Function Short Form Research Articles

Investigation of the relationship between quality of life, activity participation and environmental factors in adolescents with cerebral palsy.

The aim of this study is to examine the relationship between quality of life, activity-participation and environmental factors in adolescents with cerebral palsy. Seventy-five (75) adolescents (M:45, F:30) aged between 14-18 years (mean: 15.52±1.60 yrs) were included in the study. Participants were divided into three groups: Level I, Level II and Level III according to the Gross Motor Function Classification System. Gross Motor Function Classification System, Gross Motor Function Measure, Functional Independence Scale, Manual Ability Classification System, Pediatric Quality of Life Inventory and International Classification of Functioning, Disability and Health Child-Youth version Short Form (ICF-CY) (14-18 yrs) were used for assessments. It is found that there is a moderate and high level of correlation between quality of life and activity participation and body functions, a moderate and high level of correlation between quality of life and activity participation and body functions with gross motor function levels, and a moderate and low level correlation between environmental factors and gross motor function levels (p < 0.05). The fact that the ICF-CY short form used for cerebral palsied children is compatible with other assessment scales suggests that the use of ICF-CY short forms may be useful in assessing the health status of individuals.

The Influence of Patient Baseline Data and Mental Health in Predicting Outcomes after Hip Arthroscopy for Femoracetabular Impingement Syndrome: A Prospective Cohort Analysis

Objectives: Patient factors, including mental health, activity level, sex, and smoking, have been found to be more predictive of preoperative hip pain and function than are intra-articular findings during hip arthroscopy for femoroacetabular impingement (FAI); however, little is known about how these patient factors or pathologic findings may influence postoperative rehabilitation, recovery, and final outcome. We hypothesized that patient factors, including mental health, would more strongly correlate with patients’ one-year patient-reported outcome measures (PROMs) of hip pain and function compared to the extent of the intra- or extra-articular pathology (chondral damage, labral tear, cam, or pincer deformities) in patients undergoing surgery for FAI. Methods: A prospective cohort of patients undergoing hip arthroscopy for FAI were electronically enrolled between February 2015 and July 2017. Baseline PROMs were collected, including Hip disability and Osteoarthritis Outcome Score (HOOS) for pain, HOOS-Physical Function Shortform (HOOS-PS), Veterans RAND 12-Item Health Survey (VR-12), and University of California-Los Angeles (UCLA) Activity Score. Surgeons documented intra-articular operative findings and treatment via an all-electronic capturing system on their cellular device at the time of surgery. Proportional-odds logistic regression models were built for each one-year PROM of interest using baseline patient and surgical characteristics. However, instead of using the baseline HOOS-Pain and HOOS-PS scores as predictors, the improvement score from baseline to one year was used for the respective models. Risk factors included patient characteristics and intraoperative anatomic and pathologic findings. Results: During the study period, 555 patients underwent arthroscopic hip procedures with 494 patient undergoing hip arthroscopy for FAI. Of this FAI cohort, 489 had baseline PROMs, and 377 (77.7%) completed both preoperative and one-year PROMs. The median patient age was 33 years, mean body mass index was 25.5 kg/m2, and 72% were female. Multivariate analyses demonstrated that baseline patient characteristics are the main drivers of each PROM, and baseline PROM scores, the improvement in those scores, and smoking status have the most influence (Figure One). In terms of mental health, subjects with worse baseline VR-12 scores had less PROM improvement. For intra-operative findings, grade 3/4 articular cartilage damage was associated with worse pain and PS scores compared to those with no cartilage damage. Conclusion: This is the first prospective cohort analysis of hip arthroscopy for FAI evaluating the influence of baseline characteristics on patient outcomes at one year. This analysis was uniquely modeled to adjust for these identified patient factors to allow for accurate interpretation of their effect on the patient’s treatment. Patient factors, including score improvement, mental health, and smoking, are more predictive of one-year patient-reported outcomes of hip pain and function (as measured by HOOS) than are intra-articular findings (e.g., status of the labrum or articular cartilage) during hip arthroscopy for FAI. This information can be useful during preoperative education to help manage patients’ expectations after their arthroscopic procedure and guide their care.

