EuroQol 5-dimension Questionnaire Research Articles

Cost-effectiveness of the reverse total shoulder arthroplasty. Does indication affect outcome?

The primary aim of this study was to determine the cost-effectiveness of the reverse total shoulder arthroplasty in a prospective cohort of patients over a two-year post-operative period. Patients who underwent reverse total shoulder arthroplasty were prospectively monitored for 24 months post-operatively using the Oxford Shoulder Score, Disabilities of the Arm, Shoulder and Hand questionnaire and EuroQol 5-dimensional questionnaire. Any complications or use of health care resources were recorded. The incremental cost-effectiveness ratio was used to express the cost per quality-adjusted life year gained. Sixty-seven patients were analysed, 46 primary reverse total shoulder arthroplasty for cuff arthropathy and 21 revisions from previous arthroplasty. Both indications had comparable peri-operative shoulder scores without significant difference. Using the mean change of EuroQol 5-dimensional questionnaire at one year, the incremental cost-effectiveness ratio was calculated at £16,827.43 per quality-adjusted life year, decreasing to £8313.48 per quality-adjusted life year at two years. Primary was associated with a lower incremental cost-effectiveness ratio at two years (primary £7596.76 vs. revision £11,748.51). The estimated post-operative life expectancy of the cohort was 6.9 years with a projected cost per quality-adjusted life year of £2438.78. Reverse total shoulder arthroplasty provides a cost-effective intervention with excellent patient outcomes at two years post-operatively.

Sleep Disturbance in Patients With Lumbar Spinal Stenosis: Association With Disability and Quality of Life.

This was a cross-sectional cohort study. The objective of this study was to identify the prevalence of sleep disturbance in patients with symptomatic lumbar spinal stenosis (LSS) and to establish the relationship between sleep disturbance and both functional disability and health-related quality of life in patients with symptomatic LSS. Despite the possible association between LSS and poor sleep quality, there has been no study regarding the relationship between LSS and sleep disturbance. A total of 148 patients with LSS were divided into the poor sleeper and nonpoor sleeper groups according to Global Pittsburgh Sleep Quality Index (PSQI) score. Demographic data, Visual Analog Scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and EuroQol 5-dimension questionnaire (EQ-5D) were compared between both groups. Multiple regression analysis was performed with ODI or ODI without sleep component as the dependent variable and age, sex, PSQI, VAS for back pain, VAS for leg pain as independent variables. Of the 148 patients who participated in this study, 54 (36.5%) and 94 (63.5%) patients were classified into nonpoor sleeper and poor sleeper groups. Although there were no differences in demographic data or VAS for back or leg pain between the nonpoor sleeper and poor sleeper groups, poor sleepers demonstrated significantly higher ODI scores, and lower EQ-5D than nonpoor sleepers (P=0.003 and 0.004, respectively). There were significant correlations between the global PSQI score and both the ODI score and EQ-5D. Although the surgical treatment group showed significantly higher VAS for back pain, VAS for leg pain, ODI scores, and lower EQ-5D than the conservative treatment group, the ratio of poor to nonpoor sleepers was not different between both groups (P=0.733). In the surgical treatment group, the percent of poor sleeper decreased from 65.1% to 47.6% 6 months after surgery (P<0.001). The present study demonstrated that 'poor sleep quality' is a prevalent condition (63.5%) in patients with symptomatic LSS. Poor sleep quality has an adverse effect on functional disability and health-related quality of life in symptomatic LSS patients.

Comparing the short-term cost-effectiveness of epidural steroid injections and medical management alone for discogenic lumbar radiculopathy

