexible adult-acquired flatfoot deformity (AAFD) is controversial, and numerous procedures are frequently used in combination, including flexor digitorum longus transfer, medializing calcaneal osteotomy (MCO), heel cord lengthening/gastrocnemius recession, lateral column lengthening (LCL), Cotton osteotomy or first tarsometatarsal fusion, and spring ligament reconstruction. This article summarizes recent studies demonstrating that patients have significant improvements after operative treatment of flexible AAFD. It reviews current literature on clinical and radiographic outcomes of the MCO, LCL, and Cotton osteotomies. The authors describe how this information can be used in surgical decision making in order to tailor operative treatment to an individual patient's deformity.


Assuntos
Pé Chato/cirurgia , Pé/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transferência Tendinosa/métodos , Adulto , Artrodese/métodos , Calcâneo/cirurgia , Terapia Combinada/métodos , Tomada de Decisões/ética , Feminino , Pé Chato/diagnóstico por imagem , Pé Chato/patologia , Pé/diagnóstico por imagem , Pé/patologia , Humanos , Ligamentos Articulares/cirurgia , Masculino , Osteotomia/métodos , Medidas de Resultados Relatados pelo Paciente , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
2.
Orthop Clin North Am ; 51(1): 121-130, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739875

RESUMO

Peroneal tendon pathology is becoming an increasingly recognized source of lateral-sided ankle pain. High clinical suspicion, along with judicious physical examination coupled with confirmatory advanced imaging modalities, are necessary to make an accurate diagnosis and aid in guiding treatment. Peroneal pathology encompasses several distinct conditions. Peroneal tendon tears and injuries to the peroneal retinaculum must be identified to guide treatment. Patients with peroneal pathology report high levels of satisfaction after surgical management with most returning to their preinjury level of function. An early and accurate diagnosis, along with treatment tailored to the individual, is necessary to obtain optimal outcomes.


Assuntos
Traumatismos do Tornozelo/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia , Tornozelo/anatomia & histologia , Tornozelo/diagnóstico por imagem , Tornozelo/patologia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/patologia , Fenômenos Biomecânicos , Cadáver , Humanos , Incidência , Instabilidade Articular/epidemiologia , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Medidas de Resultados Relatados pelo Paciente , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Ruptura , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/patologia , Tendões/anatomia & histologia , Tendões/patologia
3.
BMJ ; 367: l6132, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748208

RESUMO

OBJECTIVE: To determine whether an injection of platelet rich plasma improves outcomes after acute Achilles tendon rupture. DESIGN: Randomised, placebo controlled, two arm, parallel group, participant and assessor masked, superiority trial. SETTING: Secondary care trauma units across 19 hospitals in the United Kingdom's health service. PARTICIPANTS: Recruitment commenced in July 2015 and follow-up was completed in March 2018. 230 adults aged 18 years and over were included, with acute Achilles tendon rupture presenting within 12 days of injury and managed with non-surgical treatment. Exclusions were injury at the insertion or musculotendinous junction, major leg injury or deformity, diabetes mellitus, platelet or haematological disorder, systemic corticosteroids, anticoagulation treatment, and other contraindicating conditions. INTERVENTIONS: Participants were randomised 1:1 to platelet rich plasma (n=114) or placebo (dry needle; n=116) injection. All participants received standard rehabilitation care (ankle immobilisation followed by physiotherapy). MAIN OUTCOMES AND MEASURES: Primary outcome was muscle tendon function at 24 weeks, measured objectively with the limb symmetry index (injured/uninjured×100) in maximal work done during the heel rise endurance test (an instrumented measure of repeated single leg heel rises until fatigue). Secondary outcomes included patient reported function (Achilles tendon rupture score), quality of life (short form 12 version 2®), pain (visual analogue scale), goal attainment (patient specific functional scale), and adverse events. A central laboratory analysed the quality and content of platelet rich plasma. Analyses were by modified intention to treat. RESULTS: Participants were 46 years old on average, and 57 (25%) of 230 were female. At 24 weeks, 202 (88%) participants completed the heel rise endurance test and 216 (94%) the patient reported outcomes. The platelet rich plasma was of good quality, with expected growth factor content. No difference was detected in muscle tendon function between participants receiving platelet rich plasma injections and those receiving placebo injections (limb symmetry index, mean 34.7% (standard deviation 17.7%) v 38.5% (22.8%); adjusted mean difference -3.9% (95% confidence interval -10.5% to 2.7%)) or in any secondary outcomes or adverse event rates. Complier average causal effect analyses gave similar findings. CONCLUSIONS: There is no evidence to indicate that injections of platelet rich plasma can improve objective muscle tendon function, patient reported function, or quality of life after acute Achilles tendon rupture compared with placebo, or that they offer any patient benefit. TRIAL REGISTRATION: ISRCTN54992179.


