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Clinical Orthopaedics and Related Research
Journal Prestige (SJR): 1.908  Citation Impact (citeScore): 3 Number of Followers: 79  Hybrid journal (It can contain Open Access articles)ISSN (Print) 0009-921X - ISSN (Online) 1528-1132 Published by LWW Wolters Kluwer  [330 journals]
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- Erratum to: Does Early Conversion to Below-elbow Casting for Pediatric
Diaphyseal Both-bone Forearm Fractures Adversely Affect Patient-reported
Outcomes and ROM'-
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Authors: Musters; Linde; Roth, Kasper C.; Diederix, Leon W.; Edomskis, Pim P.; Benner, Joyce L.; Reijman, Max; Eygendaal, Denise; Colaris, Joost W.
Abstract:
No abstract available
PubDate: Thu, 27 Mar 2025 00:00:00 GMT-
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- CORR® Curriculum—Orthopaedic Education: How Should Residents Be Using
Research Protected Time for Scholarly Activities'-
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Authors: Dougherty; Paul J.
Abstract: No abstract available
PubDate: Thu, 06 Mar 2025 00:00:00 GMT-
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- Not the Last Word: A Joint Registry for Resident Selection
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Authors: Bernstein; Joseph
Abstract:
No abstract available
PubDate: Tue, 04 Mar 2025 00:00:00 GMT-
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- CORR Insights®: A New Measure of Quantified Social Health Is Associated
With Levels of Discomfort, Capability, and Mental and General Health Among
Patients Seeking Musculoskeletal Specialty Care-
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Authors: Sambare; Tanmaya D.
Abstract: No abstract available
PubDate: Thu, 27 Feb 2025 00:00:00 GMT-
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- Reply to the Letter to the Editor: Acquired Acromion Compromise, Including
Thinning and Fragmentation, Is Not Associated With Poor Outcomes After
Reverse Shoulder Arthroplasty-
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Authors: Kim; Su Cheol; Yoo, Jae Chul
Abstract: No abstract available
PubDate: Tue, 25 Feb 2025 00:00:00 GMT-
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- Editor’s Spotlight/Take 5: How Does Shame Relate to Clinical and
Psychosocial Outcomes in Knee Osteoarthritis'-
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Authors: Leopold; Seth S.
Abstract:
No abstract available
PubDate: Wed, 12 Feb 2025 00:00:00 GMT-
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- CORR Insights®: Risk-stratified Care Improves Pain-related Knowledge and
Reduces Psychological Distress for Low Back Pain: A Secondary Analysis of
a Randomized Trial-
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Authors: Crijns; Tom Joris
Abstract: No abstract available
PubDate: Tue, 11 Feb 2025 00:00:00 GMT-
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- Letter to the Editor: Editorial: Should Orthopaedic Residents Be Required
to Do Research, or Would Critical Reading Programs Be a Better Use of
Their Time'-
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Authors: Kirollos; Bishoy
Abstract: No abstract available
PubDate: Mon, 10 Feb 2025 00:00:00 GMT-
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- A New Measure of Quantified Social Health Is Associated With Levels of
Discomfort, Capability, and Mental and General Health Among Patients
Seeking Musculoskeletal Specialty Care-
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Authors: Brinkman; Niels; Broekman, Melle; Teunis, Teun; Choi, Seung; Ring, David; Jayakumar, Prakash
Abstract:
Background A better understanding of the correlation between social health and mindsets, comfort, and capability could aid the design of individualized care models. However, currently available social health checklists are relatively lengthy, burdensome, and designed for descriptive screening purposes rather than quantitative assessment for clinical research, patient monitoring, or quality improvement. Alternatives such as area deprivation index are prone to overgeneralization, lack depth in regard to personal circumstances, and evolve rapidly with gentrification. To fill this void, we aimed to identify the underlying themes of social health and develop a new, personalized and quantitative social health measure.Questions/purposes (1) What underlying themes of social health (factors) among a subset of items derived from available legacy checklists and questionnaires can be identified and quantified using a brief social health measure' (2) How much of the variation in levels of discomfort, capability, general health, feelings of distress, and unhelpful thoughts regarding symptoms is accounted for by quantified social health'Methods In this two-stage, cross-sectional study among people seeking musculoskeletal specialty care in an urban area in the United States, all English and Spanish literate adults (ages 18 to 89 years) were invited to participate in two separate cohorts to help develop a provisional new measure of quantified social health. In a first stage (December 2021 to August 2022), 291 patients rated a subset of items derived from commonly used social health checklists and questionnaires (Tool for Health and Resilience in Vulnerable Environments [THRIVE]; Protocol for Responding to and Assessing Patient Assets, Risks and Experiences [PRAPARE]; and Accountable Health Communities Health-Related Social Needs Screening Tool [HRSN]), of whom 95% (275 of 291; 57% women; mean ± SD age 49 ± 16 years; 51% White, 33% Hispanic; 21% Spanish speaking; 38% completed high school or less) completed all items required to perform factor analysis and were included. Given that so few patients decline participation (estimated at < 5%), we did not track them. We then randomly parsed participants into (1) a learning cohort (69% [189 of 275]) used to identify underlying themes of social health and develop a new measure of quantified social health using exploratory and confirmatory factor analysis (CFA), and (2) a validation cohort (31% [86 of 275]) used to test and internally validate the findings on data not used in its development. During the validation process, we found inconsistencies in the correlations of quantified social health with levels of discomfort and capability between the learning and validation cohort that could not be resolved or explained despite various sensitivity analyses. We therefore identified an additional cohort of 356 eligible patients (February 2023 to June 2023) to complete a new extended subset of items directed at financial security and social support (5 items from the initial stage and 11 new items derived from the Interpersonal Support Evaluation List, Financial Well-Being Scale, Multidimensional Scale of Perceived Social Support, Medical Outcomes Study Social Support Survey, and 6-item Social Support Questionnaire, and “I have to work multiple jobs in order to finance my life” was self-created), of whom 95% (338 of 356; 53% women; mean ± SD age 48 ± 16 years; 38% White, 48% Hispanic; 31% Spanish speaking; 47% completed high school or less) completed all items required to perform factor analysis and were included. We repeated factor analysis to identify the underlying themes of social health and then applied item response theory–based graded response modeling to identify the items that were best able to measure differences in social health (high item discrimination) with the lowest possible floor and ceiling effects (proportion of participants with lowest or highest possible score, respectively; a range of different item difficulties). We also assessed the CFA factor loadings (correlation of an individual item with the identified factor) and modification indices (parameters that suggest whether specific changes to the model would improve model fit appreciably). We then iteratively removed items based on low factor loadings (< 0.4, generally regarded as threshold for items to be considered stable) and high modification indices until model fit in CFA was acceptable (root mean square of error approximation [RMSEA] < 0.05). We then assessed local dependencies among the remaining items (strong relationships between items unrelated to the underlying factor) using Yen Q3 and aimed to combine only items with local dependencies of < 0.25. Because we exhausted our set of items, we were not able to address all local dependencies. Among the remaining items, we then repeated CFA to assess model fit (RMSEA) and used Cronbach alpha to assess internal consistency (the extent to which different subsets of the included items would provide the same measurement outcomes). We performed a differential item functioning analysis to assess whether certain items are rated discordantly based on differences in self-reported age, gender, race, or level of education, which can introduce bias. Last, we assessed the correlations of the new quantified social health measure with various self-reported sociodemographic characteristics (external validity) as well as level of discomfort, capability, general health, and mental health (clinical relevance) using bivariate and multivariable linear regression analyses.Results We identified two factors representing financial security (11 items...
PubDate: Wed, 05 Feb 2025 00:00:00 GMT-
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- CORR Insights®: Do Fellowship-educated Military Orthopaedic Oncologists
Who Practice in Military Settings Treat a Sufficient Volume of Patients to
Maintain Their Oncologic Expertise'-
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Authors: Dougherty; Paul J.
Abstract: No abstract available
PubDate: Wed, 05 Feb 2025 00:00:00 GMT-
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- Editorial: The Goal is Health, Not Surgery
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Authors: Ring; David; Leopold, Seth S.