ObjectiveEpidural steroid injections (ESIs) are a commonly used treatment strategy for low back pain and lumbar radiculopathy. However, their cost-effectiveness and ability to mediate long-term quality of life (QOL) improvements is debated. We sought to analyze the cost-effectiveness of lumbar epidural steroid injections (ESIs) compared to medical management alone for patients with lumbar radiculopathy and low back pain. Patients and MethodsQOL outcomes were prospectively collected at 3- and 6-months following initial consultation. Metrics included the EuroQol-5 Dimensions (EQ-5D) questionnaire, the Pain Disability Questionnaire (PDQ), the Patient Health Questionnaire (PHQ-9) and the Visual Analogue Scale (VAS). Cost estimations were based on Medicare national payment amounts, median income, and missed workdays. A cost-utility analysis was performed based upon cost estimations and a cost-effectiveness threshold of $100,000/Quality-adjusted life year (QALY). ResultsOne hundred forty-one patients met our inclusion/exclusion criteria; 89 received ESI and 52 were treated with medical management alone. Both cohorts showed improved EQ-5D scores at 3 months but were similar to one another: ESI (ΔEQ-5D = 0.06; p = 0.03) and medical-alone (ΔEQ-5D = 0.07; p = 0.03). No significant difference was seen between groups for total costs ($2,190 vs. $1,772; p = 0.18) or cost-utility ratios ($38,710/QALY vs. $27,313/QALY; p = 0.73). At both the 3-month and 6-month endpoints, absolute differences in cost-utility was driven by overall costs as opposed to QALY gains. Medical management alone was more cost effective at both points owing to lower expenditures, however these differences were not significant. No benefits were seen in either group on the EQ-5D or any of the patient reported outcomes at the 6-month time point. ConclusionESIs were not cost-effective at either the 3-month or 6-month follow-up period. At 3 months, ESIs provide similar improvements in QOL outcomes relative to medical management and at similar costs. At 6 months, neither ESIs nor conservative management provide significant improvements in QOL outcomes.

Daily step counts and health-related quality of life before and after bilateral and unilateral total hip arthroplasty.

Purpose: We examined and compared the daily step counts and health-related quality of life of patients before undergoing either bilateral or unilateral (with or without arthritis in the opposite joint) total hip arthroplasty (THA), and for 6 months afterwards.Participants and Methods: Participants were patients who were living at home and were requested to wear accelerometers and log their daily step count preoperatively and again 6 months postoperatively. Additionally, they completed the Oxford Hip Score and EuroQol 5-Dimension questionnaires at both time points.Results: Data from 40 patients were analyzed. Patients underwent bilateral total hip arthroplasty (n=13), unilateral total hip arthroplasty with arthritis in the opposite joint (n=13), and unilateral total hip arthroplasty without arthritis in the opposite joint (n=14). The Oxford Hip Score and EuroQol 5-Dimension score showed that the daily step counts of patients who underwent bilateral or unilateral total hip arthroplasty without arthritis in the opposite joint significantly increased postoperatively, but that of patients who received unilateral THA with arthritis in the opposite joint did not change significantly. The Oxford Hip Score indicated an improvement in hip joint function after surgery, but the EuroQol 5-Dimension score did not show a significant change postoperatively in patients who received bilateral total hip arthroplasty.Conclusion: The pre- and postoperative comparisons of the participant’s daily step count after bilateral and unilateral operations without arthritis on the other side showed improvements in their amount of daily life activities. In all surgeries, Oxford Hip Score improvements were confirmed. The EuroQol 5-Dimension score of bilateral operations did not change. Bilateral operations and an understanding of unilateral postoperative qualitative support will be necessary in the future.

Factors Affecting Quality of Life and Satisfaction in Patients with Arthritis after Change to a Fixed-Dose Naproxen/Esomeprazole Combination Drug.

BackgroundIn drug therapy for patients with arthritis, a naproxen/esomeprazole combination drug may be a tolerable choice because it can minimize gastrointestinal and cardiovascular adverse effects. The aim of this study was to investigate the changes in quality of life (QOL), medication adherence, and satisfaction after switch from the existing drug to the combination drug. In addition, we analyzed the correlation between the above-mentioned variables and the stratified demographic and medical data of the patients.MethodsA prospective, noninterventional, observational study was conducted in 30 hospitals between May 2014 and July 2016. In total, 2,308 patients with osteoarthritis, 99 patients with rheumatoid arthritis, and 76 patients with ankylosing spondylitis were enrolled. Demographic information (age, sex, body mass index [BMI], alcohol consumption, and smoking) and medical information (type of arthritis, duration of disease, and comorbidities) were collected via a self-administered questionnaire. Patients were observed for more than three months after switching to the combination drug. Data on the QOL (EuroQoL 5-Dimension questionnaire [EQ-5D questionnaire]), medication adherence (Morisky Medication Adherence Scale [MMAS]), and satisfaction were collected at the first and last visits.ResultsA total of 2,483 patients enrolled at 30 hospitals completed the questionnaire. After the switch to the combination drug, the mean EQ-5D score improved from 0.72 ± 0.17 to 0.79 ± 0.14 (p < 0.001), and significant improvement was associated with female sex (p = 0.016), shorter disease duration (p < 0.001), and absence of comorbidities (p < 0.001). The mean MMAS score was 6.38 ± 1.77, indicating medium adherence. Satisfaction was significantly higher in female patients (p < 0.001), in patients with a shorter disease duration (p < 0.001), osteoarthritis (p = 0.003), and no comorbidities (p < 0.001). Serious drug-related adverse effects did not occur.ConclusionsThe overall QOL was improved with medium adherence after the switch to the combination drug. On the basis of the analysis of stratified data, sex, age, drinking, smoking, disease duration, comorbidities, and BMI might be associated with QOL, satisfaction, and adherence.