Assuntos
Tendão do Calcâneo/lesões , Tratamento Conservador/métodos , Plasma Rico em Plaquetas , Qualidade de Vida , Traumatismos dos Tendões/terapia , Adulto , Feminino , Humanos , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Recuperação de Função Fisiológica , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/psicologia , Resultado do Tratamento , Reino Unido
4.
Bone Joint J ; 101-B(11): 1423-1430, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674240

RESUMO

AIMS: The aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA). PATIENTS AND METHODS: A total of 28 patients (23 male, five female; mean age, 56 years (25 to 73)) awaiting Birmingham HRA volunteered for this prospective gait study, with an age-matched control group of 26 healthy adults (16 male, ten female; mean age, 56 years (33 to 84)). The Oxford Hip Score (OHS) and gait analysis using an instrumented treadmill were used preoperatively and more than two years postoperatively to measure the functional change attributable to the intervention. RESULTS: The mean OHS improved significantly from 27 to 46 points (p < 0.001) at a mean of 29 months (12 to 60) after HRA. The mean metal ion levels at a mean 32 months (13 to 60) postoperatively were 1.71 (0.77 to 4.83) µg/l (ppb) and 1.77 (0.68 to 4.16) µg/l (ppb) for cobalt and chromium, respectively. When compared with healthy controls, preoperative patients overloaded the contralateral good hip, limping significantly. After HRA, patients walked at high speeds, with symmetrical gait, statistically indistinguishable from healthy controls over almost all characteristics. The control group could only be distinguished by an increased push-off force at higher speeds, which may reflect the operative approach. CONCLUSION: Patients undergoing HRA improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls. HRA with an approved device offers substantial functional gains, almost indistinguishable from healthy controls. Cite this article: Bone Joint J 2019;101-B:1423-1430.


Assuntos
Artroplastia de Quadril/métodos , Marcha/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Análise da Marcha/instrumentação , Análise da Marcha/métodos , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Radiografia , Velocidade de Caminhada/fisiologia
5.
J Law Med ; 26(4): 737-741, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31682353

RESUMO

Coronial investigations of post-operative deaths can play an important role in improving the quality and safety of patient care. Correctly identifying reportable deaths in the post-operative period and reporting them to the coroner is a key responsibility of medical practitioners but may be challenging, particularly when determination of unexpectedness is problematic. Patient-reported outcome measures (PROMs) have a potential role to play in assisting clinicians with better identification of these reportable deaths. Moreover, the inclusion of PROMs within coronial investigations can assist in identifying systemic failures and result in recommendations on public health and safety. In particular, PROMs could be effective in addressing the overuse of surgery which remains a major public health concern. While the role of PROMs in clinical practice has undergone extensive research, their potential use in death investigations has been overlooked. As medicine continues to transition towards a patient-centred model of care, the use of frameworks such as PROMs will become increasingly important and may also provide benefit to the process of medicolegal death investigations.