Abstract: No abstract available
PubDate: Tue, 04 Feb 2025 00:00:00 GMT-
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- Art in Science: Molding Deformities, Then and Now
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Authors: Green; Stuart A.
Abstract:
No abstract available
PubDate: Tue, 04 Feb 2025 00:00:00 GMT-
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- CORR Insights®: How Does Shame Relate to Clinical and Psychosocial
Outcomes in Knee Osteoarthritis'-
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Authors: Ghomrawi; Hassan
Abstract: No abstract available
PubDate: Fri, 31 Jan 2025 00:00:00 GMT-
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- On Patient Safety: It Is Time to Rethink Gabapentin
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Authors: Rickert; James
Abstract: No abstract available
PubDate: Tue, 28 Jan 2025 00:00:00 GMT-
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- The Forward Movement: Amplifying Black Voices on Race and
Orthopaedics—Redefining Leadership Education-
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Authors: Owusu-Akyaw; Kwadwo
Abstract: No abstract available
PubDate: Tue, 21 Jan 2025 00:00:00 GMT-
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- Editorial Comment on the Fourth Annual I-MESH Symposium: Communicating
Complexity in Mental and Social Health-
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Authors: Lentz; Trevor A.; Jochimsen, Kate N.; Ring, David; Jayakumar, Prakash; Blackburn, Julia
Abstract:
No abstract available
PubDate: Tue, 21 Jan 2025 00:00:00 GMT-
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- Risk-stratified Care Improves Pain-related Knowledge and Reduces
Psychological Distress for Low Back Pain: A Secondary Analysis of a
Randomized Trial-
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Authors: Greenlee; Tina A.; George, Steven Z.; Pickens, Bryan; Rhon, Daniel I.
Abstract:
Background A number of efforts have been made to tailor behavioral healthcare treatments to the variable needs of patients with low back pain (LBP). The most common approach involves the STarT Back Screening Tool (SBST) to triage the need for psychologically informed care, which explores concerns about pain and addresses unhelpful beliefs, attitudes, and behaviors. Such beliefs that pain always signifies injury or tissue damage and that exercise should be avoided have been implied as psychosocial mediators of chronic pain and can impede recovery. The ability of physical therapy interventions guided by baseline stratification for risk of persistent LBP or related functional limitations to improve unhelpful pain beliefs has not been well assessed. Because treatments are aimed at addressing these beliefs, understanding a bit more about the nature of beliefs about pain (for example, attitudes and knowledge) might help us understand how to better tailor this care or even our risk-stratification approaches for future treatment of patients with LBP.Questions/purposes (1) Did patients assigned to receive risk-stratified care score higher on an assessment of pain science knowledge' (2) Did patients assigned to receive risk-stratified care have fewer unhelpful attitudes related to pain' (3) Did patients assigned to receive risk-stratified care have less pain-associated psychological distress' (4) Regardless of intervention received, is baseline SBST risk category (low, medium, or high) associated with changes in attitudes and knowledge about pain'Methods This is a secondary analysis of short-term changes in pain beliefs following the 6-week treatment phase of a randomized controlled trial that examined the effectiveness of a risk-stratified physical therapy intervention on pain-related disability at 1 year. Between April 2017 and February 2020, a total of 290 patients in the Military Health System seeking primary care for LBP were enrolled in a trial comparing a behavioral-based intervention to usual care. The intervention involved psychologically informed physical therapy using cognitive behavioral principles and included tailored education, graded exercise, and graded exposure. Individuals assigned to usual care followed treatment plans set forth by their primary care provider. Thirty-one patients were removed from Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool analyses due to missing assessments at 6 weeks (n = 15 intervention; n = 16 usual care). This resulted in 89% (259 of 290) of participants included for secondary analysis, with no difference in baseline demographic characteristics between groups. The usual-care group comprised 50% of the total study group (129 of 259), with a mean age of 34 ± 9 years; 67% (87 of 129) were men. The risk-stratified care group comprised 50% (130 of 259) of the total study group, with a mean ± SD age of 35 ± 8 years; 64% (83 of 130) were men. Six additional individuals were removed from Survey of Pain Attitudes harm scale (SOPA-h) and revised Neurophysiology of Pain Questionnaire (rNPQ) analyses for missing baseline data (n = 1 intervention) and 6-week data (n = 2 intervention; n = 3 usual care). The rNPQ captured current pain science knowledge, the SOPA-h examined patient attitudes about pain (the extent of beliefs that pain leads to damage and that movement is harmful), and the OSPRO-YF assessed patients for yellow flag clinical markers of pain-related psychological distress across 11 constructs within domains of negative mood, fear avoidance, and positive affect/coping indicative of elevated vulnerability and decreased resilience. Outcomes were assessed at baseline and 6 weeks, and data were analyzed per protocol. We assessed between-group differences at 6 weeks using linear mixed-effects models of pain attitudes and knowledge and related distress, controlling for age, gender, and baseline pain. Regardless of treatment group, we also analyzed differences in rNPQ and SOPA-h scores at 6 weeks based on SBST risk category (low versus medium or high) using generalized linear (Gaussian) regression models.Results Risk-stratified treatment was associated with improvements in pain knowledge (rNPQ mean difference 6% [95% confidence interval (CI) 1% to 11%]; p = 0.01) and a reduction in indicators of pain-associated psychological distress (OSPRO-YF mean difference -1 [95% CI -2 to 0]; p = 0.01) at 6 weeks compared with usual care. There was no difference between groups for SOPA-h score at 6 weeks (mean difference -0.2 [95% CI -0.3 to 0.0]; p = 0.09). Patients with medium- or high-risk scores on the SBST, regardless of intervention, improved slightly more on SOPA-h (β = -0.31; p < 0.01) but not rNPQ (β = 0.02; p = 0.95) than those scoring low risk.Conclusion Patients receiving risk-stratified care showed small improvements in pain knowledge and reductions in pain-related psychological distress at 6 weeks, immediately after intervention, compared with usual care. Implementation of this risk-stratified care approach for LBP was able to change patients’ perceptions about pain and reduce some of their psychological distress beyond what was achieved by usual care in this setting. As these factors are believed to favorably mediate treatment outcomes, future studies should investigate whether these improvements persist over the long term, determine how they influence clinical outcomes, and explore alternatives for risk stratification and treatment to elicit greater improvements.Level of Evidence Level III, therapeutic study.
PubDate: Tue, 21 Jan 2025 00:00:00 GMT-
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- CORR Insights®: Development of a Brief, Positively Framed Care Team
Experience Measure-
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Authors: Baumhauer; Judith F.
Abstract: No abstract available
PubDate: Tue, 21 Jan 2025 00:00:00 GMT-
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- CORR Insights®: Does Discussing Patient-reported Outcome Measures
Increase Pain Self-efficacy at an Orthopaedic Visit' A Prospective,
Sequential, Comparative Series-
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Authors: Barth; Robert J.
Abstract: No abstract available
PubDate: Tue, 31 Dec 2024 00:00:00 GMT-
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- CORR Insights®: Are Levels of Loneliness Associated With Levels of
Comfort and Capability in Musculoskeletal Illness'-
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Authors: Tan; Bryan Yijia
Abstract: No abstract available
PubDate: Tue, 31 Dec 2024 00:00:00 GMT-
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- CORR Insights®: Do Patients of Different Levels of Affluence Receive
Different Care for Pediatric Osteosarcomas' One Institution’s Experience
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Authors: Morris; Carol D.