Contribution of Personality Traits, Psychological Factors, and Health-Related Quality of Life to Medication Adherence in Patients with Rheumatoid Arthritis.

PurposeThis study sought to investigate the associations between personality traits and medication adherence and to identify predictors of good medication adherence in rheumatoid arthritis (RA) patients.Materials and MethodsA total of 207 RA patients using disease-modifying anti-rheumatic drugs were invited for an interview and questionnaire study. Medication adherence was measured using the Compliance Questionnaire for Rheumatology (CQR). Personality traits were analyzed with the five-factor model of the Korean version of the Big Five Inventory 10. Psychological factors were assessed with the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and British Columbia Cognitive Inventory. Health-related Quality of Life (HRQoL) and functional disability were evaluated with the EuroQoL-5 dimension questionnaire and Health Assessment Questionnaire. Multivariate logistic regression analyses were performed to investigate predictors of good medication adherence.ResultsNonadherence to medication was reported by 66.7%. The number of daily prescribed pills was higher in the medication adherence group than in the nonadherence group. Concomitant oral glucocorticoid doses were associated with medication adherence. A high level of conscientiousness and diabetes mellitus comorbidity were associated with better medication adherence [odds ratio (OR), 2.11; 95% confidence interval (CI), 1.01–4.38 and OR, 3.00; 95% CI, 1.12–8.07, respectively]. There were no significant differences in psychological factors or HRQoL between medication adherence and nonadherence groups.ConclusionThe personality trait of conscientiousness was associated with medication adherence among the five personality traits evaluated. Patients with diabetes mellitus also showed higher medication adherence than those without this comorbidity.

Preoperative Validation of the Patient-Reported Outcomes Measurement Information System in Patients With Articular Cartilage Defects of the Knee

To validate the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function computer adaptive test (PF CAT) with current patient-reported outcome (PRO) instruments in patients with cartilage injuries of the knee. Patients scheduled for osteochondral autograft or allograft transplant, microfracture, autologous chondrocyte implantation, allograft cartilage resurfacing, and chondroplasty were prospectively enrolled in the study and completed PROMIS PF CAT, Knee Injury and Osteoarthritis Outcome Score (KOOS activities of daily living, pain, symptoms, sport, and quality of life), Short Form-36 Health Survey (SF-36 physical function [PF] and Physical Component Summary), and EuroQol-5 Dimension questionnaires. The Spearman correlation coefficient was used to compare instruments. Instrument correlations were defined as excellent (>0.7), excellent to good (0.61-0.69), good (0.4 to 0.6), and poor (<0.39), with significance defined as P < .05. A total of 293 knees in 275 patients (54.5% male) undergoing 319 cartilage procedures were analyzed. The most commonly performed cartilage procedure was chondroplasty (n= 118; 37.0%), followed by microfracture (n= 100; 31.3%). The mean age was 34.0 ± 14.7 and the mean body mass index was 30.0 ± 6.9. The PROMIS PF CAT had an excellent correlation with the SF-36 PF (r= 0.819; P < .001), SF-36 Physical Component Summary (r= 0.766; P < .001), KOOS activities of daily living (r= 0.733; P < .001), KOOS Sport (r= 0.709; P < .001), and EuroQol-5 Dimension (r= 0.752; P < .001) instruments; an excellent-good correlation with the KOOS pain (r= 0.662; P < .001), and KOOS quality of life (r= 0.640; P < .001) scores; and a good correlation with the KOOS symptoms (r= 0.519; P < .001) scale. The PROMIS PF CAT had no floor or ceiling effects and the smallest question burden (mean 4.17 ± 0.93 questions). Dimensionality analyses demonstrated that the smallest amount of unexplained variance was present in the PROMIS PF CAT (3.6%). The PROMIS PF CAT is an effective tool for preoperative outcome assessment in patients with cartilage defects of the knee. It correlates strongly with legacy PRO measures of physical function with no ceiling and floor effects and a minimal time burden for completion. Further study is warranted to determine postoperative performance and to evaluate the responsiveness of PROMIS to change within a patient. III; Prognostic retrospective comparative study.