Effects of Language, Insurance, and Race/Ethnicity on Measurement Properties of the PROMIS Physical Function Short Form 10a in Rheumatoid Arthritis

Most studies that have evaluated patient-reported outcomes, such as those utilizing the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a) in rheumatoid arthritis (RA), have been performed in white and English-speaking populations. The aim of our study was to assess the measurement properties of the PF10a in a racially/ethnically diverse population with RA and to determine the effect of non-English language proficiency, insurance status, and race/ethnicity on the validity and responsiveness of the PF10a. Data were abstracted from electronic health records for all RA patients seen in a university-based rheumatology clinic between 2013 and 2017. We evaluated the use of the PF10a, floor and ceiling effects, and construct validity across categories of language preference, insurance, and race/ethnicity. We used standardized response means and linear mixed-effects models to evaluate the responsiveness of the PF10a to longitudinal changes in the Clinical Disease Activity Index (CDAI) across population subgroups. We included 595 patients in a cross-sectional analysis of validity and 341 patients in longitudinal responsiveness analyses of the PF10a. The PF10a had acceptable floor and ceiling effects and was successfully implemented. We observed good construct validity and responsiveness to changes in CDAI among white subjects, English speakers, and privately insured patients. However, constructs evaluated by the PF10a were less correlated with clinical measures among Chinese speakers and Hispanic subjects, and less sensitive to clinical improvements among Medicaid patients and Spanish speakers. While the PF10a has good measurement properties and is both practical and acceptable for implementation in routine clinical practice, we also found important differences across racial/ethnic groups and those with limited English proficiency that warrant further investigation.

A Machine Learning Approach to Classifying Self-Reported Health Status in a Cohort of Patients With Heart Disease Using Activity Tracker Data.

Constructing statistical models using personal sensor data could allow for tracking health status over time, thereby enabling the possibility of early intervention. The goal of this study was to use machine learning algorithms to classify patient-reported outcomes (PROs) using activity tracker data in a cohort of patients with stable ischemic heart disease (SIHD). A population of 182 patients with SIHD were monitored over a period of 12 weeks. Each subject received a Fitbit Charge 2 device to record daily activity data, and each subject completed eight Patient-Reported Outcomes Measurement Information Systems short form at the end of each week as a self-assessment of their health status. Two models were built to classify PRO scores using activity tracker data. The first model treated each week independently, whereas the second used a hidden Markov model (HMM) to take advantage of correlations between successive weeks. Retrospective analysis compared the classification accuracy of the two models and the importance of each feature. In the independent model, a random forest classifier achieved a mean area under curve (AUC) of 0.76 for classifying the physical function PRO. The HMM model achieved significantly better AUCs for all PROs (p < 0.05) other than Fatigue and Sleep Disturbance, with a highest mean AUC of 0.79 for the physical function-short form 10a. Our study demonstrates the ability of activity tracker data to classify health status over time. These results suggest that patient outcomes can be monitored in real time using activity trackers.

Evaluating the Psychometric Properties of the Migraine Functional Impact Questionnaire (MFIQ).