Abstract: No abstract available
PubDate: Tue, 31 Dec 2024 00:00:00 GMT-
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- CORR Insights®: Is It Possible to Develop a Patient-reported Experience
Measure With Lower Ceiling Effect'-
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Authors: Crijns; Tom Joris
Abstract: No abstract available
PubDate: Wed, 18 Dec 2024 00:00:00 GMT-
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- Letter to the Editor: Acquired Acromion Compromise, Including Thinning and
Fragmentation, Is Not Associated With Poor Outcomes After Reverse Shoulder
Arthroplasty-
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Authors: Davulcu; Cumhur Deniz
Abstract: No abstract available
PubDate: Tue, 10 Dec 2024 00:00:00 GMT-
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- How Does Shame Relate to Clinical and Psychosocial Outcomes in Knee
Osteoarthritis'-
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Authors: Yeo; Jia Ying; Lim, Chien Joo; Yang, Su-Yin; Tan, Bryan Yijia
Abstract:
Background Knee osteoarthritis (OA) is a common and disabling condition that often carries severe psychosocial implications. Chronic illness–related shame has emerged as a substantial psychosocial factor affecting individuals with knee OA, but it is unclear how chronic illness–related shame is associated with the long-term clinical and psychosocial outcomes in individuals with knee OA.Questions/purposes (1) Does a higher level of shame correlate with worse clinical and psychosocial outcomes at baseline among individuals with knee OA' (2) Is a higher level of shame at baseline associated with worse clinical and psychosocial outcomes at 4-month and 12-month follow-up among individuals with knee OA' (3) Are sociodemographic characteristics correlated with levels of shame among individuals with knee OA'Methods Between June 2021 and February 2022, we screened 977 patients based on the inclusion criteria of (1) age 45 years or older, (2) independent in community mobility with or without walking aids, (3) proficient in English or Chinese language, and (4) met the clinical criteria for OA diagnosis outlined by the National Institute for Health and Care Excellence. Of these patients, 47% (460) were eligible and enrolled. A further 53% (517) were excluded for prespecified reasons. Of the 460 enrolled patients, 7% (30) dropped out before data collection began, and 46% (210) of patients did not complete the psychological questionnaires, leaving 48% (220) of patients for analysis. From this final sample, 25% (56) were lost to follow-up at 4 months, and an additional 7% (16) were lost by the 12-month follow-up, leaving 67% (148) of the original eligible group for analysis. All patients were recruited from the outpatient clinics of the orthopaedic and physiotherapy departments across two Singapore hospitals within the National Healthcare Group. The study population had a mean ± SD age of 64 ± 8 years, with 69% (152 of 220) women, and the mean ± SD duration of knee OA symptoms was 6 ± 6 years. Outcome measures used were the Chronic Illness-Related Shame Scale (CISS), the 12-item Knee Injury and Osteoarthritis Outcome Score (KOOS-12), Patient Health Questionnaire 4 (PHQ-4), the 8-item Arthritis Self-Efficacy Scale (ASES-8), and the Brief Fear of Movement Scale (BFOM). The CISS is a validated tool specifically designed to measure feelings of shame (internal and external shame) in individuals living with chronic illness. The scale has been validated for use among patients with knee OA in Singapore. The functional outcome measure used was the Modified Barthel Index. Data on demographic characteristics were collected. Data were collected at baseline, 4-month follow-up, and 12-month follow-up. Statistical analyses included the Spearman correlation, linear regression, and cluster analysis.Results At baseline, there was a weak to moderate negative correlation between CISS scores and KOOS-12 and ASES-8 scores (Spearman correlation coefficients ranged from -0.46 to -0.36; all p values < 0.001), indicating that higher levels of shame were associated with slightly to moderately worse knee function and lower self-efficacy. There was a modest positive correlation between CISS scores and PHQ-4 and BFOM scores (the Spearman correlation coefficients ranged from 0.43 to 0.46; all p values < 0.001), indicating that higher levels of shame were linked to more psychological distress and greater fear of movement. At the 4-month follow-up, a higher CISS score at baseline was associated with a decrease in KOOS-12 (adjusted coefficient -0.86 [95% confidence interval (CI) -1.33 to -0.40]; p < 0.001) and ASES-8 (adjusted coefficient -0.12 [95% CI -0.19 to -0.06]; p < 0.001) scores, indicating worsened knee function and reduced self-efficacy over time. Higher CISS scores at baseline were also associated with an increase in PHQ-4 (adjusted coefficient 0.23 [95% CI 0.14 to 0.31]; p < 0.001) and BFOM (adjusted coefficient 0.22 [95% CI 0.08 to 0.36]; p = 0.002) scores at the 4-month follow-up, reflecting greater psychological distress and greater fear of movement. At the 12-month follow-up, a higher CISS score at baseline was associated with a decrease in KOOS-12 (adjusted coefficient -0.72 [95% CI -1.25 to -0.19]; p = 0.008) and ASES-8 (adjusted coefficient -0.12 [95% CI -0.20 to -0.04]; p = 0.002) scores, indicating that those with higher initial levels of shame continued to experience poorer knee function and lower self-efficacy. Higher CISS scores at baseline were also associated with an increase in PHQ-4 (adjusted coefficient 0.13 [95% CI 0.04 to 0.21]; p = 0.004) as well as BFOM (adjusted coefficient 0.20 [95% CI 0.06 to 0.34]; p = 0.007) scores at the 12-month follow-up, indicating ongoing psychological distress and fear of movement. Cluster analysis found that unemployed older patients with lower CISS scores and BMI, as well as having unilateral arthritis and shorter duration of OA, were observed to have better knee function at 4 months (mean difference 7 [95% CI 1 to 12]; p = 0.02) and 12 months (mean difference 7 [95% CI 1 to 13]; p = 0.02) compared with the opposite. After controlling for age, gender, ethnicity, and employment status, the regression analysis found that higher BMI was related to higher CISS scores (adjusted coefficient 0.21 [95% CI 0.07 to 0.34]; p = 0.003).Conclusion Chronic illness–related shame has a small to modest association with clinical and psychosocial outcomes for individuals with knee OA. Healthcare professionals should routinely incorporate psychosocial assessments to identify and manage shame early, potentially improving both clinical and psychosocial outcomes. R...
PubDate: Tue, 03 Dec 2024 00:00:00 GMT-
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- Development of a Brief, Positively Framed Care Team Experience Measure
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Authors: Brinkman; Niels; Ramtin, Sina; Fatehi, Amir; Crijns, Tom J.; Ring, David; Jayakumar, Prakash; Koenig, Karl
Abstract:
Background Measures that quantify clinician fulfillment and engagement with work (clinician experience measures) have the potential to improve the quality, effectiveness, and enjoyment of patient care. Many existing measures of clinician fulfillment and engagement with work are relatively long and potentially burdensome, negatively framed, or address personal well-being. A measure with a small number of items that address positive attributes to which a team aspires may be a more useful measure to guide organizational improvement efforts.Questions/purposes In a series of cross-sectional studies we asked: (1) Can we develop a brief, positively framed, and team-oriented care team experience measure (CTEM)' (2) How does the CTEM perform relative to the Team Climate Inventory (TCI)'Methods In a first step, the clinical leadership group of a nascent multispecialty group practice curated 21 items, some from existing engagement and burnout measures and others based on suggestions from clinical leaders. After pilot testing and interviews with specific clinicians, these items were then administered to all clinicians in the practice, and 44% (120 of 274) participated. Factor analysis identified three groups of items (factors). In a second step, 43% (493 of 1135) of patient-facing employees (75% [368] of whom were women and 45% [222] of whom were ages 42 to 61 years) of a statewide musculoskeletal specialty practice rated 12 items (two from each of the factors identified in the first stage and six new items recommended by administrative leaders) and completed the TCI. Participants were then randomly allocated to a learning cohort (70% [343 participants]), in which we performed factor analysis and item response theory to develop a new CTEM and validation cohort (30% [150 participants]) to test the consistency of the findings. The best-performing items in terms of factor loadings (the degree to which an individual item represents an identified factor or “theme”; we chose a minimum of 0.4 as items above this threshold are generally regarded as stable), item discrimination (ability to measure different experiences among participants), item difficulty (the ability of an item to contribute to variation in scores), and model fit (the degree to which the estimates of the statistical model align with the observed data) were selected to form a new three-item CTEM. The CTEM was subsequently evaluated for internal consistency (Cronbach alpha, which measures the extent to which different subsets of the included items would provide the same measurement), floor and ceiling effects (the percentage of the lowest and highest possible scores, with high percentages indicating that information is lost because of the inability of a tool to measure the extremes of variation), and correlation with the TCI.Results Factor analysis identified two groups of items representing “effectiveness” (nine items, including “I am proud of the work we do”) and “collaboration” (three items, including “Our team encourages everyone’s input before making changes”). The best-performing items of “effectiveness” (two items) and “collaboration” (one item) were selected to form the three-item CTEM, which had good internal consistency (Cronbach α = 0.77;> 0.7 generally considered acceptable); a notable ceiling (37%; higher than desired, common with experience measures, and—in our opinion—acceptable for routine use given the trade-off of limited participant burden) and limited floor effect (1.3%); strong correlation with the TCI (Spearman ρ 0.77 [95% confidence interval 0.70 to 0.85]), which supports convergent validity (part of construct validity, meaning correlation with measures of related concepts); and similar correlations with participant characteristics compared with the TCI, supporting construct and criterion validity (association with real-world outcomes).Conclusion A small number of positively framed, team-oriented questions (the CTEM) can quantify clinician and care team experience and provide a practical and feasible method for health organizations to monitor and improve the experience of their clinicians.Clinical Relevance Routine measurement of organizational climate at regular intervals using a brief, user-friendly, team-oriented measure might help organizations improve their culture and help their clinicians feel appreciated and engaged.