Repeat treatment with capsaicin 8% patch (179mg capsaicin cutaneous patch): Effects on pain, quality of life, and patient satisfaction in painful diabetic peripheral neuropathy: an open-label, randomized controlled clinical trial

Objective: To determine long-term safety and effectiveness of repeat treatments with a high concentration capsaicin patch. Methods: In this 52-week, open-label, randomized controlled study, patients with painful diabetic peripheral neuropathy (PDPN) received either capsaicin patch: (30- or 60-min; 1–7 treatments to the feet) plus SOC or SOC alone. Effectiveness was assessed, by changes from baseline to end of study (EoS), in average and severity of pain, pain interference with daily function (Brief Pain Inventory-Diabetic Neuropathy version), responder rates, Patient Global Impression of Change (PGIC), and EuroQol 5-dimension (EQ-5D) questionnaire. Results: 468 patients were randomized (n=156 and n=157, 30 and 60-min respectively; SOC alone, n=155). Safety data have been reported previously. Changes in average pain from baseline to EoS (mean percentage (SD)) were: 30-min, −37.5% (32.9); 60-min, −40.8% (39.7); SOC alone, −13.9% (74.6). The difference between groups increased progressively from −17.7% and −18.6% at Month 1 for 30- and 60-min., respectively, to −21.9% and −24% at Month 12. More 30% responders occurred in the capsaicin groups (30-min, 67.3%; 60-min, 67.5%) and more felt: very much or much improved” (30-min, 24.2%; 60-min, 24.5%), compared with SOC alone (40.6% and 9.5% respectively). A greater mean improvement in EQ-5D utility index and EQ-5D visual analog scale score, from baseline to Month 12, was observed with the 30-min (0.12) and 60-min (0.15) versus SOC alone (0.07) and mean (SD), 30–min (10.4 [18.5]) and 60-min (11.2 [21.4]) versus SOC alone (5.5 [18.1]) respectively. Conclusion: Capsaicin 8% patch showed differential effectiveness over SOC alone, further increasing with repeat treatments.

Cardiac self-efficacy and quality of life in patients with coronary heart disease: a cross-sectional study from Palestine

BackgroundPsychological factors, such as self-efficacy, are important in understanding the progress and management of coronary heart disease (CHD), and how patients make lifestyle modifications to compensate for the disease. The main objectives of this research are to assess patterns of cardiac self-efficacy (CSE) and quality of life (QoL) among CHD patients, and to determine the factors that affect their QoL.MethodsA cross-sectional descriptive correlational study was carried out between August 2016 and December 2016. We used a structured questionnaire completed by interviewers during face-to-face interviews with patients. Cardiac self-efficacy was evaluated using three scales: 1) the 5-item perceived efficacy in patient- physician interaction scale (PEPPI-5); 2) the self-efficacy for managing chronic diseases 6-item scale (SEMCD-6) and 3) Sullivan’s cardiac self-efficacy scale 13-items (SCSES). The 5-level version of the EuroQoL 5-dimensions questionnaire (EQ-5D-5 L), and Euroqol Visual Analogue Scale (EQ VAS) were used to evaluate health-related QoL (HRQoL) among CHD patients. Multiple binary logistic regression was carried out to evaluate the influence on the QoL score of demographic and medical characteristics, and self-efficacy factors.ResultsA total of 275 patients participated in our study. The patients’ mean age was 59.51 ± 1.005 years. The HRQoL was measured by the EQ-5D-5 L index score and EQ-VAS score; their means were 0.62 ± 0.16 and 57.44 ± 1.61, respectively. The QoL showed moderate positive correlations with the PEPPI-5 (r = 0.419; p-value < 0.001), SEMCD-6 (r = 0.419; p-value < 0.001), and SCSES score (r = 0.273; p-value < 0.001). Multiple binary logistic regression showed that only patients with higher PEPPI-5 score (odds ratio (OR) = 1.11; 95% confidence interval (CI) =1.01–1.22; p = 0.036), and higher SCSES score (OR = 1.10; 95% CI = 1.03–1.17; p = 0.004) were significantly associated with a high QoL score. Moreover, multiple binary logistic regression model showed that patients with higher numbers of medications (OR = 0.23; 95% CI = 0.07–0.78); p = 0.018) remained significantly associated with impaired QoL.ConclusionsLower levels of self-efficacy and poorer patient-physician interactions predicted poor HRQoL. Thus, health providers should be aware of these factors in CHD patients when trying to improve their QoL.