BackgroundMigraine is a chronic neurologic disease that can be associated with significant migraine‐related impact, disability, and burden. Patient‐reported outcome measures (PRO) are included in clinical trials of migraine interventions to capture treatment effects from a patient perspective. Clinical and regulatory guidelines also encourage use of PROs in trials. The Migraine Functional Impact Questionnaire (MFIQ) is a novel PRO measure, assessing the impact of migraine on Physical Function (PF), Usual Activities (UA), Social Function (SF), and Emotional Function (EF), in the past 7 days. Scientific methods recommended to meet the requirements of the U.S. Food and Drug Administration were followed, to ensure that the MFIQ content included outcomes that were relevant to adults with migraine and were clinically relevant, specifically to evaluate preventive treatments for migraine.ObjectiveThe objective of this study was to conduct item analyses informing item reduction and scoring, and to evaluate the psychometric properties of the MFIQ.MethodsIn a prospective, observational study, adults with migraine completed the MFIQ as well as additional clinical and PRO instruments, including the Headache Impact Test (HIT‐6TM), Patient‐Reported Outcomes Measurement Information System Physical Function Short Form 10a (PROMIS‐PF), Migraine‐Specific Quality‐of‐Life Questionnaire (MSQ), and Patient Global Rating of Change (PGIC). Item‐level evaluation, item response theory (IRT), and factor analysis were used to select final MFIQ items, identify domains, and inform scoring. Psychometric properties of the MFIQ were evaluated to assess reliability (internal consistency and test–retest), validity (construct and known‐groups), and responsiveness.ResultsThe study enrolled 569 adults with migraine. Subjects had an average age of 39.9 years (SD 12.0), 87.2% were female, and 80.8% were white. Five items were dropped from the draft version based on results of item‐level analyses reviewed in the context of previous qualitative research to produce the final 26‐item MFIQ (v.2). Four domain scores (PF, UA, SF, and EF) and a global item score for impact on UA were identified. Higher scores on a 0‐100 scale represent greater impact. All scores exhibited high internal consistency (α ≥ 0.89) and moderate test–retest reliability among stable subjects (ICCs ≥ 0.47). Construct validity was demonstrated by significant correlations (all P < .0001) between MFIQ domain scores, related PRO scores, and the frequency of migraine days and headache days. All domain scores differentiated between subgroups (“known groups”) defined based on established levels of clinical severity: number of monthly migraine and headache days, migraine interference levels and scores on other PRO instruments (P < .05). Improvements in MFIQ scores corresponded with clinical improvement (percent reduction in monthly migraine days), improvement in migraine interference with daily activities, and related improvements in PRO scores (P < .05), demonstrating that the MFIQ was responsive to changes in migraine impact.ConclusionsThe MFIQ is a reliable and valid measure that can be used to collect data about migraine impact. The MFIQ is being used to evaluate outcomes of migraine interventions in clinical trials and observational studies. It could potentially also be used in clinical practice both for initial and ongoing assessments for monitoring outcomes and to enhance communication between patients and healthcare professionals for the management of migraine.

Content validity of the National Comprehensive Cancer Network \u2013 Functional Assessment of Cancer Therapy \u2013 Breast Cancer Symptom Index (NFBSI-16) and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form with advanced breast cancer patients

BackgroundThe purpose of this study is to evaluate the content validity of the National Comprehensive Cancer Network – Functional Assessment of Cancer Therapy – Breast Cancer Symptom Index (NFBSI-16) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10b among patients with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer.MethodsCognitive debriefing interviews sought to evaluate patients’ ability to read, understand, and meaningfully respond to the questionnaires, as well as to evaluate the questionnaires’ relevance in the target patient population. Interviews were conducted by telephone and lasted approximately 90 min. Audio recordings were transcribed, anonymized, and analyzed using qualitative data analysis software.ResultsFifteen cognitive debriefing interviews were conducted with women (mean age 66.0 years [standard deviation = 12.4]). Patients reported metastases in the bone (86.7%), liver (20.0%), lung (13.3%), skin (6.7%), and lymph node (6.7%) (not mutually exclusive). All patients for whom data were available demonstrated understanding of the instructions and the recall period of the NFBSI-16 (n = 14/14, 100.0%) and the PROMIS (n = 14/14, 100.0%). Greater than 90% of patients demonstrated understanding of each of the items in the NFBSI-16 and the PROMIS. Greater than 70% of patients demonstrated understanding of the response options of the NFBSI-16, > 90% understood response options of PROMIS Items 1–6, and ≥ 50% understood response options of PROMIS Items 7–10. Conceptual relevance was supported for most items in both questionnaires based on patients’ reports of experiencing the concepts as part of their breast cancer experience.ConclusionsThe results of the cognitive debriefing interviews provide evidence that the NFBSI-16 and PROMIS Physical Function Short Form 10b have content validity in the HR+/HER2- advanced breast cancer patient population. Patients may benefit from additional instructions at the point the response options reverse direction in the PROMIS.

Effectiveness of Platelet-Rich Plasma in the Management of Knee Osteoarthritis in a Rural Clinic

Osteoarthritis (OA) is a degenerative disease causing decreased mobility. Use of autologous platelet-rich plasma (PRP) provides a reparative alternative in the management of OA. This study assessed effectiveness of nurse practitioner-injected PRP to manage knee OA in a rural setting. Twenty patients were followed for 1 month after PRP treatment. Knee function and pain levels were assessed using a knee function score (Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form [KOOS-PS]). Overall, the 20 patients who participated in this study experienced significant improvement in knee function scores, decreased pain, and decreased use of pain medications.