PubDate: Tue, 03 Dec 2024 00:00:00 GMT-
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- Does Discussing Patient-reported Outcome Measures Increase Pain
Self-efficacy at an Orthopaedic Visit' A Prospective, Sequential,
Comparative Series-
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Authors: Schultz; Emily A.; Gomez, Giselle I.; Gardner, Michael J.; Hu, Serena S.; Safran, Marc; Amanatullah, Derek F.; Shapiro, Lauren M.; Kamal, Robin N.
Abstract:
Background Pain self-efficacy, or the ability to carry out desired activities in the presence of pain, can affect a patient’s ability to function before and after orthopaedic surgery. Previous studies suggest that shared decision-making practices such as discussing patient-reported outcome measures (PROMs) can activate patients and improve their pain self-efficacy. However, the ability of PROMs to influence pain self-efficacy in patients who have undergone orthopaedic surgery has yet to be investigated.Questions/purposes (1) Is immediately discussing the results of a PROM associated with an increase pain self-efficacy in new patients presenting to the orthopaedic surgery clinic' (2) Is there a correlation between patient resilience or patient involvement in decision-making in changes in pain self-efficacy'Methods This was a prospective, sequential, comparative series completed between February to October 2023 at a single large tertiary referral center at a multispecialty orthopaedic clinic. Orthopaedic subspecialties included total joint arthroplasty, spine, hand, sports, and trauma. The first 64 patients underwent standard care, and the following 64 had a conversation with their orthopaedic surgeon about their PROMs during the initial intake visit. We collected scores from the Pain Self-Efficacy Questionnaire (PSEQ), Brief Resilience Scale (BRS), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function form (PF-SF10a) and data on demographic characteristics before the visit. The PSEQ is a validated PROM used to measure pain self-efficacy, while the BRS measures the ability of patients to recover from stress, and the PROMIS PF-SF10a is used to assess overall physical function. PROMs have been utilized frequently for their ability to report the real-time physical and psychological well-being of patients. In the standard care group, the PROMIS PF-SF10a score was not discussed with the patient. In the PROMs group, the physician discussed the PROMIS PF-SF10a score using a script that gave context to the patient’s score. Additional conversation about the patient’s score was permitted but not required for all patients. Scores from the Observing Patient Involvement in Decision Making (OPTION-5) instrument were recorded during the visit as a measure of patient involvement in clinical decision-making. After the visit, both groups completed the PSEQ. The primary outcome was change in the PSEQ. Change in pain self-efficacy was recorded as greater or less than the minimum clinically important difference, previously defined at 8.5 points for the PSEQ [10]. The secondary outcomes were correlation between PSEQ change and the BRS or OPTION-5.Results Between the PROMs and standard care groups, there was no difference in the change in PSEQ scores from before the visit to after (mean ± SD change in control 4 ± 10 versus change in PROMs group 3 ± 7, mean difference 1 [95% confidence interval (CI) -2.0 to 4.0]; p = 0.29). Fifty-six percent (36 of 64) of patients in the standard care group demonstrated an increase in pain self-efficacy (of whom 22% [14 of 64] had clinically important improvements), and 59% (38 of 64) of patients in the PROMs group demonstrated an increase in pain self-efficacy (of whom 19% [12 of 64] had clinically important improvements). In the control group, there was no correlation between the change in PSEQ score and resiliency (BRS score r = -0.13 [95% CI -0.36 to 0.12]; p = 0.30) or patient involvement in decision-making (OPTION-5 r = 0.003 [95% CI -0.24 to 0.25]; p = 0.98). Similarly, in the PROMs group, there was no correlation between the change in PSEQ score and resiliency (BRS score r = -0.10 [95% CI -0.33 to 0.16]; p = 0.45) or patient involvement in decision-making (OPTION-5 r = -0.02 [95% CI -0.26 to 0.23]; p = 0.88).Conclusion Discussing PROMs results (PROMIS PF-SF10a) at the point of care did not increase pain self-efficacy during one visit. Therefore, surgeons do not need to discuss pain self-efficacy PROM scores in order to influence patient pain self-efficacy. While PROMs remain valuable tools for assessing patient outcomes, further work may assess whether the collection of PROMs itself may increase pain self-efficacy or whether longitudinal discussion of PROMs with patients changes pain self-efficacy.Level of Evidence Level II, therapeutic study.
PubDate: Fri, 22 Nov 2024 00:00:00 GMT-
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- Are Levels of Loneliness Associated With Levels of Comfort and Capability
in Musculoskeletal Illness'-
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Authors: Ponce; Haley; Cordero, Rafael; Ring, David; Sayegh, George; Azarpey, Ali; Jayakumar, Prakash
Abstract:
Background Variation in levels of pain intensity and incapability among patients with musculoskeletal conditions is associated with measures of mindset (unhelpful thoughts [such as hurt equals harm] and feelings of distress [overwhelm, rumination] regarding bodily sensations) and circumstances (social health as well as security in finances, roles, home, and support) as much or more so than pathophysiology severity. Loneliness is an important aspect of social health, it is associated with worse mental health, and it has been identified as worthy of attention and intervention by health authorities in several countries. It is estimated that up to one-third of adults older than 45 years of age experience loneliness. Given that a large percentage of people seeking musculoskeletal specialty care are older than 45 years, identification of notable levels of loneliness and an association with greater levels of pain intensity and incapability would support screening and treatment of feelings of loneliness as part of comprehensive, whole-person, musculoskeletal care strategies.Questions/purposes In a cross-sectional study of people seeking musculoskeletal specialty care for upper and lower extremity conditions, we asked: (1) Are there factors associated with levels of capability including greater feelings of loneliness' (2) Are there factors associated with levels of pain intensity including greater feelings of loneliness'Methods We recruited 146 new and returning, English-speaking, adult patients without cognitive deficiencies seeking care in metropolitan musculoskeletal specialty offices. Three patients were excluded because they did not complete the measures of pain intensity and incapability, and 143 were analyzed, including 57% (82) women with a mean age ± SD of 56 ± 17 years and 71% (102) with an upper extremity condition. Participants completed validated measures of feelings of loneliness (University of California, Los Angeles [UCLA] Loneliness Scale), thoughts and feelings regarding sensations (three items each validated in a factor analysis of commonly used measures), and levels of incapability (PROMIS Physical Function computer adaptive test), and pain intensity (pain intensity on an 11-point ordinal scale between 0 [no pain] and 10 [the most intense possible pain]). In the multivariable analysis, we measured the relationship between levels of incapability and pain intensity and feelings of loneliness, accounting for demographic factors and thoughts and feelings regarding sensations.Results Accounting for potential confounding variables such as income level and insurance status, we found that lower levels of capability were moderately associated with greater feelings of distress regarding symptoms (such as rumination or a sense of overwhelm; regression coefficient [RC] -0.99 [95% confidence interval (CI) CI -1.5 to - 0.51]; p < 0.001) and that higher levels of capability were more modestly associated with having an upper rather than lower extremity condition (RC 4.4 [95% CI 1.5 to 7.3]; p = 0.003) and an income between USD 46,000 and USD 75,000 (RC 6.7 [95% CI 1.4 to 12]; p = 0.01) compared with an income less than USD 24,000 a year. Levels of capability were not associated with levels of loneliness (RC = -0.15 [95% CI -0.38 to 0.086]; p = 0.22), even though the mean level of loneliness was 54, representing moderate to high levels of loneliness. Higher levels of pain intensity were moderately associated with greater feelings of distress regarding symptoms (RC 0.35 [95% CI 0.22 to 0.47]; p < 0.001) and also modestly associated with greater level of unhelpful thoughts about symptoms (such as pain equating to injury) (RC 0.19 [95% CI 0.036 to 0.34]; p = 0.002), having a 4-year college degree (RC -1.4 [95% CI -2.4 to -0.26]; p = 0.02), and having a postcollege graduate degree (RC -1.35 [95% CI -2.4 to -0.26]; p = 0.02) compared with high school or less education but not with higher levels of loneliness.Conclusion The observation that levels of musculoskeletal incapability and pain intensity have limited association with loneliness reinforces the evidence that other cognitive and emotional factors are the key modifiable personal factors in musculoskeletal illness. Our findings do not discount the importance of addressing loneliness in musculoskeletal care, but efforts to tackle loneliness alone may be less effective than efforts to focus on loneliness in addition to thoughts and feelings regarding bodily sensations.Level of Evidence Level II, prognostic study.