Could Euroqol 5 Dimension questionnaire predict the characteristics of a hospitalization?

Abstract Background Health related quality of life (HRQL) reflects how a particular state of health could influence individual wellbeing. Pathologies have a significant impact on the life, but the same conditions can be perceived differently so subjective evaluation by patient can be a valuable help to the doctors. The aim of the study is to describe how the HRQL may correlate with some clinical conditions. Methods A cross-sectional study was conducted in January-March 2019 in a private clinic. The Euroqol-5 Dimension (EQ-5D) questionnaire is a measure of quality of life to capture physical, mental and social functioning of patients and it was submitted at the time of admission. Examined variables were: age, sex, hospitalization period, EQ-5D index, EQ-5D dimensions (mobility, self-care, activity, pain, depression) and mini-mental state examination (MMSE). The sample was divided into subgroups for age (S1:&amp;lt;75 years, S2:&amp;gt;75) and for presence of problems (with or without). Statistical analysis was conducted using Stata 12. Results A total of 59 patients were admitted, but only 33 (69.7% females) received the EQ-5D questionnaire. Average age was 80.2±12.3, higher for females (p = 0.02). The average length of stay was 12.7±9.4 days. The mean of EQ-5D index for the patients was 0.36±0.27 (S1:0.38±0.26; S2:0.27±0.3) and it did not seem to be significantly correlated with variables. The frequency of the EQ-5D dimensions problem stratified by age group was: mobility 96.97%(S1 21.21%, S2 75.76%), self-care 90.91%(S1 21.21%, S2 69.7%), usual activity 93.94%(S1 21.21%, S2 72.73%), pain 87.88%(S1 18.18%, S2 69.7%), depression 66.66%(S1 15.15%, S2 51.51%). The length of stay showed a significant correlation with pain(Spearman r=-0.45, p = 0.018) and depression(r = 0.46, p = 0.015). Conclusions The majority of patients showed low level of EQ-5D index which is reflected in a low level of perceived HRQL. Pain and depression are the two dimensions that have shown a possible correlation. Key messages The EQ-5D index does not appear correlated to variables such as sex, age and length of stay. Depression and pain could be two important factors influencing a patient’s admission and its length.

PRO132 DISEASE BURDEN OF X-LINKED HYPOPHOSPHATEMIA

X-linked hypophosphatemia (XLH) is a rare genetic disease, serious, debilitating and deforming condition, characterized by renal phosphate wasting. XLH is caused by loss of function of the PHEX gene resulting in enhanced secretion of the phosphaturic hormone FGF23 and leading defective bone mineralization, leading to rickets and impaired physical function.This disease, which affects 1:20.000 people, results in impaired quality of life (QoL) of patients, since, despite the treatments, suffer progressive and debilitating complications. The main objective of the study was to determine QoL of patients, children and adults suffering XLH, as well as their caregivers. A multicentre, observational and cross-sectional study has been carried out by a scientific committee consisted of 17 health professionals experts in XLH. QoL was assessed with the following EuroQol-5 Dimensions (EQ-5D) questionnaires: the EQ-5D-3L proxy (completed by caregivers or parents of children under 12 years), the EQ-5D-3L (completed by patients aged between 12 and 18 years), and the EQ-5D-5L (completed by adult patients and caregivers). The total number of participants for this project was 50 patients, 21 children and 29 adults, and their corresponding caregivers. Children had mobility problems due to difficulties walking, moderate pain or discomfort, problems doing their daily activities and felt anxious or depressed. In addition, children showed problems washing or dressing themselves. Similarly, a high percentage of adults were unable to walk, suffered extreme pain, showed difficulties to carry out their daily activities, and reported anxiety and depression. Moreover, the results of QoL for caregivers and parents were slightly lower than the general Spanish population. In conclusion, both children and adults, showed an important deterioration in QoL that were worse than the general Spanish population. These findings suggest the need for new treatments, as in many cases, the conventional treatment does not prevent disease complications and the impairment of QoL.