Assuntos
Médicos Legistas , Medidas de Resultados Relatados pelo Paciente , Causas de Morte , Humanos
6.
Bone Joint J ; 101-B(11): 1431-1437, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674251

RESUMO

AIMS: It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. PATIENTS AND METHODS: Patients undergoing Birmingham Hip Resurfacing completed the Veteran's Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups. RESULTS: Overall, 18% of patients reported reductions in mHHS total score exceeding MCID, and 21% reported similar reductions for WOMAC function scores. Nonetheless, almost all patients remained above PASS thresholds for WOMAC function (98%) and mHHS (93%). Overall, 66% of patients with mHHS scores < PASS at two years reported scores > PASS at latest follow-up. Conversely, 6% of patients deteriorated from > PASS to < PASS between follow-ups. Multivariable modelling indicated body mass index (BMI) > 27 kg/m2, VR-36 Physical Component Score (PCS) < 51, VR-36 Mental Component Score (MCS) > 55, mHHS < 84 at two years, female sex, and bone graft use predicted these deteriorating patients with 79% accuracy and an area under the curve (AUC) of 0.84. CONCLUSION: Due to largely acceptable results at a later follow-up, extensive monitoring of multiple PROMs is not recommended for Birmingham Hip Resurfacing patients unless they report borderline or unacceptable hip function at two years, are female, are overweight, or received a bone graft during surgery. Cite this article: Bone Joint J 2019;101-B:1431-1437.


Assuntos
Artroplastia de Quadril/reabilitação , Nível de Saúde , Atividades Cotidianas , Adulto , Assistência ao Convalescente/estatística & dados numéricos , Artroplastia de Quadril/métodos , Transplante Ósseo/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/reabilitação , Osteoartrite do Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Índice de Gravidade de Doença , Inquéritos e Questionários
7.
Medicine (Baltimore) ; 98(40): e17440, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577765

RESUMO

To prove the equivalence of the Korean version of the Foot and Ankle Outcome Score (FAOS) in the printed (PFAOS) vs the electronic (EFAOS) form in a multicenter randomized study.Overall, 227 patients with ages ranging from 20 to 79 years from 16 dedicated foot and ankle centers were included. Patients were randomized into either a 'paper first' group (P-F group, n = 113) or an 'electronic device (tablet computer) first' group (E-F group, n = 114). The first evaluation either by paper (P-F group) or tablet (E-F group) was followed by a second evaluation the following day. The difference between the PFAOS and EFAOS results in each group was calculated and analyzed. To evaluate the benefit of each methodology, the time consumed per evaluation was compared and patients were asked which methodology they preferred and which was the easiest to use.There were no significant differences in age or sex between the groups. An intraclass correlation coefficient (ICC) value of 0.934 (95% confidence interval [CI]: 0.912-0.950, P < .001) was confirmed in PFAOS and EFAOS, showing a significant correlation between the 2 methodologies. EFAOS was completed in a shorter amount of time than PFAOS. The majority of patients agreed that EFAOS was easier to complete than PFAOS.The paper or electronic forms of the Korean adaptation of FAOS were considered equivalent. The shorter time of completion and the preference for the electronic version over paper by patients deems the electronic FAOS a promising option to consider in future.


Assuntos
Computadores de Mão , Pé/fisiologia , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , República da Coreia , Fatores de Tempo , Adulto Jovem
8.
Health Qual Life Outcomes ; 17(1): 150, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31506078