PubDate: Tue, 19 Nov 2024 00:00:00 GMT-
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- CORR Insights®: Is Kinesiophobia Associated With Quality of Life, Level
of Physical Activity, and Function in Older Adults With Knee
Osteoarthritis'-
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Authors: Stern; Brocha Z.
Abstract: No abstract available
PubDate: Tue, 19 Nov 2024 00:00:00 GMT-
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- What Are the Most Clinically Effective Nonoperative Interventions for
Thumb Carpometacarpal Osteoarthritis' An Up-to-date Systematic Review and
Network Meta-analysis-
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Authors: Thakker; Arjuna; Ramchandani, Jai Parkash; Divall, Pip; Sutton, Alex; Johnson, Nicholas; Dias, Joseph
Abstract:
Background Thumb carpometacarpal osteoarthritis (CMC-1 OA) is a common and debilitating condition, particularly among older adults and women. With the aging population, the prevalence of CMC-1 OA is expected to rise, emphasizing the need to find effective nonoperative strategies. So far, for determining the most effective nonoperative interventions in CMC-1 OA, two network meta-analyses (NMAs) have been published. However, these NMAs were limited to specific intervention types: one comparing multiple splints and the other comparing different intraarticular injections. Therefore, an NMA that compared all nonoperative intervention types is urgently needed.Questions/purposes This study aimed to assess and compare the effectiveness of available nonoperative interventions (both nonpharmacologic and pharmacologic) for CMC-1 OA to establish which nonoperative options are more effective than control in terms of (1) pain, (2) function, and (3) grip strength.Methods We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) NMA guidelines (PROSPERO: CRD2021272247) and conducted a comprehensive search across Medline, Embase, CENTRAL, and CINAHL up to March 2023. We included randomized controlled trials (RCTs) and quasi-RCTs evaluating nonoperative interventions for symptomatic CMC-1 OA, excluding inflammatory or posttraumatic arthritis. Studies comparing ≥ 2 interventions or against a control, focusing on pain reduction, functional improvement, and grip strength, were selected. We assessed methodologic quality using the modified Coleman Methodology Score, including only studies scoring> 70. Risk of bias was evaluated with the Risk of Bias 2.0 tool, and evidence quality with Confidence in Network Meta-Analysis (CINeMA). Of 29 screened studies, 22 (21 RCTs and one quasi-RCT) were included, involving 1631 women and 331 men. We analyzed eight different nonoperative interventions, including splints, hand exercises, injections, and multimodal treatment (≥ 2 nonpharmacologic interventions or nonpharmacologic with a pharmacologic intervention). Six studies had a low risk of bias, eight had a high risk, and the remainder were moderate. We extracted mean and SD scores, and NMA and pairwise analyses were performed at short- (≤ 3 months) and medium-term (> 3 to ≤ 12 months) time points. Standardized mean differences were re-expressed into common units for interpretation, which were the VAS (range 0 to 10) for pain, the DASH test (range to 100) for function, and pounds for grip strength. Clinical recommendations were considered strong if the mean differences exceeded the minimum clinically important difference—1.4 points for VAS, 10 points for DASH, and 14 pounds for grip strength—and were supported by moderate or high confidence in the evidence, as assessed using CINeMA methodology.Results Our NMA (based on moderate or high confidence) showed a clinically important reduction in pain at the short-term time point for multimodal treatment and hand exercises versus control (mean difference VAS score -5.3 [95% confidence interval (CI) -7.6 to -3.0] and -5.0 [95% CI -8.5 to -1.5]). At the medium-term time point, only the rigid carpometacarpal-metacarpophalangeal (CMC-MCP) splint was superior to control (mean difference VAS score -1.9 [95% CI -3.1 to -0.6]) and demonstrated clinical importance. For function, only the rigid CMC-MCP splint demonstrated a clinically important improvement at the medium-term time point versus control (mean difference DASH score -11 [95% CI -21 to -1]). Hand exercises resulted in a clinically important improvement in short-term grip strength versus control (mean difference 21 pounds [95% CI 11 to 31]).Conclusion This systematic review and NMA show that multimodal treatment and hand exercises reduce short-term pain and improve grip strength, while a rigid CMC-MCP splint enhances medium-term function. Future research should evaluate long-term efficacy.Level of Evidence Level I, therapeutic study.
PubDate: Tue, 19 Nov 2024 00:00:00 GMT-
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- CORR Insights®: What Are the Most Clinically Effective Nonoperative
Interventions for Thumb Carpometacarpal Osteoarthritis' An Up-to-date
Systematic Review and Network Meta-analysis-
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Authors: Wolf; Jennifer Moriatis
Abstract: No abstract available
PubDate: Tue, 19 Nov 2024 00:00:00 GMT-
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- CORR Insights®: Randomized Controlled Trials Studying Nonoperative
Treatments of Osteoarthritis Often Use Misleading and Uninformative
Control Groups: A Systematic Review-
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Authors: Landy; David Cooper
Abstract: No abstract available
PubDate: Tue, 12 Nov 2024 00:00:00 GMT-
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- Do Fellowship-educated Military Orthopaedic Oncologists Who Practice in
Military Settings Treat a Sufficient Volume of Patients to Maintain Their
Oncologic Expertise'-
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Authors: Anderson; Ashley B.; Rivera, Julio A.; Flint, James H.; Souza, Jason; Potter, Benjamin K.; Forsberg, Jonathan A.
Abstract:
Background Fellowship-trained orthopaedic oncologists in the US military provide routine clinical care and also must maintain readiness to provide combat casualty care. However, low oncologic procedure volume may hinder the ability of these surgeons to maintain relevant surgical expertise. Other low-volume specialties within the Military Health System (MHS) have established partnerships with neighboring civilian centers to increase procedure volume, but the need for similar partnerships for orthopaedic oncologists has not been examined. The purpose of this study was to characterize the practice patterns of US military fellowship–trained orthopaedic oncologists.Questions/purposes We asked the following questions: (1) What are the diagnoses treated by US military fellowship–trained orthopaedic oncologists' (2) What are the procedures performed by US military fellowship–trained orthopaedic oncologists'Methods We queried the Military Data Repository, a centralized repository for healthcare data for all healthcare beneficiaries (active duty, dependents, and retirees) within the Defense Health Agency using the MHS’s Management and Reporting Tool for all international common procedure taxonomy (CPT) codes and ICD-9 and ICD-10 codes associated with National Provider Identifier (NPI) numbers of active duty, military fellowship–trained orthopaedic oncologists. Fellowship-trained orthopaedic oncologists were identified by military specialty leaders. Then, we identified all procedures performed by the orthopaedic oncologist based on NPI numbers for fiscal years 2013 to 2022. We stratified the CPT codes by top orthopaedic procedure categories (such as amputation [performed for oncologic and nononcologic reasons], fracture, arthroplasty, oncologic) based on associated ICD codes. These were then tabulated by the most common diagnoses treated.Results Thirteen percent (796 of 5996) of the diagnoses were oncologic, of which 45% (357 of 796) were malignant. Forty-four percent (158 of 357) of the malignancies were primary and 56% (199 of 357) were secondary; this translates to an average of 2 patients with primary and 2.5 patients with secondary malignancies treated per surgeon per year. During the study period, nine orthopaedic oncologists performed 5996 orthopaedic procedures, or 74 procedures per surgeon per year. Twenty-one percent (1252 of 5996) of the procedures were oncologic; the remaining procedures included 897 arthroplasties, 502 fracture-related, 275 amputations for a nononcologic indication, 204 infections, 142 arthroscopic, and 2724 other procedures.Conclusion Although military orthopaedic oncologists possess expert skills that are directly translatable to combat casualty care and operational readiness, within MHS hospitals they treat relatively few patients with oncologic diagnoses, and less than one-half of those involve malignancies.Clinical Relevance Despite postgraduation procedure volume raining stable over the last decade, it is unknown how many new patient visits for oncologic diagnoses and how many corresponding tumor procedures are necessary to maintain competence or build confidence after musculoskeletal oncology fellowship training. It is important to note that there are no military orthopaedic oncology fellowships, and all active duty orthopaedic oncologists undergo training at civilian institutions. Military-civilian partnerships with high-volume cancer centers may enable military orthopaedic oncologists to work at civilian cancer centers to increase their oncologic volume to ensure sustainment of operationally relevant knowledge, skills, and abilities and improve patient care and outcomes.
