Evaluation Of Outcome Measures Research Articles

Trends in outcomes used to measure the effectiveness of UK-based support interventions and services targeted at adults with experience of domestic and sexual violence and abuse: a scoping review

ObjectivesIn the UK, a range of support services and interventions are available to people who have experienced or perpetrated domestic and sexual violence and abuse (DSVA). However, it is currently...

Long-term outcome of the Sauvé-Kapandji procedure in patients with post-traumatic distal radioulnar joint disorders.

The aims of this study were to retrospectively assess the occurrence of complications or need for secondary wrist procedures after the Sauvé-Kapandji procedure, and to prospectively assess patient-reported outcomes at long-term follow-up. All patients treated with the Sauvé-Kapandji procedure in our tertiary referral hospital between January 2008 and September 2021 were identified and contacted to complete the Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist/Hand Evaluation outcome measures. In total, 30 patients, with a median follow-up of 82 months, were included in this study. Complications occurred in 6 of 30 patients, which resulted in six secondary wrist procedures. Mean Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist/Hand Evaluation scores were 30.1 and 33.6, respectively. We conclude that in respect of long-term outcomes, the Sauvé-Kapandji procedure can still be deemed to be a useful procedure, especially in patients with few other reconstructive options.Level of evidence: IV.

Dysphagia Prevalence in Progressive Supranuclear Palsy: A Systematic Review and Meta-Analysis.

The objective of this systematic review was to determine the prevalence of dysphagia and aspiration in people with progressive supranuclear palsy (PSP). A search of six electronic databases was performed from inception to April 2022. No context restrictions were set. All primary research comprising figures to derive a prevalence rate were included. Two independent reviewers screened search results. Data were extracted by one reviewer. Conflicts were resolved by discussion with a third reviewer. The quality of included studies was assessed using the JBI Checklist for Prevalence Studies. From 877 studies, 12 were eligible for inclusion. Dysphagia had to be confirmed using instrumental assessments, clinical swallowing evaluation, screening, and patient-reported outcome measures (PROM). A random-effects meta-analysis calculated a pooled dysphagia prevalence in 78-89% (95% CI [60.6, 89.1], [78.9, 95.0]). depending on the chosen assessment method, and a pooled aspiration prevalence of 23.5% (95% CI [14.5, 33.7]). The included studies were of moderate quality, with high risk of selection and coverage bias and low to moderate risk of measurement bias. Dysphagia is highly prevalent in a sample of participants with mostly moderately severe PSP. Aspiration occurs in a quarter of this sample and is likely to increase as the disease progresses. Given the low general prevalence of PSP, studies remain at high risk for selection bias. Prospective research should focus on the development of dysphagia in the course of PSP and its subcategories using instrumental assessment and consider all phases of swallowing. REGISTRATION: The protocol of this systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) in April 2021 (registration number: CRD42021245204).

An evaluation of survive and thrive: a 10-week group psychoeducational course for adult interpersonal trauma survivors in Scotland

ABSTRACT Emerging evidence supports a phased approach to trauma treatment, including manualised group-based interventions, to facilitate symptom reduction resulting from complex trauma sequelae. This study investigates the efficacy of Survive and Thrive, a 10-week group psychoeducational course for adult survivors of interpersonal trauma. Between August 2019 and February 2022, participants were enrolled on the course. The Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM) and Difficulties in Emotion Regulation Scale—Short Form (DERS-SF) were administered pre-intervention and immediately post-intervention. In addition, thematic analysis was applied to qualitative feedback. Results revealed significant reductions in CORE-OM and DERS-SF scores post-intervention, with minimal variability in scores attributed to group delivery (either face-to-face or online). The thematic analysis demonstrated that normalising trauma symptoms and providing coping skills positively impacted participants’ experiences. At the same time, the breadth and nature of the content were observed to be an occasional barrier to engagement. In summary, this study proposes that group-based psychoeducational interventions are generally effective for those with mild-to-moderate symptoms of complex trauma. However, further evidence is needed to offer more nuanced recommendations for identifying individuals who may benefit the most from these interventions.