Should the EuroQol-Five Dimensions Replace the Oswestry Disability Index When Tracking Lumbar Tubular Microdecompression Outcomes?

Patient-reported outcomes measures (PROMs) are critical in evaluating the effectiveness of surgical spine interventions. The Oswestry Disability Index (ODI) is commonly used but tedious to administer routinely. The EuroQol-5 Dimensions (EQ-5D) questionnaire is easier to administer but not traditionally used to measure spine surgical results. This study aimed to investigate the correlation of commonly administered PROMs in lumbar tubular microdecompression patients, and to consider whether ODI could be predicted from remaining PROMs. This study examined 304 index lumbar tubular microdecompression patients with PROMs collected at routine intervals. Spearman correlation coefficients were calculated for each pairwise combination of the following PROMs: ODI, EQ-5D index, leg pain visual analog scale (VAS), low back pain VAS, health state item. Linear regression modeling was conducted to predict ODI from the remaining four PROMs. The patients had a mean age of 65.55 ± 12.97 years and 46.4% were male. Each combination of PROMs demonstrated a statistically significant pairwise correlation (P < 0.001). ODI showed strong correlation with EQ-5D index (r=-0.77), leg pain VAS (r= 0.73), and back pain VAS (r= 0.65), but weak correlation with health state item (r=-0.33). Forwards stepwise model selection yielded a multiple linear regression model including all four PROMs predictors, with an adjusted R2 of 0.690. There was strong correlation between predicted and observed ODI (r= 0.83, P < 0.001). ODI can be predicted from EQ-5D, leg and low back pain VAS, and health state items with moderate accuracy. The added utility of capturing ODI routinely may not out-weigh the challenges in doing so.

Midline lumbar interbody fusion (MIDLIF) with cortical screws: initial experience and learning curve.

A variety of surgical techniques can be used to achieve lumbar spinal fusion for management of degenerative conditions. Transforaminal lumbar interbody fusion (TLIF) is the most popular technique; however, midline lumbar interbody fusion (MIDLIF) is a valid alternative to the more traditional pedicle screw trajectory with potential advantages. The aim of this study is to evaluate the clinical outcomes from a cohort of patients submitted to MIDLIF in a single hospital during the surgical team's initial learning period. The first 30 consecutive patients who underwent single- or two-level MIDLIF surgery for lumbar degenerative disease were included in this retrospective study. Patients' demographics, surgical data, length of hospitalisation, and perioperative complications were analysed. Preoperative and postoperative radiographic parameters were obtained. Validated questionnaires, Core Outcome Measure Index for the back, Euro-QoL 5-Dimensional Questionnaire, and Oswestry Disability Index, were used for clinical assessment. Mean surgery time was 278.53 ± 82.16 min and mean hospitalisation time was 6.17 ± 3.51 days. Six patients experienced complications, four of which being dural tears with no consequences, and two required reoperations during the mean follow-up of 25.23 ± 9.74 months. Preoperative and postoperative radiological parameters did not demonstrate significant differences. All clinical parameters significantly improved after surgery (p < 0.001). A complexity score was developed to more accurately compare the different procedures, and it strongly correlated with surgery duration (r = 0.719, p < 0.001). Furthermore, a moderate correlation was found between a developed Duration Index and the patient's order number (r = - 0.539, p = 0.002). In our initial experience, MIDLIF showed to be effective in significantly improving the patients' functional status, pain scores, and quality of life. The technique seems safe, with an acceptably low complication rate. Hence, MIDLIF can be considered as a promising alternative to more traditional TLIF and PLIF techniques even at the beginning of the learning curve.