Predictors of Pain and Function Before Knee Arthroscopy.

Background:Patient-reported outcome measures are commonly used to measure knee pain and functional impairment. When structural abnormality is identified on examination and imaging, arthroscopic partial meniscectomy and chondroplasty are commonly indicated for treatment in the setting of pain and decreased function.Purpose:To evaluate the relationship between patient characteristics, mental health, intraoperative findings, and patient-reported outcome measures at the time of knee arthroscopy.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Between February 2015 and October 2016, patients aged 40 years and older who were undergoing routine knee arthroscopy for meniscal and cartilage abnormality, without reconstructive or restorative procedures, were prospectively enrolled in this study. Routine demographic information was collected, and the Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, Quality of Life (QoL), and Physical Function Short Form (PS) subscales and the mental and physical component subscales of the Veterans RAND 12-Item Health Survey (VR-12 MCS and VR-12 PCS) were administered preoperatively on the day of surgery. Intraoperative findings were collected in a standardized format. Patient demographics, intraoperative findings, and the VR-12 MCS were used as predictor values, and a multivariate analysis was conducted to assess for relationships with the KOOS and VR-12 as dependent variables.Results:Of 661 eligible patients, baseline patient-reported outcomes and surgical data were used for 638 patients (97%). Lower scores on both subscales of the VR-12 were predicted by female sex, positive smoking history, fewer years of education, and higher body mass index (BMI). All KOOS subscales were negatively affected by lower VR-12 MCS scores, female sex, lower education level, and higher BMI in a statistically meaningful way. Positive smoking history was associated with worse scores on the KOOS-PS. Abnormal synovial status was associated with worse KOOS-Pain.Conclusion:The demographic factors of sex, smoking status, BMI, and education level had an overwhelming impact on preoperative KOOS and VR-12 scores. Of interest, mental health as assessed by the VR-12 MCS was also a consistent predictor of KOOS scores. The only intraoperative finding with a significant association was abnormal synovial status and its effect on KOOS-Pain scores.

Predictive Factors and Duration to Return to Sport After Isolated Meniscectomy.

Background:Return to sport (RTS) after meniscectomy is an important metric for young, active patients. However, the impact of the duration from surgery to RTS on clinical outcomes is not fully understood and is not reflected in outcome scores.Purpose:To establish when patients RTS after meniscectomy and to determine predictive measures for the ability to return to their preinjury activity.Study Design:Case-control study; Level of evidence, 3.Methods:All patients undergoing meniscectomy between 2016 and 2017 from a single institution were assessed for inclusion. RTS, type of activity, and level of function upon returning were obtained. The minimal clinically important difference (MCID), substantial clinical benefit, and patient acceptable symptom state (PASS) were calculated for the Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) questionnaire using anchor-based and distribution-based approaches. Preoperative knee-specific and generic quality-of-life scores were analyzed to determine their predictive power of RTS. A multivariate logistical analysis was also performed to determine which demographic variables corresponded to RTS.Results:Overall, 94 patients (mean age, 51.0 ± 11.1 years) who underwent meniscectomy participated in sports within 6 months of surgery. Of these patients, 76.6% returned to sport without permanent restrictions at a mean of 8.6 ± 6.9 weeks postoperatively. RTS rates for low-, medium-, and high-intensity activities were 75.0%, 70.0%, and 82.5%, respectively. RTS was associated with achieving the PASS for the KOOS–Physical Function short form (PS), KOOS-Pain, and KOOS-Sports (P = .004, P = .007, and P = .006, respectively) but not for the IKDC questionnaire (P = .3). Achieving the MCID was associated with RTS for the KOOS-Sports, KOOS-Pain, and IKDC questionnaire (P < .001, P = .03, and P = .001, respectively). There was no preoperative or intraoperative variable that was predictive of RTS. Preoperative KOOS-PS scores ≥37.8 (area under the curve = 76.3%) and KOOS-Pain scores ≥51.4 (area under the curve = 72.5%) were predictive of RTS.Conclusion:Approximately 77% of patients returned to sport after meniscectomy at a mean of 2 months postoperatively. The level of activity intensity did not significantly alter the rate of RTS. Higher preoperative scores on the KOOS-PS and KOOS-Pain were predictive of RTS. Identifying these factors allows physicians to counsel patients on expected outcomes after meniscectomy.