PubDate: Wed, 30 Oct 2024 00:00:00 GMT-
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- Do Patients of Different Levels of Affluence Receive Different Care for
Pediatric Osteosarcomas' One Institution’s Experience-
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Authors: Kell; David; Yang, Daniel; Lee, Juliana; Orellana, Kevin; Wetzel, Sarah; Arkader, Alexandre
Abstract:
Background The published reports examining socioeconomic factors and their relationship to osteosarcoma presentation and treatment suggest an association between lower socioeconomic status and a worse response to chemotherapy and lower survivorship. However, the driving factors behind these disparities are unclear. The Child Opportunity Index was developed by diversitydatakids.org (https://www.diversitydatakids.org/) in 2014 to cumulatively quantify social determinants of health in an index specifically tailored toward a pediatric population and organized by census tract. The Childhood Opportunity Index can be used to explore the relationship between a patient’s socioeconomic background and disparities in osteosarcoma presentation, treatment, and outcomes.Question/purposes Are differences in a child’s Childhood Opportunity Index score associated with differences in (1) time from symptom onset to first office visit for osteosarcoma, (2) timing of chemotherapy or timing and type of surgical resection, or (3) initial disease severity, development of metastatic disease, or overall survival'Methods A retrospective therapeutic study was conducted using data drawn from the institutional records of a large pediatric tertiary cancer center located in the Mid-Atlantic region of the United States from the years 2006 to 2022. Our main site is in an urban setting, with ample access to public transit. Patients were excluded from analysis if they were seeking a second opinion or our institution was not the main point of orthopaedic care (20% [45 of 223]). Of the remaining patients, those with incomplete electronic medical records (24% [43 of 178]), resided in an international country (5% [9 of 178]), presented after relapse (4% [8 of 178]), or lacked 2 years of follow-up at our institution (3% [5 of 178]) were excluded as well. A total of 113 pediatric patients (children younger than 18 years) met the inclusion criteria. The Child Opportunity Index is a composite index derived from three domains (education, health and environment, and social and economic) and 29 indicators within the domains that serve to capture the cumulative effect of disparities on child well-being. National Childhood Opportunity scores were collected and scored from 1 to 100. Each score represents an equal proportion of the US population of children 18 years of age or younger. A higher number indicates higher levels of socioeconomic opportunity. The overall Childhood Opportunity Index score was then broken down into three groups representative of the child’s relative socioeconomic opportunity: lowest tertile for scores < 34, middle tertile for scores between 34 and 66, and highest tertile for scores> 66. Means, ranges, medians, IQRs, and percentages were used to describe the study sample. Data analysis was conducted across the three groups (lowest tertile, middle, and highest), assessing differences in time to presentation, treatment variations, disease severity, and overall survivorship. Chi-square and Fisher exact tests were applied to compare categorical variables. Mann-Whitney U tests compared continuous data. Kaplan-Meier survival analysis, stratified by Childhood Opportunity Index tertile, was performed for a 5-year period to evaluate the development of metastatic disease and overall survivorship. A log-rank test was applied to evaluate statistical significance. Due to the small sample size, we were unable to control potential confounders such as race and insurance. However, the three domains (education, health and environment, and social and economic) encapsulated by the Childhood Opportunity Index data indirectly account for disparities related to race and insurance status.Results There was no association between lower levels of socioeconomic opportunity, as expressed by the lack of difference between the Childhood Opportunity Index tertiles for the interval between symptom onset and first office visit (mean ± SD lowest tertile 77 ± 67 days [95% confidence interval (CI) 60 to 94], middle tertile 69 ± 94 days [95% CI 50 to 89], and highest tertile 56 ± 58 days [95% CI 41 to 71]; p = 0.3). Similarly, we found no association between lower levels of socioeconomic opportunity, as expressed by the lack of difference between the Childhood Opportunity Index tertiles and the time elapsed from the first office visit to the first chemotherapy session (lowest tertile 19 ± 12 days [95% CI 12 to 26], middle 19 ± 14 days [95% CI 11 to 26], and highest 15 ± 9.7 days [95% CI 8.4 to 21]; p = 0.31), the time to surgical resection (lowest tertile 99 ± 35 days [95% CI 87 to 111], middle 88 ± 28 days [95% CI 77 to 99], and highest 102 ± 64 days [95% CI 86 to 118]; p = 0.24), or the type of surgical resection (limb-sparing versus amputation: 84% [21 of 25] in lowest tertile, 83% [24 of 29] in the middle tertile, and 81% [48 of 59] in the highest tertile received limb-sparing surgery; p = 0.52). Finally, we found no differences in terms of disease-free survival at 5 years (lowest tertile 27% [95% CI 7.8% to 43%], middle 44% [95% CI 23% to 59%], and highest 56% [95% CI 40% to 67%]; p = 0.22), overall survival (lowest 74% [95% CI 58% to 95%], middle 82% [95% CI 68% to 98%], and highest 64% [95% CI 52% to 78%]; p = 0.27), or in terms of survivorship of the cohort, excluding patients who presented with metastatic disease (lowest 84% [95% CI 68% to 100%], middle 91% [95% CI 80% to 100%], and highest 68% [95% CI 55% to 83%]; p = 0.10).Conclusion In our single-center retrospective study of 113 children who presented with osteosarcoma, we did not find an association between a patient’s nati...