Usage Trends of Patient-reported Outcome Measures in Shoulder Literature.

Quantifying patient outcomes is integral in orthopaedic practice, and patient-reported outcome measures (PROMs) assist with this goal and assist clinicians in assessing subjective outcomes (pain, satisfaction, etc.). This study seeks to identify the most highly used PROMs in the shoulder literature and analyze their usage trends. PubMed was queried for all shoulder-based articles published in eight selected journals from 2007 to 2017. Articles were assessed for PROM usage, surgical approach, surgical procedure, and disease pathology. Frequency analyses identified the most used PROMs overall, and for each approach, procedure, and pathology. Last, usage trends, question number, validation, and clinician dependence of PROMs with ≥20 uses were analyzed. In total, 1,740 of 2,462 articles (71%) used 105 unique PROMs 4,394 times during the study. PROM usage increased 18%, and the use of multiple PROMs increased by 20%. PROMs with a clinician component increased 21% slower than the baseline. Twenty-two PROMs (17%) had >20 uses, with the most used PROMs being the Constant-Murley Score (783), American Shoulder and Elbow Surgeons Shoulder Score (731), Visual Analog Scale (685), Simple Shoulder Test (372), and the University of California, Los Angeles, Shoulder Rating Scale (274). PROMs demonstrating the greatest usage increase were the EuroQol 5-Dimensions Questionnaire (1,282%), Shoulder Pain and Disability Index (638%), Western Ontario Rotator Cuff Index (632%), Western Ontario Osteoarthritis of the Shoulder Index (582%), and Oxford Shoulder Score (462%)-all without a clinician component. PROM usage is increasing, often with multiple PROMs being used to evaluate patient outcomes. PROMs without a clinician component are growing at higher rates than their clinician-dependent counterparts, highlighting an emphasis on patient reporting of outcomes. This study suggests that the American Shoulder and Elbow Surgeons Shoulder Score, Oxford Shoulder Score, Visual Analog Scales-all without a mandatory clinician component and high levels of use-will be the most highly used PROMs moving forward to assess shoulder function.

Decompression for recurrent carpal tunnel syndrome provides significant functional improvement and patient satisfaction.

This prospective single-centre study describes the functional outcomes, satisfaction and health-related quality of life after open revision carpal tunnel decompression for recurrent carpal tunnel syndrome. The QuickDASH, patient satisfaction and EuroQol-5 dimensions questionnaires were collected preoperatively and postoperatively over a 5-year period (2013-2018). The median time to revision was 13.3 years (range 3.9-35.4 years; interquartile range 7.2-15.9 years). Outcomes were available for 14 hands in 13 patients at a mean of 20 months after revision surgery. The mean preoperative and postoperative QuickDASH scores were 55 and 29, respectively, and the mean improvement in QuickDASH was 26. The mean improvement in EuroQol-5 dimensions score was 0.1, and 13 of the 14 patients were satisfied. The net promoter score was 85. This study confirms that patients undergoing revision open carpal tunnel decompression for recurrent carpal tunnel syndrome experience a significant improvement in function and health-related quality of life. Level of evidence: IV.

Impact of K-Line (-) in the Neck-Flexion Position on Patient-reported Outcomes After Cervical Laminoplasty For Patients With Ossification of the Posterior Longitudinal Ligament.

This study was a post hoc analysis of prospective data. The objective of this study was to investigate whether K-line (-) in the neck-flexion position [f-K-line (-)] affects patient-reported outcome measures after cervical laminoplasty for patients with ossification of the posterior longitudinal ligament (OPLL). The f-K-line was recently proposed as a predictor of poor outcomes after laminoplasty for patients with OPLL. However, its impact on patient-reported outcome measures remains to be elucidated. We analyzed prospectively collected data from 68 patients with cervical myelopathy due to OPLL who underwent double-door laminoplasty between 2008 and 2015. Patients were categorized into f-K-line (-) and f-K-line (+) groups on a baseline neck-flexion radiograph. Outcome measures included the Japanese Orthopaedic Association score, EuroQol 5-Dimensional Questionnaire, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, and 11-point Numerical Rating Scale for pain. The degree of satisfaction with the outcome was assessed at the 2-year follow-up using a 7-point Numerical Rating Scale. Of the 68 patients, 22 (32%) and 46 (68%) were grouped into the f-K-line (-) and f-K-line (+) groups, respectively. The 2 groups showed no significant difference in baseline functions. The f-K-line (-) group showed a significantly lower recovery rate of the Japanese Orthopaedic Association score and a significantly lower gain in EuroQol 5-Dimensional Questionnaire score than compared with the f-K-line (+) group at the 2-year follow-up. Among the 5 domains of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, cervical function, and upper extremity function were significantly lower in the f-K-line (-) group than in the f-K-line (+) group. Patients in the f-K-line (-) group also reported a significantly higher pain intensity in the upper and lower extremities and a significantly lower degree of satisfaction compared with those in the f-K-line (+) group. The f-K-line (-) was significantly associated with poorer functional recovery, higher pain intensity in the extremities, and lower patient satisfaction after cervical laminoplasty for patients with OPLL.