Clinically Significant Gains in Skillful Grasp Coordination by an Individual With Tetraplegia Using an Implanted Brain-Computer Interface With Forearm Transcutaneous Muscle Stimulation

ObjectiveTo demonstrate naturalistic motor control speed, coordinated grasp, and carryover from trained to novel objects by an individual with tetraplegia using a brain-computer interface (BCI)-controlled neuroprosthetic. DesignPhase I trial for an intracortical BCI integrated with forearm functional electrical stimulation (FES). Data reported span postimplant days 137 to 1478. SettingTertiary care outpatient rehabilitation center. ParticipantA 27-year-old man with C5 class A (on the American Spinal Injury Association Impairment Scale) traumatic spinal cord injury InterventionsAfter array implantation in his left (dominant) motor cortex, the participant trained with BCI-FES to control dynamic, coordinated forearm, wrist, and hand movements. Main Outcome MeasuresPerformance on standardized tests of arm motor ability (Graded Redefined Assessment of Strength, Sensibility, and Prehension [GRASSP], Action Research Arm Test [ARAT], Grasp and Release Test [GRT], Box and Block Test), grip myometry, and functional activity measures (Capabilities of Upper Extremity Test [CUE-T], Quadriplegia Index of Function-Short Form [QIF-SF], Spinal Cord Independence Measure–Self-Report [SCIM-SR]) with and without the BCI-FES. ResultsWith BCI-FES, scores improved from baseline on the following: Grip force (2.9 kg); ARAT cup, cylinders, ball, bar, and blocks; GRT can, fork, peg, weight, and tape; GRASSP strength and prehension (unscrewing lids, pouring from a bottle, transferring pegs); and CUE-T wrist and hand skills. QIF-SF and SCIM-SR eating, grooming, and toileting activities were expected to improve with home use of BCI-FES. Pincer grips and mobility were unaffected. BCI-FES grip skills enabled the participant to play an adapted “Battleship” game and manipulate household objects. ConclusionsUsing BCI-FES, the participant performed skillful and coordinated grasps and made clinically significant gains in tests of upper limb function. Practice generalized from training objects to household items and leisure activities. Motor ability improved for palmar, lateral, and tip-to-tip grips. The expects eventual home use to confer greater independence for activities of daily living, consistent with observed neurologic level gains from C5-6 to C7-T1. This marks a critical translational step toward clinical viability for BCI neuroprosthetics.

Necrotizing fasciitis and the midterm outcomes after survival.

Background and Aims:Radical surgical intervention is necessary to save patients’ lives in cases of necrotizing fasciitis. This leads to persistent disabilities and most likely to a deteriorated quality of life. The purpose of this study was to evaluate the midterm outcomes after survival of necrotizing fasciitis.Materials and Methods:A retrospective analysis of 69 patients, treated for necrotizing fasciitis between 2003 and 2012. The patients were identified using the International Classification of Diseases (10th Revision) code M 72.6. Of the 50 survivors, 22 patients completed the Short Form 36 and Short Musculoskeletal Function Assessment questionnaires as a postal survey. The follow-up averaged 59 months (range: 6–128 months).Results:The average age at the time of necrotizing fasciitis was 60.0 years. The body mass index average was 29.7. The patients had a significantly decreased physical component summary score of 33.3 compared to a normative group (p < 0.001) (Short Form 36). They further showed a significantly decreased dysfunction and bother indices (Short Musculoskeletal Function Assessment) (p < 0.001). An increased age (⩾70 years) was associated with an inferior role emotional (p = 0.048) and physical functioning (p = 0.011) as well as social functioning (p = 0.038) (Short Form 36). The majority of patients (16, 72.7%) complained of pain at the final follow-up and 50% of patients required an assistive device on a regular basis.Conclusion:Patients who survived necrotizing fasciitis suffer from functional impairment and changed body appearance. Assistive devices or pain medication are often required, and the patients present with significantly decreased physical, social, and emotional functioning at the midterm follow-up. The patient’s age is a critical factor regarding functional or mental outcome parameters. Further research on the post-hospital course and long-term multidisciplinary care is required to improve the outcomes of these patients.