RESUMO

BACKGROUND AND PURPOSE: Psychological factors including fear of pain, re-injury during movement (kinesiophbia) affect return-to-sport rates after anterior cruciate ligament (ACL) reconstructive surgery. Clinicians often encounter in the daily practice that athletes explain lack of self-confidence or psychological readiness during the sports activity. The Tampa Scale for Kinesiophobia (TSK) has been used to evaluate psychological outcomes in patients with ACL injuries in many countries and translated into Japanese version in 2013. However, no researchers validated its reliability, validity, and responsiveness of TSK for patients with ACL injury up to now. The purpose of this study was to evaluate the measurement properties of the Japanese version of the TSK (TSK-J) in patients with ACL injuries. STUDY DESIGN: Cohort study (Diagnostic); Level of evidence, 2. METHODS: This prospective study was performed in the department of orthopaedic surgery at the university hospital of Juntendo from Sep 2016 and Apr 2017. Patients who diagnosed with ACL injury with or without reconstruction surgery completed several patient-reported outcome measures (PROMs) were included in this study. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines were used to evaluate reliability, validity, responsiveness, and interpretability of the TSK-J. RESULTS: 222 patients were included in this study. The TSK-J for ACL injured patients showed good internal consistency (Cronbach's alpha = 0.79) and excellent test-retest reliability (intra-class correlation coefficient, ICC2,1 = 0.90, 95% CI = 0.81 to 0.95). In addtion, the TSK-J was significantly but moderately correlated with the IKDC-SKF (r = - 0.49, P <0.001), VAS-Sports (r = - 0.48, P <0.001), and JACL-25 (r = 0.48, P <0.001). The effect size (ES) was small with the Cohen's d = - 0.2. The minimal important difference (MID) was - 1.3 points. No significant TSK-J score change was observed over 1-year after ACL reconstruction (r = - 0.12, P <0.001). There were no floor or ceiling effects. CONCLUSIONS: Our study demonstrated that the Japanese version of TSK has good reliability. However, its low validity and responsiveness indicate that it may not the best way to assess psychological factors for patients with ACL injury.


Assuntos
Lesões do Ligamento Cruzado Anterior/psicologia , Medo/psicologia , Dor/psicologia , Medidas de Resultados Relatados pelo Paciente , Adulto , Reconstrução do Ligamento Cruzado Anterior/psicologia , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Feminino , Humanos , Japão , Masculino , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Traduções , Adulto Jovem
10.
Gan To Kagaku Ryoho ; 46(9): 1345-1356, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31530769

RESUMO

In recent years, the importance of patient-reported outcomes(PRO)in addition to clinician-outcome assessment has been particularly recognized in clinical trials and routine clinical care of practice. PRO is defined as "any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else". For example, in oncology field, NCI-CTCAE has conventionally been used for adverse event assessment. However, it has been pointed out that the adverse event reported by medical staffs tends to underestimate as compared by patients themselves. Hence, PRO version of the Common Terminology Criteria for Adverse Events(PRO-CTCAE), is expected to play an important role. In this article, the background of importance of PRO in oncology, the role of PRO in clinical outcome assessments, the difference between PRO and QOL, significance that PRO evaluation brings to patients and clinical practice, PRO-CTCAE and recent methodology of PRO research will be overviewed.


Assuntos
Neoplasias , Medidas de Resultados Relatados pelo Paciente , Coleta de Dados , Humanos , Oncologia
11.
Bone Joint J ; 101-B(9): 1138-1143, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474148

RESUMO

AIMS: The aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approaches. PATIENTS AND METHODS: A total of 95 patients with a tibial fracture requiring an intramedullary nail were randomized to treatment using a supra- or infrapatellar approach. Anterior knee pain was assessed at four and six months, and one year postoperatively, using the Aberdeen Weightbearing Test - Knee (AWT-K) score and a visual analogue scale (VAS) score for pain. The AWT-K is an objective patient-reported outcome measure that uses weight transmitted through the knee when kneeling as a surrogate for anterior knee pain. RESULTS: A total of 53 patients were randomized to a suprapatellar approach and 42 to an infrapatellar approach. AWT-K results showed a greater mean proportion of weight transmitted through the injured leg compared with the uninjured leg when kneeling in the suprapatellar group compared with the infrapatellar group at all timepoints at all follow-up visits. This reached significance at four months for all timepoints except 30 seconds. It also reached significance at six months at 0 seconds, and for one year at 60 seconds. CONCLUSION: The suprapatellar surgical approach for antegrade tibial nailing is associated with less anterior knee pain postoperatively compared with the infrapatellar approach Cite this article: Bone Joint J 2019;101-B:1138-1143.