A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme

BackgroundThis study assessed whether a relatively newly developed Parent and Infant (PIN) parenting support programme was cost-effective when compared to services as usual (SAU).MethodsThe cost-effectiveness of the PIN programme versus SAU was assessed from an Irish health and social care perspective over a 24-month timeframe and within the context of a non-randomised, controlled before-and-after trial. In total, 163 parent-infant dyads were included in the study (86 intervention, 77 control). The primary outcome measure for the economic evaluation was the Parenting Sense of Competence Scale (PSOC).ResultsThe average cost of the PIN programme was €647 per dyad. The mean (SE) cost (including programme costs) was €7,027 (SE €1,345) compared to €4,811 (SE €593) in the control arm, generating a (non-significant) mean cost difference of €2,216 (bootstrap 95% CI -€665 to €5,096; p = 0.14). The mean incremental cost-effectiveness of the PIN service was €614 per PSOC unit gained (bootstrap 95% CI €54 to €1,481). The probability that the PIN programme was cost-effective, was 87% at a willingness-to-pay of €1,000 per one unit change in the PSOC.ConclusionsOur findings suggest that the PIN programme was cost-effective at a relatively low willingness-to-pay threshold when compared to SAU. This study addresses a significant knowledge gap in the field of early intervention by providing important real world evidence on the implementation costs and cost-effectiveness of a universal early years parenting programme. The challenges involved in assessing the cost-effectiveness of preventative interventions for very young children and their parents are also discussed.Trial registrationISRCTN17488830 (Date of registration: 27/11/15). This trial was retrospectively registered.

Common Subjective Mental Workload Assessment Measures: Advantages and Disadvantages

Background: The amount of mental resources required to perform simultaneously a series tasks is considered as mental workload (MWL). High and Low mental workload in the workplace is usually associated with mental fatigue, decreased performance, human error, and even harmful long-term health effects. Among the various MWL assessment techniques, the outcome measures such as questionnaires are easier and more practical in workplace settings. We aimed to compare the three current commonly advocated and used questionnaires. Material and Methods: Three common different outcome measures for evaluation of the MWL are NASA Task Load Index (NASA-TLX), Subjective Workload Assessment Technique (SWAT), and the CarMen-Q workload questionnaire. Among them the NASA-TLX is well known and more popular with six subscales that are used extensively in industrial and official workplaces. SWAT is the simplest one with three dimensions. The NASA-TLX is preferable method because of its higher sensitivity, especially in low MWL conditions. The CarMen-Q questionnaire is a new questionnaire with 29 items and 4 subscales that focuses on cognitive workload and mental fatigue. Conclusion: SWAT is the simplest and less sensitive measure than the NASA-TLX and CarMen-Q questionnaires. In contrast, the NASA-TLX is widely used and more known instrument for MWL evaluation.

Outcome Measures for Medical and Surgical Treatment of Prolactinomas. Is the Role of Surgery Underestimated?

Abstract Introduction The first line treatment for prolactinomas is currently dopamine agonists (DAs). Medical management is prolonged, associated with side effects, financial, and psychological burdens. In dedicated centers, pituitary surgery is a low-risk alternative. We evaluated outcome measures of medical and surgical treatment, to assess, if the role of surgery is underestimated. Methods We reviewed the charts of 4,660 pituitary patients, managed at the University of Colorado, from 2004 to 2019. The final analysis included 154 patients with prolactinomas, managed medically, and 120 patients, treated surgically. Primary outcome measures were percentage of tumor volume reduction and prolactin level (ng/mL). Mann–Whitney test was used for quantitative variables, contingency tables, and chi-square tests for qualitative variables. Statistical significance was set at p < 0.05. Results DAs alone were more frequently used for microprolactinomas and Knosp grade 0 adenomas. Surgery was more often performed for macroprolactinomas, giant adenomas, tumors with suprasellar extension, mixed consistency, and sellar floor erosion. Among macroprolactinomas, mean tumor volume reduction after treatment with DAs alone, DAs and surgery, and surgery alone was 53.8, 94.9, and 94.1%, respectively. Prolactin levels after treatment were not significantly different. Continuous DA treatment was required in 94.3% patients in the medical group versus 39.6% in the surgical group. Conclusions Surgery for macroprolactinomas achieved greater tumor volume reduction and dose reduction or discontinuation of DAs. Prolactin levels achieved did not differ significantly between the groups. Over 60% of patients, undergoing surgery, were able to discontinue DAs. The current treatment paradigm may underestimate the role of surgery in the management of prolactinomas.