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion

IntroductionRobotic guidance (RG) and computer-assisted navigation (NV) have seen increased adoption in instrumented spine surgery over the last decade. Although there exists some evidence that these techniques increase radiological pedicle...

Similar results with kinematic and mechanical alignment applied in total knee arthroplasty.

This meta-analysis compared the results of kinematic alignment (KA) and mechanical alignment (MA) applied in total knee arthroplasty (TKA). Randomized controlled trials and cohort studies comparing functional, radiological, and perioperative results and complications in TKA with KA and MA were collected from databases and included in the analysis. Nine trials were included. KA showed a better performance in terms of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (mean difference [MD] = - 9.06, 95% confidence interval [CI] - 14.69, - 3.42) and Oxford knee score (OKS) (MD = 4.72, 95% CI 0.24, 9.21); however, the Knee Society score (KSS), knee injury and osteoarthritis outcome score (KOOS), EuroQoL 5-dimension questionnaire (ED-5D), range of motion, and complications were similar for KA and MA (n.s.). KA resulted in slightly more varus alignment in the tibia [mechanical medial proximal tibial angle (mMPTA) MD = - 2.45, 95% CI - 2.89, - 2.01) and more valgus alignment in the femur (mLDFA MD = - 2.06, 95% CI - 2.48, - 1.65) than MA (P < 0.05), but showed similar results in terms of the joint line orientation angle (JLOA) (MD = 0.54, 95% CI - 2.59, 3.66), hip-knee-ankle angle (HKA), anatomical knee angle (AKA), femoral flexion-extension angle (FFA), and tibial slope (TS). The preoperative results, including the incision length, hospital stay, and changes in hemoglobin, were also similar. KA achieved functional, radiological, and perioperative results similar to those of MA and did not increase the complication rate. KA is an acceptable and satisfactory method for application in TKA. III.

P.132 Is a positive nerve root sedimentation sign associated with better outcomes after lumbar laminectomy?

Background: The nerve root sedimentation sign (SedSign) has been correlated with clinically significant lumbar spinal stenosis (LSS), and promoted as a possible prognostic indicator. However, diagnostic methods were not clearly defined in prior reports. In this study, the clinically validated Saskatchewan Spine Pathway enabled diagnosis of neurogenic claudication due to LSS. The objective was to compare the outcome of lumbar laminectomy for neurogenic claudication with respect to SedSign. Methods: This was a retrospective analysis of prospectively-collected data in patients with neurogenic claudication who underwent lumbar laminectomy. Outcome measures included Oswestry Disability Index, Visual Analogue Scale (VAS) for back and leg pain, and EuroQol 5-Dimension questionnaire. Results: Laminectomy was performed in 106 patients, and 60 were SedSign positive. Outcomes did not differ with respect to SedSign for all outcome measures, in non-instrumented and instrumented cohorts. Improvement in walking distance was associated with dural cross-sectional area of stenosis (p=0.02). VAS back and leg improvements were associated with back dominant (p=0.038) and leg dominant (p=0.0036) pain. Conclusions: This is the largest analysis of SedSign with respect to operative outcomes, and the only study with validated criteria for defining neurogenic claudication. Although other radiological and clinical factors are associated with improvements, SedSign did not correlate with laminectomy outcome.

Novel Approaches to Value Assessment Within the Cost-Effectiveness Framework

Novel Approaches to Value Assessment Within the Cost-Effectiveness Framework