Assuntos
Artralgia/prevenção & controle , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Dor Pós-Operatória/prevenção & controle , Patela/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Artralgia/etiologia , Pinos Ortopédicos/efeitos adversos , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Medidas de Resultados Relatados pelo Paciente , Tíbia/lesões , Tíbia/cirurgia , Adulto Jovem
12.
J Drugs Dermatol ; 18(9): 918-923, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524348

RESUMO

Background: Facial chemical peels are highly sought after by patients with photodamage, acne, and melasma. An advanced, physician-strength superficial peel, containing 3% retinol with other firming and volumizing ingredients was developed to exfoliate, improve the appearance of fine lines and wrinkles, and plump and firm skin, while promoting a bright, even complexion. Objective: A clinical study was conducted to evaluate the tolerability, safety, and efficacy of the 3% retinol peel with a supportive homecare regimen across a range of peel candidates, females aged 18-65 years, with photodamage, acne, hyperpigmentation or melasma, and skin of color, over a series of 2-4 peels. Method: The 3% retinol peel formulation was administered under physician direction in 6-week intervals. Subjects with photodamaged skin, acne, hyperpigmentation/melasma, or skin of color (Fitzpatrick skin types IV-VI) received 2-4 peels along with a supportive homecare regimen. Dermatologist grading, self-assessment, and digital photography documented tolerability and efficacy parameters. Results: 24 subjects participated in the study with a total of 78 peels administered (Photodamage group, n=14 [with an Acne subgroup, n=5]; Melasma group, n=5; Skin of Color, n=5). The 3% retinol peel along with the homecare regimen was well tolerated under physician direction in all skin types and conditions assessed. Obvious peeling was noticeable in many subjects 3 days post-peel and resolved by day 7. In the photodamaged group, dermatologist clinical grading of fine lines, wrinkles, pore size, laxity, mottled pigmentation, lack of clarity/radiance, and overall photodamage was significantly improved (P<0.05). Benefits were observed in all groups and supported by self-assessment. Digital photography demonstrated tolerability in the days immediately post-peel, along with benefits to photodamage. Conclusion: The 3% retinol superficial peel was well tolerated and an efficacious cosmetic treatment under physician supervision in subjects of all skin types to firm skin, improve fine lines and wrinkles, and promote a bright, even complexion. J Drugs Dermatol. 2019;18(9):918-923.


Assuntos
Acne Vulgar/tratamento farmacológico , Abrasão Química/métodos , Melanose/tratamento farmacológico , Envelhecimento da Pele/efeitos dos fármacos , Vitamina A/administração & dosagem , Administração Cutânea , Adolescente , Adulto , Idoso , Abrasão Química/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Autoadministração , Pele/efeitos dos fármacos , Pigmentação da Pele/efeitos dos fármacos , Resultado do Tratamento , Vitamina A/efeitos adversos , Adulto Jovem
13.
Accid Anal Prev ; 132: 105279, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31491683