Cost-effectiveness of providing university students with a mindfulness-based intervention to reduce psychological distress: economic evaluation of a pragmatic randomised controlled trial

ObjectiveIncreasing numbers of young people attending university has raised concerns about the capacity of student mental health services to support them. We conducted a randomised controlled trial (RCT) to explore...

Improving cognition in people with multiple sclerosis: study protocol for a multiarm, randomised, blinded trial of multidomain cognitive rehabilitation using a video-serious game (E-SEP cognition)

IntroductionMultiple sclerosis (MS) is a prevalent neurological disease characterised by disseminated areas of demyelination and atrophy within the central nervous system, inducing cognitive disorders in 45%–65% of persons with MS...

Piloting patient-reported outcome measures for evaluation of the Irish Chronic Disease Programme

Abstract Background The Irish National Integrated Care Programme for Chronic Disease (ICPCD) aims to deliver end-to-end, patient-centred care across three clinical programmes; Heart, Respiratory and Diabetes. Patient-reported outcome measures (PROMs) are a means of objectively measuring changes in patients’ subjectively-perceived health status over time in response to services. As such, PROMs facilitate service monitoring and evaluation and are an important tool for the ICPCD to ensure optimal, patient-centred, value-based healthcare delivery. Methods To select the most appropriate PROMs instrument for use across ICPCD, comprehensive literature review was undertaken followed by key stakeholder consultation in winter 2022. Following consideration against a set of pre-determined criteria the EQ-5D-5L, a well-validated, reliable PROMs instrument, was selected as the most appropriate PROMs instrument for use. Study design involved pilot implementation of EQ-5D-5L in one ICPCD ambulatory care hub service followed by mixed methods evaluation of staff experience of the pilot. Results The pilot was conducted from April to June 2023 among a socio-demographically diverse sample of patients attending their first and last episode of care with the ICPCD diabetic patient education service in Galway. Following service attendance there was a significant aggregate improvement in self-reported overall health rating but no significant change in self-reported mobility, self-care, usual activities, pain/discomfort or anxiety/depression. Predominant staff concerns included staff and patient burden and the need for adequate staff resourcing and information technology support. Conclusions In conjunction with key national stakeholders findings from the pilot will be used to support the development of a PROMs implementation plan at scale for adoption across all ICPCD services. Ultimately national implementation will support the ongoing delivery of high quality patient-centred care within ICPCD services. Key messages • PROMs facilitate service evaluation and are an important tool for the Irish National Integrated Care Programme for Chronic Disease (ICPCD) to ensure optimal patient-centred healthcare delivery. • This pilot will support PROMs implementation at scale across ICPCD services and ultimately reinforce the ongoing delivery of high-quality, value-based, integrated healthcare.

''I felt marvellous e-cycling. If I had long hair I would have flicked it": a qualitative investigation of the factors associated with e-cycling engagement among adults with type 2 diabetes.

Physical activity (PA) is a key component in the management of type 2 diabetes. However, this population have low rates of PA engagement. Electrically assisted cycling has been identified as a means through which to increase PA by incorporating activity into daily life, while overcoming some of the barriers to conventional cycling. The determinants of e-cycling among people living with chronic disease are largely unknown. The aim of this research was to explore the determinants of e-cycling among individuals with type 2 diabetes using the Theoretical Domains Framework (TDF) and the Capability, Opportunity and Motivation for Behaviour change model (COM-B). This information is important for determining the suitability of future e-cycling initiatives and, if appropriate, inform future e-cycling interventions. One-to-one semi structured interviews were conducted with 16 participants from the e-cycling arm of a pilot randomised controlled trial between September 2019 and April 2020. The TDF was used to develop the interview guide. The framework method of analysis was used, incorporating both deductive and inductive reasoning. A conceptual model of the factors that influence e-cycling in this population was created. The most commonly reported TDF domains were skills, knowledge, belief about capabilities, belief about consequences and environmental context and resources. Specifically, e-bike training facilitated e-cycling engagement by providing participants with the skills, knowledge, and confidence needed to ride the e-bike and ride on the road. In addition, the enjoyment of e-cycling was a key facilitator to engagement. Participants engaged in e-cycling to improve their health rather than for environmental reasons. Most barriers to e-cycling related to the natural or physical environment. This study provides insight into the personal, social, and environmental factors associated with e-cycling in this population. The findings of this study can be used to develop a more refined e-cycling intervention targeting the factors identified as influencing e-cycling engagement. In addition, this information will help in the selection of mechanistic outcome measures for evaluation.