PubDate: Wed, 30 Oct 2024 00:00:00 GMT-
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- Is It Possible to Develop a Patient-reported Experience Measure With Lower
Ceiling Effect'-
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Authors: Brinkman; Niels; Looman, Rick; Jayakumar, Prakash; Ring, David; Choi, Seung
Abstract:
Background Patient-reported experience measures (PREMs), such as the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) or the Wake Forest Trust in Physician Scale (WTPS), have notable intercorrelation and ceiling effects (the proportion of observations with the highest possible score). Information is lost when high ceiling effects occur as there almost certainly is at least some variation among the patients with the highest score that the measurement tool was unable to measure. Efforts to identify and quantify factors associated with diminished patient experience can benefit from a PREM with more variability and a smaller proportion of highest possible scores (that is, a more limited ceiling effect) than occurs with currently available PREMs.Questions/purposes In the first stage of a two-stage process, using a cohort of patients seeking musculoskeletal specialty care, we asked: (1) What groupings of items that address a similar aspect of patient experience are present among binary items directed at patient experience and derived from commonly used PREMs' (2) Can a small number of representative items provide a measure with potential for less of a ceiling effect (high item difficulty parameters)' In a second, independent cohort enrolled to assess whether the identified items perform consistently among different cohorts, we asked: (3) Does the new PREM perform differently in terms of item groupings (factor structure), and would different subsets of the included items provide the same measurement results (internal consistency) when items are measured using a 5-point rating scale instead of a binary scale' (4) What are the differences in survey properties (for example, ceiling effects) and correlation between the new PREM and commonly used PREMs'Methods In two cross-sectional studies among patients seeking musculoskeletal specialty care conducted in 2022 and 2023, all English-speaking and English-reading adults (ages 18 to 89 years) without cognitive deficiency were invited to participate in two consecutive, separate cohorts to help develop (the initial, learning cohort) and internally validate (the second, validation cohort) a provisional new PREM. We identified 218 eligible patients for the initial learning cohort, of whom all completed all measures. Participants had a mean ± SD age of 55 ± 16 years, 60% (130) were women, 45% (99) had private insurance, and most sought care for lower extremity (56% [121]) and nontraumatic conditions (63% [137]). We measured 25 items derived from other commonly used PREMs that address aspects of patient experience in which patients reported whether they agreed or disagreed (binary) with certain statements about their clinician. We performed an exploratory factor analysis and confirmatory factor analysis (CFA) to identify groups of items that measure the same underlying construct related to patient experience. We then applied a two-parameter logistic model based on item response theory to identify the most discriminating items with the most variability (item difficulty) with the aim of reducing the ceiling effect. We also conducted a differential item functioning analysis to assess whether specific items are rated discordantly by specific subgroups of patients, which can introduce bias. We then enrolled 154 eligible patients, of whom 99% (153) completed all required measures, into a validation cohort with similar demographic characteristics. We changed the binary items to 5-point Likert scales to increase the potential for variation in an attempt to further reduce ceiling effects and repeated the CFA. We also measured internal consistency (using Cronbach alpha) and the correlation of the new PREM with other commonly used PREMs using bivariate analyses.Results We identified three groupings of items in the learning cohort representing “trust in clinician” (13 items), “relationship with clinician” (7 items), and “participation in shared decision-making” (4 items). The “trust in clinician” factor performed best of all three factors and therefore was selected for subsequent analyses. We selected the best-performing items in terms of item difficulty to generate a 7-item short form. We found excellent CFA model fit (the 13-item and 7-item versions both had a root mean square error of approximation [RMSEA] of < 0.001), excellent internal consistency (Cronbach α was 0.94 for the 13-item version and 0.91 for the 7-item version), good item response theory parameters (item difficulty ranging between -0.37 and 0.16 for the 7-item version, with higher values indicating lower ceiling effect), no local dependencies, and no differential item functioning among any of the items. The other two factors were excluded from measure development due to low item response theory parameters (item difficulty ranging between -1.3 and -0.69, indicating higher ceiling effect), multiple local dependencies, and exhausting the number of items without being able to address these issues. The validation cohort confirmed adequate item selection and performance of both the 13-item and 7-item version of the Trust and Experience with Clinicians Scale (TRECS), with good to excellent CFA model fit (RMSEA 0.058 [TRECS-13]; RMSEA 0.016 [TRECS-7]), excellent internal consistency (Cronbach α = 0.96 [TRECS-13]; Cronbach α = 0.92 [TRECS-7]), no differential item functioning and limited ceiling effects (11% [TRECS-13]; 14% [TRECS-7]), and notable correlation with other PREMs such as the JSPPPE (ρ = 0.77) and WTPS (ρ = 0.74).Conclusion A relatively brief 7-item measure of patient experience focused on trust can elimina...
PubDate: Fri, 25 Oct 2024 00:00:00 GMT-
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- CORR Insights®: Does Integration of Graded Motor Imagery Training Augment
the Efficacy of a Multimodal Physiotherapy Program for Patients With
Frozen Shoulder' A Randomized Controlled Trial-
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Authors: McAllister Nolan; Betsy
Abstract: No abstract available
PubDate: Tue, 15 Oct 2024 00:00:00 GMT-
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- Is Kinesiophobia Associated With Quality of Life, Level of Physical
Activity, and Function in Older Adults With Knee Osteoarthritis'-
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Authors: Chua; Shaun Kai Kiat; Lim, Chien Joo; Pua, Yong Hao; Yang, Su-Yin; Tan, Bryan Yijia
Abstract:
Background Beyond knee pain itself, the fear of movement, also known as kinesiophobia, recently has been proposed as a potential factor contributing to disability and functional limitation in patients with knee osteoarthritis (OA). Nevertheless, the available evidence on the association of kinesiophobia with patient-reported outcome measures (PROMs) in knee OA remains limited.Questions/purposes Among patients with nonoperatively treated knee OA, we asked: (1) Is kinesiophobia associated with decreased quality of life (QoL), functional outcomes, and physical activity' (2) What are the patient disease and psychosocial demographic factors associated with kinesiophobia'Methods This was a multicenter, cross-sectional study of 406 general orthopaedic patients from two urban, referral-based tertiary hospitals in Singapore under a single healthcare group who received nonoperative treatment for knee OA. Between July 2020 and January 2022, a total of 1541 patients were treated for knee OA nonoperatively. Based on that, 60% (923) of patients were rejected due to refusal to participate in the study, 3% (52) of patients were enrolled but did not show up for their appointments for data collection, and a further 10% (160) had incomplete data sets, leaving 26% (406) for this study’s analysis. The mean age of patients was 64 ± 8 years, 69% were women, and 81% were Chinese. The level of kinesiophobia in patients was measured using the Brief Fear of Movement scale, a validated 6-item questionnaire ranging from a score of 6 to 24 to measure kinesiophobia in OA, with higher scores representing higher levels of kinesiophobia. In terms of PROMs, the QoL and functional level of patients were measured using the QoL and activities of daily living (ADL) components of the widely validated 12-item Knee Injury and Osteoarthritis Outcome Score (KOOS-12). The KOOS-12 is a questionnaire consisting of 12 items encompassing three domains (QoL, ADL, and pain), with each item ranging from 0 to 4 and higher scores representing worse outcomes. The University of California, Los Angeles (UCLA) Activity Scale was used to measure the level of physical activity in patients. The UCLA score is a descriptive 10-level activity scale ranging from a score of 1 to 10, with higher scores representing greater physical activity levels. A directed acyclic graph, which is a relationship map used to depict and visualize the confounders between the studied variables, was used to identify the confounders between kinesiophobia and PROMs (QoL, function, and physical activity). An ordinal regression model was used to explore: (1) the association between kinesiophobia (as measured using the Brief Fear of Movement scale) and PROMs (as measured using KOOS QoL, KOOS ADL, and the UCLA Activity Scale), adjusting for key confounders such as age, gender, pain, side of arthritis, OA duration/severity, and psychosocial factors (for example, depression, anxiety, and education levels), and (2) the association between kinesiophobia (Brief Fear of Movement scale) and various patient disease and psychosocial demographic factors.Results After accounting for confounders, greater kinesiophobia (higher Brief Fear of Movement scores) was associated with lower QoL (KOOS QoL score adjusted IQR OR 0.69 [95% confidence interval (CI) 0.53 to 0.90]; p = 0.007) and lower physical activity (UCLA score adjusted IQR OR 0.68 [95% CI 0.52 to 0.90]; p = 0.007); however, there was no association between kinesiophobia and function (KOOS ADL score adjusted IQR OR 0.90 [95% CI 0.70 to 1.17]; p = 0.45). After adjusting for age, gender, OA duration, pain, and BMI, higher levels of anxiety (Patient Health Questionnaire 2 [PHQ-2] anxiety score adjusted OR 2.49 [95% CI 1.36 to 4.58]; p = 0.003) and depression (PHQ-2 depression score adjusted OR 3.38 [95% CI 1.73 to 6.62]; p < 0.001) were associated with higher levels of kinesiophobia. Education level, OA disease severity, side of arthritis (unilateral versus bilateral), and history of previous injury or surgery on the knee were not associated with kinesiophobia.Conclusion Clinicians should assess for kinesiophobia and other psychological comorbidities such as depression and anxiety at the point of initial evaluation and subsequent follow-up of knee OA with simple validated tools like the Brief Fear of Movement scale (kinesiophobia) in the clinic. This allows for clinicians to identify high-risk individuals and offer evidence-based treatment such as cognitive behavioral therapies with a multidisciplinary team, including a physical therapist and psychologist, to manage these psychological comorbidities and improve outcomes in patients with knee OA. While kinesiophobia was found to be associated with poorer QoL and physical activity, future studies including larger observational cohort studies should be conducted to determine causal and prognostic relationships between kinesiophobia and outcomes in knee OA.Level of Evidence Level III, prognostic study.