RESUMO

BACKGROUND: Pedestrians, cyclists and motorcyclists are vulnerable to serious injury due to limited external protective devices. Understanding the level of recovery, and differences between these road user groups, is an important step towards improved understanding of the burden of road trauma, and prioritisation of prevention efforts. This study aimed to characterise and describe patient-reported outcomes of vulnerable road users at 6 and 12 months following orthopaedic trauma. METHODS: A registry-based cohort study was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and included pedestrians, cyclists and motorcyclists who were hospitalised for an orthopaedic injury following an on-road collision that occurred between January 2009 and December 2016. Outcomes were measured using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3 L), Glasgow Outcome Scale - Extended (GOS-E) and return to work questions. Outcomes were collected at 6 and 12 months post-injury. Multivariable generalized estimating equations (GEE), adjusted for confounders, were used to compare outcomes between the road user groups over time. RESULTS: 6186 orthopaedic trauma patients met the inclusion criteria during the 8-year period. Most patients were motorcyclists (42.8%) followed by cyclists (32.6%) and pedestrians (24.6%). Problems were most prevalent on the usual activities item of the EQ-5D-3 L at 6-months post-injury, and the pain/discomfort item of the EQ-5D-3 L at 12 months. The adjusted odds of reporting problems on all EQ-5D-3 L items were lower for cyclists when compared to pedestrians. Moreover, an average cyclist had a greater odds of a good recovery on the GOS-E, (AOR 2.75, 95% CI 2.33, 3.25) and a greater odds of returning to work (AOR = 3.13, 95% CI 2.46, 3.99) compared to an average pedestrian. CONCLUSION: Pedestrians and motorcyclists involved in on-road collisions experienced poorer patient-reported outcomes at 6 and 12 months post-injury when compared to cyclists. A focus on both primary injury prevention strategies, and investment in ongoing support and treatment to maximise recovery, is necessary to reduce the burden of road trauma for vulnerable road users.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Qualidade de Vida , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/reabilitação , Adolescente , Adulto , Idoso , Ciclismo/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Estudos Longitudinais , Masculino , Motocicletas/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Pedestres/estatística & dados numéricos , Sistema de Registros , Adulto Jovem
14.
Health Qual Life Outcomes ; 17(1): 148, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470865

RESUMO

BACKGROUND: Hand injuries occur at any age and cause disability in hand and arm function as well as impaired quality of life, but no study has focused on hand disability and quality of life in the elderly after a hand injury. Globally, the population over 60 years of age is expected to double by 2050 and more hand injuries are estimated among the elderly population. Our goal is to obtain more information and a better understanding of problems elderly patients experience after a hand injury to be able in the future to optimally relocate resources in the health care sector with respect to numbers and injury pattern as well as to health status of these patients. METHODS: Patients aged more than 65 years with a traumatic hand/wrist/forearm injury treated (July 1st 2013 - June 30th 2014) at department of Hand Surgery, Malmö, Sweden were included. Health-related outcome questionnaires, i.e. QuickDASH, SF-36, Visual Analogue Scale (VAS), Cold Intolerance Severity Score (CISS), and general information were mailed to the patients (time from injury: > 1.5-2.5 years). The participants were compared in groups according to age, gender, cold intolerance, injury severity and previous occupation. RESULTS: One hundred and thirty-seven participants responded [response rate 55%; non-responders (n = 113); only difference between groups was that non-responders were older]. Women were older than men at the time of injury (p = 0.04) and differed regarding living conditions. The main differences in QuickDASH, all VAS questions, and the majority of SF-36 subscales (p < 0.05) were found in the participants with CISS > 50, who experienced more impairment. More serious injuries (Modified HISS) were found to have higher QuickDASH and CISS score as well as more functional impairment (p < 0.05). Few differences were found in groups divided according to age, gender (although men experiencing less functional impairment in QuickDASH), previous occupation and injured hand. CONCLUSIONS: Patients aged more than 65 years at the time a hand injury was sustained, generally experience a high-level quality of life and limited functional problems after such an injury, but patients with CISS > 50 and with a more serious injury were more severely affected.


Assuntos
Traumatismos da Mão/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Idoso , Avaliação da Deficiência , Feminino , Traumatismos da Mão/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Suécia/epidemiologia
15.
Psychiatr Danub ; 31(Suppl 3): 406-410, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488761