What Constitutes Well-being? Five Views Among Adult People from the Netherlands on what is Important for a Good Life

Well-being has gained interest as object of study in the social sciences and as an outcome measure for policy evaluation. However, little agreement exists with respect to the substantive meaning of well-being, the dimensions of well-being that should be considered in a multi-dimensional approach, and the variety of well-being conceptions people have for their own lives. This study explored conceptions of “a good life for you” among 1,477 adult people from the Netherlands by means of Q-methodology, based on a theoretical framework synthesizing the main theories of well-being. We find five distinct views on what people consider to be a good life for themselves: “Health and feeling well”, “Hearth and home”, “Freedom and autonomy”, “Social relations and purpose” and “Individualism and independence”. While there is strong agreement with respect to the importance of feeling both physically and mentally well, the views diverge considerably regarding aspects such as social relations, autonomy, spirituality, and material welfare. Associations between viewpoints and respondent characteristics had face validity. The findings of this study have significant implications for the development of measures of well-being and policies aimed to improve population well-being. Further research is required into the prevalence of these views on well-being in the population, their relation to respondent characteristics and into differences in views over time and between countries with different socio-economic, political and cultural environments.

Relationship between medication adherence for opioid use disorder and health care costs and health care events in a claims dataset

IntroductionMedication for opioid use disorder (MOUD) has well-documented benefits for treating OUD, though its efficacy depends on patient adherence. We know little about outcomes of MOUD nonadherence compared to treatment regimens without MOUD, and this article aims to address the gap. This analysis focused on office-based MOUD treatment (buprenorphine and naltrexone) to evaluate the long-term impact of adherence on subsequent health care costs and health care events. MethodsWith claims data from 2017 to 2019, we used propensity score (PS) weighting to create three comparable cohorts of patients: 1) Adherent: filled MOUD prescription & ≧80 % of days covered by MOUD (N = 1045); 2) Nonadherent: filled MOUD & < 80 % of days covered (N = 1116), 3) did not fill MOUD (N = 16,784). The study defined three time intervals based on a patient's most recent MOUD episode: A 6-month baseline period before initiation of MOUD or random index date for those with MOUD; a 6-month treatment period, during which adherence or nonadherence was established; and a 12-month follow-up period to evaluate outcome measures. The study used generalized PS methodology to examine the effect of proportion of days covered (PDC) as a continuous measure of adherence. ResultsAmong patients who filled MOUD, adherence to MOUD was significantly predicted by having less severe OUD, being older, having fewer inpatient visits and lower outpatient costs before the start of treatment. Adherent patients displayed significantly lower health care costs in the follow-up period compared to nonadherent MOUD patients, and lower odds of experiencing health care events. The nonadherent MOUD group displayed significantly higher odds of health care events compared to patients who had no evidence of receiving MOUD in claims data (NO-MOUD). Among patients prescribed MOUD, each 10 % increase in PDC was associated with a significant decrease in inpatient/outpatient costs and in odds of health care events. ConclusionsThis analysis aligns with previous findings about the importance of maintaining long-term adherence to MOUD in supporting patient outcomes. The results also suggest a novel finding that despite confounder control via PS methods, nonadherent patients display poorer outcomes compared to similar NO-MOUD patients.