PubDate: Wed, 09 Oct 2024 00:00:00 GMT-
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- Randomized Controlled Trials Studying Nonoperative Treatments of
Osteoarthritis Often Use Misleading and Uninformative Control Groups: A
Systematic Review-
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Authors: Adu; Yaw; Ring, David; Teunis, Teun
Abstract:
Background Because there are no known treatments that alter the natural course of the pathophysiology of osteoarthritis, nonoperative treatment needs to be compared with known effective treatments that seek to mitigate symptoms or with similarly invasive inert (placebo) treatments to determine effectiveness. Comparing a treatment to an uninformative control group may inappropriately legitimize and support the use of potentially ineffective treatments. We therefore investigated the prevalence of inappropriate control groups in musculoskeletal research and asked whether these are associated with reporting a positive treatment effect.Questions/purposes We systematically reviewed randomized trials of nonoperative treatments of osteoarthritis and asked: (1) What proportion of randomized trials use uninformative control groups (defined as a treatment less invasive than the tested treatment, or a treatment that might possibly not outperform placebo but is not acknowledged as such)' (2) Is the use of uninformative control groups independently associated with reporting a positive treatment effect (defined as p < 0.05 in favor of the intervention, or as making a recommendation favoring the intervention over the control treatment)'Methods In a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Cochrane, and Embase up to September 2023 for randomized controlled trials published between 2020 to 2022 that compared one or more nonoperative treatments for the symptoms of osteoarthritis. We excluded studies that contained a surgical treatment group. We identified 103 trials that met eligibility criteria, with a total of 15,491 patients. The risk of bias was high in 60% (n = 62) of trials using the Cochrane Risk of Bias Tool, version 2. Although the high risk of bias in the included studies is concerning, it does not invalidate our design; instead, it highlights that some studies may use flawed methods to recommend treatments with unproven effectiveness beyond nonspecific effects because the kinds of bias observed would tend to increase the apparent benefit of the treatment(s) being evaluated. We used logistic regression to test the association of uninformative control groups with a positive treatment effect, accounting for potential confounders such as conflict of interest and study bias using the Cochrane Risk of Bias score.Results The use of uninformative control groups (treatments less invasive than the tested treatment, or treatments that might not outperform placebo but are not acknowledged as such) was found in 46% (47 of 103) of included studies. After accounting for potential confounding, there was no association between reporting positive treatment effects and the use of an uninformative control group. Studies with a low risk of bias had a lower likelihood of reporting a positive treatment effect (OR 0.2 [95% confidence interval 0.05 to 0.9]; p = 0.04, model pseudo R2 = 0.21).Conclusion The finding that recent studies that mimic high-level evidence often use uninformative control groups that do not adequately account for nonspecific effects (perceived treatment benefits unrelated to a treatment’s direct physiological effects) points to a high risk of legitimizing ineffective treatments. This raises the ethical imperative for patients, clinicians, journal peer reviewers, and journal editors to hold researchers to the standard of an adequate, informative control group. Awareness and risk of bias checklists might help patients and clinicians forgo new treatments based on seemingly high-level evidence that may carry only iatrogenic, financial, and psychological harm (false hope, in particular).Level of Evidence Level I, therapeutic study.
PubDate: Fri, 04 Oct 2024 00:00:00 GMT-
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- Does Integration of Graded Motor Imagery Training Augment the Efficacy of
a Multimodal Physiotherapy Program for Patients With Frozen Shoulder' A
Randomized Controlled Trial-
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Authors: Yasaci; Zeynal; Celik, Derya
Abstract:
Background Despite the availability of numerous treatment modalities for frozen shoulder, spanning from nonsurgical approaches to surgical interventions, a consensus regarding the most effective treatment remains elusive. Current studies emphasize that pain in frozen shoulder affects central nervous system activity and leads to changes in cortical structures, which are responsible for processing sensory information (like pain) and controlling motor functions (like movement). These cortical changes highlight the importance of including the central nervous system in the management of frozen shoulder. It is therefore recommended that treatment should provide more effective management by focusing not only on the shoulder region but also on the cortical areas thought to be affected.Questions/purposes Among patients treated nonsurgically for frozen shoulder, is graded motor imagery added to a multimodal physical therapy program more effective than multimodal physical therapy alone in terms of (1) Shoulder Pain and Disability Index (SPADI) scores, (2) pain with activities and QuickDASH (Q-DASH) scores, and (3) ROM after 8 weeks of treatment'Methods In this randomized clinical trial, we considered the following as eligible for inclusion: (1) ROM < 50% compared with the unaffected shoulder, (2) clinically and radiologically confirmed primary frozen shoulder, and (3) 30% loss of joint ROM in at least two planes compared with the unaffected shoulder. Diagnosis of patients was based on patient history, symptoms, clinical examination, and exclusion of other conditions. A total of 38 patients with frozen shoulder were randomly assigned to either the graded motor imagery group (n = 19) or the multimodal physiotherapy group (n = 19). The groups did not differ in age, height, weight, gender, and dominant and affected side. In both groups, there were no losses to follow-up during the study period, and there was no crossover between groups. The multimodal physiotherapy program encompassed a variety of treatments, including stretching exercises, ROM exercises, joint-oriented mobilization techniques, scapular mobilization, strengthening exercises, and the application of cold agents. The graded motor imagery program, as an addition to the multimodal physiotherapy program, included the following steps: (1) left-right discrimination (identifying left and right body parts), (2) motor imagery (mentally visualizing movements), and (3) mirror therapy training (using mirrors to trick the brain into thinking the affected part is moving). Both groups of patients participated in a program of 12 sessions, each lasting approximately 45 minutes, twice a week for 6 weeks. Participants were assessed at baseline, after 6 weeks, and at 8 weeks. The primary outcome was the SPADI score, which ranges from 0 to 100, with higher values denoting greater disability. The minimum clinically important difference (MCID) for SPADI scores is reported to be 13.2 points. Secondary outcomes were shoulder ROM, Numeric Pain Rating Scale activity score (scored from 0 points, indicating “no pain,” to 10 points, indicating “worst pain imaginable”), and Q-DASH score (ranging from 0 to 100 points, with a higher score indicating higher functional disability). Repeated-measures analysis of variance was used to compare means between one or more variables based on repeated observations.Results After 8 weeks of treatment, patients treated with graded motor imagery plus multimodal physical therapy experienced greater mean ± SD improvement from baseline in terms of SPADI scores than did the multimodal physical therapy group (65 ± 9 versus 55 ± 12, mean difference 10 points [95% confidence interval 4 to 17 points]; p = 0.01). Graded motor imagery when added to standard therapy did not produce a clinically important difference in pain scores with activity compared with physical therapy alone (7.0 ± 1.3 versus 5.9 ± 1.4, mean difference 1 point [95% CI 0.2 to 2.0 points], which was below our prespecified MCID; p = 0.04). However, improvements in Q-DASH score at 8 weeks were superior in the graded motor imagery group by a clinically important margin (58 ± 6 versus 50 ± 10, mean difference 9 points [95% CI 3 to 14 points], which was below our prespecified MCID; p = 0.01). ROM was generally better in the group that received the program augmented by graded motor imagery, but the differences were generally small.Conclusion Adding graded motor imagery to a multimodal physiotherapy program was clinically superior to multimodal physiotherapy alone in improving function in patients with frozen shoulder. However, no clinically superior scores were achieved in ROM or activity-related pain. Additionally, the follow-up period was short, considering the tendency of frozen shoulder to recur. Although adding graded motor imagery provides superiority in many scores and does not require high-budget equipment, the disadvantages such as the difference in some scores being sub-MCID and the need for expertise and experience should not be ignored. Consequently, while graded motor imagery shows promise, further research with longer follow-up periods is recommended to fully understand its benefits and limitations in the treatment of frozen shoulder.Level of Evidence Level I, therapeutic study.
PubDate: Tue, 17 Sep 2024 00:00:00 GMT-
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