RESUMO

BACKGROUND: Bariatric surgery or reconstructive body contouring surgery performed after weight loss, has the potential to have a major impact one's body image, health-related quality of life (HRQOL) and mental wellbeing. Many researches show interest in measuring this impact using generic instruments that unfortunately are not specifically oriented toward bariatric or surgery patients. The BODY-Q is a new patient-reported outcome (PRO) instrument designed to measure patient perceptions of weight loss and/or body contouring. In this article, we describe the methods used to translate and culturally adapt the French version of the BODY-Q. MATERIAL AND METHOD: We followed the recommendation for translation process established by the International Society for Pharmacoeconomics and Outcome Research (ISPOR) and the World Health Organisation (WHO). This process included two forward translations, one backward translation, a review by a panel of expert and cognitive debriefing interviews with patient. Our aim was to ensure a conceptual and culturally valid translation. RESULTS: This translation process led to a conceptually and culturally equivalent French version of the Body-Q. Backward translation comparison to the English original version led to the identification of 16 differences necessitating re-translation. The expert panel offered support to identify inadequate expressions and proposed changes to the translations. The cognitive debriefing interviews with 15 patients contributed to minor changes in the translation. CONCLUSIONS: This thorough method of translation and cultural adaptation allowed us to develop a conceptually and culturally valid French translation of the BODY-Q.


Assuntos
Contorno Corporal/psicologia , Linguística , Medidas de Resultados Relatados pelo Paciente , Traduções , Imagem Corporal/psicologia , Competência Cultural , França , Humanos , Qualidade de Vida , Reprodutibilidade dos Testes , Perda de Peso
16.
Occup Ther Int ; 2019: 8270637, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31485200

RESUMO

Introduction: This study aimed to validate the Hong Kong version of the Knee Injury and Osteoarthritis Outcome Score (HK-KOOS) for patients with knee osteoarthritis. Methods: Content validity was assessed using the Item and Scale Content Validity Index (I-CVI and S-CVI). Test-retest reliability and internal consistency were assessed by the Intraclass Correlation Coefficient (ICC) and Cronbach's alpha. Dimensionality was assessed by performing exploratory factor analysis (EFA). Convergent and Divergent Validity was performed by examining the correlation between the HK-KOOS and the Chinese version of the Short Form 12 (SF-12) Health Survey, the Chinese Modified Barthel Index (C-MBI), and the Visual Analogue Scale for Pain (VAS-Pain). Ceiling and floor effects were also examined. Results: A total of 125 participants were recruited in this study. In general, all instructions, items, and response options were considered as understandable, indicating a satisfactory cross-cultural adaptation. The I-CVI and S-CVI scores were 0.80-1 and 0.90-1, respectively, indicating excellent content validity in terms of relevance, representativeness, and understandability. The test-retest reliability of all HK-KOOS subscales was satisfactory with ICC exceeding 0.70 for all domains. Cronbach's alpha exceeded 0.80 for all subscales, indicating satisfactory internal consistency. Medium to strong correlations were found between the HK-KOOS and the VAS-Pain, SF-12, and C-MBI. However, factor analysis indicated a seven-factor structure, rather than the original five-factor structure. Items on pain and activities of daily living were loaded in the same factors. A floor effect was present in the sports and recreation subscale. Discussion and Conclusions: Future studies should further examine the dimensionality of the KOOS. The HK-KOOS is a culturally adapted, reliable, and valid outcome measure instrument to be used in Hong Kong patients with primary knee osteoarthritis.


Assuntos
Traumatismos do Joelho/reabilitação , Terapia Ocupacional , Osteoartrite do Joelho/reabilitação , Medidas de Resultados Relatados pelo Paciente , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Análise Fatorial , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Traduções
18.
BMC Ophthalmol ; 19(1): 192, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438884