Successful Return to Sport and Daily Activities After Suture Augmentation of Both the Anterior Talofibular Ligament and Calcaneofibular Ligament

To evaluate the return to sport and daily activities in addition to clinical outcomes after modification of the Brostöm repair, specifically using suture augmentation for concomitant fixation of both the anterior talofibular ligament and calcaneofibular ligament. Patients who had grade III ankle sprains and lateral ankle instability, all of whom failed supervised conservative management, were included. Patients underwent a modified Broström procedure consisting of suture augmentation for both the anterior talofibular ligament and calcaneofibular ligament. For clinical outcome evaluation, Foot and Ankle Ability Measure (FAAM) and Karlsson-Peterson Scoring System for Ankle Function questionnaires coupled with questions regarding time of return to sport and level of sports activity were used. Thirty-one patients were included. The differences in preoperative and postoperative FAAM scores for both the Activities of Daily Living subscale and Sports subscale were significant (P < .001). The FAAM Activities of Daily Living score improved from an average of 46.06 preoperatively to 77.49 postoperatively (P < .001, 99% confidence interval, 26.4-36.4). The FAAM Sports score improved from an average of 4 preoperatively to 19.31 postoperatively (P < .001, 99% confidence interval, 11.6-19.0). For the Karlsson-Peterson Scoring System for Ankle Function, the surveyed population reported a mean of 82.74 points out of 100 post-op (standard deviation 20.14). The mean time to return to sport activity was 5.72 months. Mean follow-up time was 24.12 months. This variant Broström procedure with suture anchors and augmentation of both the anterior talofibular ligament and calcaneofibular ligament was effective in helping patients return to their preinjury functionality level in both daily life and sports activity. Level IV, therapeutic case series.

Useful outcome measures in INPH patients evaluation.

Idiopathic normal pressure hydrocephalus (INPH) is a neurological disorder that is potentially reversible and clinically characterized by a specific triad of symptoms, including gait disturbance, cognitive disorders, and urinary incontinence. In INPH assessment, the most commonly used test is the Timed Up and Go test (TUG), but a more comprehensive assessment would be necessary. The first aim of the present study is to verify the sensitivity of a protocol with both clinical and instrumental outcome measures for gait and balance in recognizing INPH patients. The second aim is to verify the most important spatio-temporal parameters in INPH assessment and their possible correlations with clinical outcome measures. Between January 2019 and June 2022, we evaluated 70 INPH subjects. We assessed balance performances with the Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), and TUG, both single (ST) and dual task (DT). We also performed an instrumental gait assessment with the GAITRite electronic walkway system, asking the patients to walk on the carpet for one minute at normal speed, fast speed, and while performing a dual task. We compared the results with those of 20 age-matched healthy subjects (HS). INPH patients obtained statistically significant lower scores at the BBS, SPPB, and TUG DT but not at the TUG ST, likely because the DT involves cognitive factors altered in these subjects. Concerning instrumental gait evaluation, we found significant differences between HS and INPH patients in almost all spatio-temporal parameters except cadence, which is considered a relevant factor in INPH guidelines. We also found significant correlations between balance outcome measures and gait parameters. Our results confirm the usefulness of BBS and suggest improving the assessment with SPPB. Although the TUG ST is the most commonly used test in the literature to evaluate INPH performances, it does not identify INPH; the TUG DT, instead, might be more useful. The GAITRite system is recognized as a quick and reliable tool to assess walking abilities and spatio-temporal parameters in INPH patients, and the most useful parameters are stride length, stride width, speed, and the percentage of double support. Both clinical and instrumental evaluation may be useful in recognizing subjects at risk for falls.

Agreement between video-based clinician-rated tools and patient-reported outcomes on gait assessment in individuals with multiple sclerosis.