Home-Based Exercise Prehabilitation During Preoperative Treatment for Pancreatic Cancer Is Associated With Improvement in Physical Function and Quality of Life.

Purpose: To investigate relationships among physical activity, changes in physical function, and health-related quality of life (HRQOL) among patients with pancreatic adenocarcinoma enrolled in a home-based exercise prehabilitation program. Methods: Patients with resectable pancreatic adenocarcinoma receiving preoperative chemotherapy and/or chemoradiation were enrolled on this prospective, single-arm trial and were advised to perform ≥60 minutes each of moderate-intensity aerobic exercise and strengthening exercise weekly. Activity was measured via self-report and accelerometers, including moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary activity (SA). Physical function measures at baseline and restaging follow-up included 6-minute walk test (6MWT), 5 times sit-to-stand (5×STS), handgrip strength (HGS), 3-m walk for gait speed (GS), and the PROMIS Physical Function Short Form. HRQOL was measured via the FACT-Hep questionnaire. Results: Fifty participants with mean age 66 years (standard deviation = 8 years) were enrolled. The 6MWT, 5×STS, and GS significantly improved from baseline to restaging follow-up (P=.001, P=.049, and P=.009, respectively). Increases in self-reported aerobic exercise, weekly MVPA, and LPA were associated with improvement in 6MWT (β=.19, P=.048; β=.18, P=.03; and β=.08, P=.03, respectively) and self-reported physical functioning (β=.02, P=.03; β=.03, P=.005; and β=.01, P=.02, respectively). Increased weekly LPA was associated with increased HRQOL (β=.03, P=.02). Increased SA was associated with decreased HRQOL (β=-.02,P=.01). Conclusions: Patients with potentially resectable pancreatic cancer exhibit meaningful improvement in physical function with prehabilitation; physical activity was associated with improved physical function and HRQOL. These data highlight the importance of physical activity during treatment for pancreatic cancer.

Laparoskopik histerektominin cinsel işlevler ve yaşam kalitesi üzerine etkisi: 12 aylık izlem sonuçları

Purpose: The purpose of this study is to investigate the effect of laparoscopic hysterectomy for benign reasons on the quality of life and sexual function of the patients with 12-month follow-up results.Materials and Methods: This prospective cohort study included 28 patients who had a laparoscopic hysterectomy. The participants` quality of life and sexual function level was measured with the Female Sexual Function Index (FSFI) and Short Form 36 Quality of Life Scale (SF-36) before and the first year after the operation. Results: There were no significant differences on the participants` sexual function scores between preoperation, and the first year after the operation. Although there was an improvement in all of the sub-domain scores, only sexual desire scores decreased after the operations, but these results were not statistically significant. However, quality of life scores, in all sub-domains, significantly increased after the surgery except the vitality. The vitality scores of the participants decreased.Conclusion: There is no effect of laparoscopic hysterectomy on sexual functioning, and there is a positive effect on the quality of life in the 12-month follow-up.

Joint replacement in X-linked hypophosphatemia

X-linked hypophosphatemia (XLH) is associated with a pervasive, severe degenerative osteoarthritis. We conducted a retrospective chart review/patient survey using the Knee or Hip Osteoarthritis Outcome Score Physical Function Short Form. Fourteen total knee arthroplasties and 7 total hip arthroplasties among 11 patients were included. The mean KOOS-PS score was 31.4 ± 9.7 with a mean follow up of 6.9 years. Mean HOOS-PS score was 14.8 ± 12.9 at a mean follow up of 7.6 years. One knee failed due to aseptic loosening and one hip was revised due to polyethylene wear. In conclusion, total joint arthroplasty is beneficial in XLH.