RESUMO

BACKGROUND: A patient's perception of how their glaucoma is managed will influence both adherence to their medication and outcome measures such as quality of life. METHODS: Prospective consecutive study using a Glaucoma Patient-reported Outcome and Experience Measure (POEM) modified for an Australian ophthalmic private clinical practice setting. The Australian Glaucoma POEM consists of eight items related to the patient's understanding of the diagnosis and management, acceptability of the treatment, whether they feel their glaucoma is getting worse, interfering with their daily life and concerns regarding loss of vision as well as addressing whether they feel safe under the care of their glaucoma team and how well their care is organised. RESULTS: Two hundred and two patients (M:F 91:111) participated in the study. Mean ± standard deviation for subject age was 69 ± 13 years. Patient's overall perception of their treatment and outcome was favourable. Younger patients felt their glaucoma interfered more with their daily lives and were more worried about losing vision from glaucoma. The greater the number of medications in use, the more they felt their glaucoma was getting worse and that glaucoma interfered with their daily lives. With all other variables accounted for by the multivariate linear model, female patients more strongly agreed that they understood their glaucoma diagnosis and glaucoma management. The patients with a severe visual defect in their worse eye, reported a greater perceived understanding of their glaucoma diagnosis and management and that they felt that glaucoma had a greater interference on their daily life. They were also more concerned about losing vision from glaucoma than their fellow glaucoma patients with less severe or no visual field deficit in the worse eye. CONCLUSIONS: The modified POEM demonstrates potential to capture the concerns of a practice's glaucoma cohort with a view to enhancing the quality of glaucoma care delivered.


Assuntos
Glaucoma/terapia , Pressão Intraocular/fisiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde , Acuidade Visual , Campos Visuais/fisiologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Glaucoma/epidemiologia , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Prospectivos , Qualidade de Vida , Queensland/epidemiologia , Inquéritos e Questionários , Adulto Jovem
19.
Anaesthesia ; 74(11): 1439-1455, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31429919

RESUMO

We performed a systematic review using 'consensus-based standards for the selection of health measurement instruments' (COSMIN) criteria to identify and evaluate the quality of patient-reported outcome measures (PROM) instruments that have been utilised to assess functional recovery following caesarean section, and determine the optimal instrument for use in this setting. A literature search was performed using five databases. Studies were included if a psychometrically validated instrument was used to assess functional recovery following caesarean section. The COSMIN appraisal checklist was utilised to: assess the quality of included studies reporting PROMs; determine psychometric quality of instruments; and identify the most promising instruments for use after caesarean section. We identified 13 PROMs used to assess the quality of recovery after caesarean section in 20 studies that included 9214 patients. All PROMs contained between two and seven domains. Five out of the 13 PROMs were specific to postpartum recovery. Only two of these PROM instruments were specifically designed for use after caesarean section (Obstetric Quality of Recovery-11 and Recovery from Caesarean Section Scale). We found very few adequate measures of functional recovery following caesarean section. Overall, the Obstetric Quality of Recovery-11 achieved the highest COSMIN standards for any PROM. Future development of PROMs for use after caesarean section should include multiple domains, and undergo validation as outlined by the COSMIN criteria.


Assuntos
Cesárea/estatística & dados numéricos , Lista de Checagem/métodos , Medidas de Resultados Relatados pelo Paciente , Recuperação de Função Fisiológica , Consenso , Feminino , Humanos , Gravidez , Psicometria , Inquéritos e Questionários
20.
Stud Health Technol Inform ; 264: 694-698, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438013

RESUMO

Digital solutions transform the way clinical services can be provided and make it possible for patients to participate in decisions concerning their own treatment. With the aim to support a better and more efficient healthcare system in Denmark, it has been agreed among authorities and care providers to establish a national infrastructure for sharing data between hospitals, municipalities, general practitioners and patients and concurrently develop standardized national digital cross-sector questionnaires for the purpose. Sharing data via the national infrastructure enables proactive involvement through patient reported outcomes (PRO). The national infrastructure forms a paradigm shift 1) for collaboration by moving from a baton-passing workflow to sharing-based workflow and 2) for the development of digital cross-sector questionnaires. Cross-sector questionnaire definitions are stored in a national questionnaire repository, and are used in local PRO applications to capture the patients' responses.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Assistência à Saúde , Dinamarca , Clínicos Gerais , Humanos , Inquéritos e Questionários
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