To our knowledge, no studies compared the video-clinician-based tools and patient-reported questionnaires in assessing gait and balance in people with MS (pwMS). The present study investigated the correlation and agreement between video-clinician-based objective measurement tools and patient-reported outcome measures (PROMs) in gait and balance evaluation. A prospective cross-sectional study was conducted with 55 pwMS. Video analysis-based gait was evaluated by the Tinetti Gait Assessment (TGA), Gait Assessment and Intervention Tool (GAIT), and Functional Ambulation Classification Scale (FACS) by the clinician. Participants' self-reported gait and balance were assessed with the Multiple Sclerosis Walking Scale-12 (MSWS-12) and Activity-Specific Balance Confidence Scale (ABC). There was a moderate positive correlation between ABC with TGA and FACS (r1: 0.552, r2: 0.510, p < 0.001). ABC was strongly correlated with GAIT (r: - 0.652, p < 0.001). A moderate positive correlation was observed between MSWS-12 with TGA and FACS (r1: - 0.575, r2: - 0.524, p < 0.001). In addition, there was a strong positive correlation between MSWS-12 and GAIT (r: - 0.652, p < 0.001). Clinician-rated tools and PROMs were within the agreement limits regarding the unstandardized beta values p < 0.001). Clinician-based gait and balance tools demonstrate consistent results with PROMs in pwMS. Considering the low cost and practical use of PROMs, in cases where video-based clinician-based measurements cannot be provided (time, space, and technical inadequacies), questionnaires can provide concordant results at moderate and severe levels compared with objective tools.

ADCC's Improving Goal Concordant Care Initiative: Implementing Primary Palliative Care Principles.

High-quality, timely goals of care communication (GOCC) may improve patient and caregiver outcomes and promote care that is consistent with patient preferences. Cancer patients, and their loved ones, appreciate GOCC; however, oncologists often lack formal communication training, institutional support and structures necessary to promote the delivery, documentation, and longitudinal follow-up of GOCC. The Alliance of Dedicated Cancer Centers (ADCC), representing 10 U.S. academic cancer hospitals, undertook the Improving Goal Concordant Care Initiative (IGCC). This national, 3-year implementation initiative was designed in Fall 2019 by a workgroup of quality, oncology, and palliative care leaders, as well as patient and family advisory committee members (PFAC). IGCC addresses systemic gaps by requiring four core components for participation: 1) Implementation of a formal communication skills training (CST) program, 2) Structured GOCC documentation in the electronic medical record that is visible to all clinicians, 3) Expectations regarding the timing and patient populations for GOCC, and 4) Implementation of a measurement framework. Dyads of palliative and oncology leaders committed to attend regularly scheduled, ADCC-led, virtual meetings during the design and implementation phase, incorporating PFAC feedback at every stage. Using the RE-AIM framework, we describe process and outcome evaluation measures defined by implementation and measures workgroups and collected routinely, including: CST completion; trainee evaluation response rate, trainee-reported quality of CST, trainee changes in self-efficacy and distress; percent of high-priority patients participating in GOCC, and patient-reported response to the "Heard and Understood" scale (HU). IGCC's impact will be assessed using claims-based utilization metrics near the end of life (EOLM) and followed longitudinally. Qualitative evaluations near the completion of IGCC will provide insight into perceived barriers, enabling factors, and sustainability. Implementation of all IGCC components has begun at all sites. ADCC-wide, 35% of MD/DOs have completed CST (range by site: 8%-100%). CST is highly rated; in Quarter 3, 2022, 93%-100%, 90%-100% and 87%-100% of respondents reported above average to excellent CST quality, likelihood to use the skills and likelihood to recommend CST to others, respectively. Clinician self-efficacy and distress ratings are expected in late 2023. All sites have identified patient populations and continue to refine automated triggers and timelines; uptake of GOCC documentation has been slow. Eight of 10 sites have submitted patient-reported HU data. EOLM data are expected for all sites in early 2024. Flexibility in implementation with shared definitions, measures, and learnings about approaches optimizes the ability of all centers to collaborate and make progress in improving GOCC. Flexibility adds to the complexity of understanding intervention effectiveness, the critical intervention components and the fidelity necessary to achieve specific outcomes.

Adequacy of traditional curette versus powered shaver for adenoid clearance: a comparative study