Measurement properties of the OARSI core set of performance-based measures for hip osteoarthritis: a prospective cohort study on reliability, construct validity and responsiveness in 90 hip osteo­arthritis patients

Background and purpose — Improvement of physical function is one of the main treatment goals in severe hip osteoarthritis (OA) patients. The Osteoarthritis Research Society International (OARSI) has identified a core set of performance-based tests to assess the construct physical function: 30-s chair stand test (30-s CST), 4x10-meter fast-paced walk test (40 m FPWT), and a stair-climb test. Despite this recommendation, available evidence on the measurement properties is limited. We evaluated the reliability, validity, and responsiveness of these performance-based measures in patients with hip OA scheduled for total hip arthroplasty (THA).Patients and methods — Baseline and 12-month follow-up measurements were prospectively obtained in 90 end-stage hip OA patients who underwent THA. As there is no gold standard for comparison, the hypothesis testing method was used for construct validity and responsiveness analysis. A test can be assumed valid if ≥75% of predefined hypotheses are confirmed. A subgroup (n = 30) underwent test–retest measurements for reliability analysis. The Oxford Hip Score, Hip injury and Osteoarthritis Outcome Score—Physical Function Short Form, pain during activity score, and muscle strength were used as comparator instruments.Results — Test–retest reliability was appropriate; intraclass correlation coefficient values exceeded 0.70 for all 3 tests. None of the performance-based measures reached 75% hypothesis confirmation for the construct validity or responsiveness analysis.Interpretation — The performance-based tests have good reliability in the assessment of physical function. Construct validity and responsiveness, using patient-reported measures and muscle strength as comparator instruments, could not be confirmed. Therefore, our findings do not justify their use for clinical practice.

Muscular strength and function after total hip arthroplasty performed with three different surgical approaches: one-year follow-up study.

Surgical approach influences short-term muscular strength, and leg-strength asymmetry has been demonstrated after total hip arthroplasty (THA). We evaluated muscular strength, physical function and patient-reported outcome measures (PROMs) up to 12 months postoperatively, in patients operated on using 3 different surgical approaches. 60 patients scheduled for primary THA were allocated to the direct lateral (DLA), posterior (PA) or anterior (AA) approach. The following parameters were evaluated: leg press and abduction strength, pain, 6-minute walking test, Harris Hip Score and Hip disability and Osteoarthritis Outcome Score - Physical Function Shortform (HOOS-PS). Abduction strength in the DLA group was significantly more reduced than the PA and AA groups 12 months postoperatively (p < 0.001). A significant interleg difference in abduction (p < 0.01) and leg press (p < 0.03) persisted in all groups up to 6 months, and up to 12 months in the DLA (p < 0.05). In the AA group, interleg difference in leg press was present up to 12 months (p = 0.01). Pain scores were higher in the DLA than the AA group at 6 months (p = 0.01). Patients in the PA group had better HOOS-PS score than those in the DLA group 3 months postoperatively (p = 0.02). No intergroup differences in pain or PROMs were found 12 months postoperatively. Patients operated via the DLA had reduced muscular strength, HOOS-PS scores and higher pain scores than those who underwent PA and AA type surgery. The non-operated leg was significantly stronger than the operated leg in all groups 6 months postoperatively and this persisted up to 12 months postoperatively for the DLA and AA groups. Clinical Trial Protocol number: ClinicalTrials.gov (NCT01506024).

ASSOCIATION OF SLEEP DURATION, PHYSICAL FUNCTION AND SOCIAL ACTIVITY IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT

The relationship between sleep duration and functional decline in older adults with mild cognitive impairment (MCI) is unknown. Our objective was to examine the independent relationship between sleep duration, physical functioning and social activity in community-dwelling older adults with MCI. Analyses were conducted on baseline data from participants enrolled in the Healthy Patterns Clinical Trial (Hodgson; R01NR015226-02S1). Measures included Barthel Index for activities of daily living, Promis Physical Function Short Form for physical functioning, and Promis Item Bank Social for social activity. We used Spearman’s correlation and multivariate linear regression. A total of 18 individuals (72.2% male) aged 75.8 (SD 8.4) with mean Clinical Dementia Rating (CDR) scores of 1.06 (SD 0.68) were enrolled. Sleep duration ranged from 4.5 to 13.5 with mean 8.47 (SD 2.05) hours. Longer sleep duration was significantly associated with poorer levels of activities of daily living (r = -0.742, p = .001) and trended towards significance with physical functioning (r = -0.406, p = .095) in bivariate analyses. After controlling for age, sex, number of medications, CDR, and depression, sleep duration was independently associated with activities of daily living (β = -15.899, p = .001). The relationship between sleep duration and social activity was not significant (r = -0.352, p = .166). Our preliminary results suggest longer sleep may be a cause or early sign of declining physical functional in older adults with MCI. Further prospective studies are necessary to determine the long-term effect of sleep duration on physical or social functioning in MCI patients.