Background: Adenoid growth is a prevalent aetiology of blockage of nasal passage in paediatric patients, and multiple techniques exist for their surgical removal. The objective of this investigation was to study the efficacy of the conventional curette versus the endoscopic guided powered shaver in the context of adenoid clearance. Methods: In this study, a comparative analysis was performed on a sample of 119 patients, consisting of two distinct groups. Group I-60 patients who underwent conventional adenoidectomy, while group II-59 patients who underwent endoscopic microdebrider-assisted adenoidectomy. The methods employed in this study were in accordance with established medical practises. The research evaluated outcome measures including surgical duration, haemorrhage, and perioperative and postoperative adverse events. Results: Group I, 17 (28.3%) received adenoidectomy as a standalone procedure, group II, 22 (37.3%) received adenoidectomy as a standalone procedure. An adenotonsillectomy was executed on 21 patients, accounting for 35% of group I, and 10 patients, accounting for 16.9% of group II. The study found that group I exhibited significantly reduced operation time and blood loss compared to group II (20.88±4.41 vs. 29.00±4.15 minutes and 13.47±3.02 vs. 18.64±3.16 millilitres, respectively). Intraoperative complications were observed in 10% of patients in group I and 5.1% of patients in group II. The group II participants exhibited a more rapid onset of symptomatic relief compared to those in group I. There was no evidence of recurrence in the cohort of patients who underwent endoscopic microdebrider-assisted adenoidectomy. Conclusions: Endoscopic microdebrider-assisted adenoidectomy is a superior and dependable technique compared to curettage, exhibiting improved clearance rates and patient contentment.

Poster 180: A prospective randomized comparative study between isolated eccentric versus conventional exercise therapy in athletes with rotator cuff tendinopathy

Objectives: To compare the effectiveness of an isolated Eccentric exercise program versus Conventional exercise program in athletes with rotator cuff tendinopathy. Methods: The study included 80 athletes with rotator cuff (RC) tendinopathy (diagnosed on Magnetic resonance imaging) presenting to author’s tertiary level institute. Patients were randomized into two groups of 40 each. The eccentric exercise group (n = 40, mean age = 26.4years ) received an isolated eccentric training combined with stretching, while the conventional exercise group received scapular stabilization exercises, concentric RC strengthening exercises and stretching. (n = 40, mean age = 25.2years). Patients in both groups fulfilled 12 week daily home based exercise program and received treatments twice a week for 3 months. Primary outcome measures were shoulder pain (a 0–100mm Visual Analog Scale; VAS) and function measured with the Constant Murley score and Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcome measures were isometric abduction strength in 45° in the scapular plane (Hand held dynamometer) and shoulder range of motion (forward elevation, abduction and external rotation). All measurements were taken at baseline, at 12, and 24weeks. There was no statistically significant difference in pre-intervention scores between two groups. The study was approved by Institutional Review Board. Results: After 24 weeks, both groups showed a significant decrease in VAS scores and DASH score and a significant increase in the Constant Murley score. No statistically significant differences were found between the groups for any of the evaluated outcome measures. In the EE group, there was a slight deterioration in both CM and VAS scores between 12 and 24 weeks, but this did not reach statistical significance. Both groups also had a significant increase in isometric muscle strength between baseline and 24 weeks. Conclusions: A 12 week isolated eccentric training program of the rotator cuff is as effective (but not superior to) as conventional exercise program for the rotator cuff tendinopathy in athletes.

Role of imaging in morphea assessment: A review of the literature.

Localized scleroderma, known as morphea, is a connective tissue disorder characterized by inflammation and fibrosis of the skin and the soft tissue. There exist no universally accepted validated outcome measures in order to monitor the disease activity. Besides clinical scores to evaluate outcome measures, imaging modalities are increasingly utilized in assessing patients with morphea, such as high-frequency ultrasonography (US), shear-wave elastography (SWE), and magnetic resonance imaging (MRI). However, the accuracy of these imaging modalities in monitoring morphea activity is not yet clear. To review the literature regarding the role of imaging modalities in assessing patients with morphea. In this study, we searched the PubMed/Medline database for articles published from inception until February 2023. A total number of 23 original articles in three categories of US, elastography, and MRI were included. Regarding US, criteria, including increased dermal thickness, increased echogenicity of the subcutaneous tissue, and decreased dermal echogenicity, were indicators of active morphea lesions when using high frequencies probe (18-20MHz) color Doppler sonography. Moreover, studies evaluating SWE, a novel method to quantitatively assess tissue stiffness, demonstrated increased dermal stiffness in active lesions. Studies showed that MRI can help to determine the depth of disease, particularly as a first-line and follow-up diagnostic tool, especially in generalized and deep morphea. In addition, brain MRI may be useful for patients with localized craniofacial scleroderma experiencing new or worsening neurological symptoms.