Poster 74: Known Groups Construct Validity of the PROMIS Physical Function Short Form Among Lower Limb Orthosis Users

Poster 74: Known Groups Construct Validity of the PROMIS Physical Function Short Form Among Lower Limb Orthosis Users

Survival, Complications and Outcomes of the Birmingham Hip Resurfacing Compared to Cementless Total Hip Arthroplasty

Aim: Metal-on-metal hip arthroplasty is developed to address specific complications experienced with the use of cementless hip arthroplasty. However, there is a lack of comparative studies. The aim of this study was to evaluate the survival, complications and functional outcome of the Birmingham Hip Resurfacing (BHR) and compare it to the cementless Omnifit hip prosthesis. Materials and methods: We retrospectively compared a cohort BHR (n = 104) and Omnifit (n = 117) prostheses. Outcome measures included Oxford Hip Score (OHS), Hip disability and Osteoarthritis Outcome Score - Physical function Short Form (HOOS-PS) and EuroQol EQ-5D. Survival and complications were registered. Results: Survival was 86% in the BHR group and 92% in the Omnifit group after six years follow-up. Survival distributions were not significantly different. Prognostic factor for revision in the BHR group was a smaller femoral component size. The BHR group had significantly better OHS, HOOS-PS and EQ-5D scores and less pain in rest and during weight bearing compared to the Omnifit group. Conclusion: The BHR has significant better functional outcome and less pain than the Omnifit cohort, however, because of high revision rates and severe complications, general use is not recommended. Specific complications for the Omnifit femoral component are thigh pain and aseptic loosening, for which a revision offers a solution.

Long-term patient reported outcomes following acetabular fracture fixation

IntroductionPatient reported outcome scores may be the preferred method to assess clinical results following acetabular fracture fixation. However, in current acetabular fracture research, there is a scarcity of studies using these scores and long-term follow-up is lacking. The aim of this study is to describe long-term patient reported outcomes following acetabular fracture surgery and to evaluate the association between reduction quality and these outcome measures. MethodsPatients who received operative fixation for acetabular fractures (1992–2012) were sent questionnaires (short musculoskeletal functional assessment (SMFA) function index and short form (SF)-12), which was returned by 106 patients (22%) (mean age 51 years, 74% male). Mean follow-up was 11.3 years and hip survivorship 78%. Reduction quality was assessed on postoperative CT or plain pelvic radiography (PXR) (3 patients). Reductions were graded as adequate (CT: <1 mm step and <5 mm gap/PXR: ≤3 mm displacement) or inadequate (CT: ≥1 mm step and/or ≥5 mm gap/PXR: >3 mm displacement). Outcome scores between native hip versus total hip arthroplasty (THA) and adequate versus inadequate reduction groups were compared and association between reduction quality and hip survivorship was determined. Subgroup analysis was performed in older patients (≥50 years). ResultsPatients with native hips reported overall superior relevant outcome scores (SMFA function index (p = 0.047), mobility (p = 0.048) and SF-12 physical component (p = 0.008)) compared to THA patients. Hip survivorship was associated with adequate reductions (p = 0.019). In the native hip group, an adequate reduction was also associated with lower (better) clinical scores (exceeding the minimal clinical important difference) (MCID) specifically for SMFA function index (p = 0.117) and mobility (p = 0.022). In elderly patients, the native hip versus THA group had similar outcomes, and adequate reductions were associated with hip survivorship as well as superior clinical scores (at least exceeding the MCID) in those who retained their native hip. ConclusionAt long-term follow-up, acetabular fracture surgery is associated with excellent patient reported outcomes. Patients who retain their native hip have overall superior relevant (SMFA and SF-12) function scores compared to those who convert to THA. Adequate reductions (on CT) were associated with both hip survivorship and superior outcome scores in patients who retain their hip.