Patient Outcome Measures Research Articles

A comparative analysis of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty for posterior glenoid wear patterns.

Reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (TSA) are well-known methods of treating glenohumeral arthritis, which often leads to posterior wear of the glenoid. This study compared minimum two-year outcome measures in patients treated with RSA and TSA for Walch B2 and B3 glenoids. Thirty-eight shoulders underwent TSA and 40 shoulders underwent RSA by two fellowship-trained shoulder surgeons at a tertiary referral center. The mean time for follow-up was 25.9 months and 25.5 months for RSA and TSA groups, respectively (P=0.47). The RSA group consisted of 27 males and 13 females; whereas the TSA group had 37 males and 1 female (P = <0.001). The mean age for RSA was 71 years old, 61 years for TSA (P = <0.001). TSA patients demonstrated superior average active external rotation (47° vs 40°; P=0.003) and internal rotation (60° vs 52°; P=0.002). Active forward elevation did not significantly differ. The TSA group had 7 (18.4%) postoperative complications, the RSA group had 3 (7.5%) (P=0.27). The most common complication was cephalic vein thrombosis. No complication required revision. Patients with shoulder osteoarthritis and posterior glenoid wear patterns with an intact rotator cuff who underwent TSA had similar outcomes as RSA. While the TSA group had superior active external rotation and internal rotation at 2 years postoperative compared with RSA, the 2-year active forward elevation was equivalent. Both groups had similar 2-year outcomes for strength in all planes and in all three clinical-outcome scoring systems. The TSA group demonstrated a higher incidence of postoperative complications. Neither group required reoperations. These results indicate that TSA and RSA can be safely utilized in posterior glenoid wear patterns with good clinical outcomes. Level III; Retrospective cohort study.

Development and Testing of a Patient Outcome Measure for Interprofessional Tuberculosis Care: A Delphi Study

Background: A chronic medical condition such as tuberculosis can be physically and emotionally challenging for both health practitioners and patients and their families. Tuberculosis requires a team-based care model that provides resilience and coordinated work, such as the one offered by an interprofessional collaborative practice team. Despite the increasing interest in interprofessional-based care globally, there is a notable lack of measures to assess patient impact. We aimed to develop a patient outcome measure to quantify the functional impact of interprofessional care on tuberculosis patients. Methods: The study involved four phases: 1) developing a conceptual framework and creating items, 2) evaluating the construct through Delphi studies to obtain international consensus, 3) back-to-back translation into Indonesian, and 4) re-evaluating the construct with Delphi study to obtain Indonesian consensus. The consensus was reached if the Content Validity Index covers at least 70% agreement from experts, an interquartile range &lt;1, and a median score of 4 or 5 on a 5-point Likert-type scale. The COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) guidelines were used to assess item relevance, comprehensibility, and comprehensiveness. Results: A total of 65 international and 61 Indonesian participants in the Delphi studies. The final instrument consists of 44 items organized into five domains. All items were relevant to the construct being measured and deemed understandable, and significant concerns related to TB care were comprehensively addressed in the instrument. Conclusion:The findings indicate that the instrument content validity was good, fulfilling COSMIN requirements for items' relevance, comprehensibility, and comprehensiveness. Doi: 10.28991/ESJ-2025-09-01-08 Full Text: PDF

Enhancing doctor-patient communication using large language models for pathology report interpretation

BackgroundLarge language models (LLMs) are increasingly utilized in healthcare settings. Postoperative pathology reports, which are essential for diagnosing and determining treatment strategies for surgical patients, frequently include complex data that can be challenging for patients to comprehend. This complexity can adversely affect the quality of communication between doctors and patients about their diagnosis and treatment options, potentially impacting patient outcomes such as understanding of their condition, treatment adherence, and overall satisfaction.Materials and methodsThis study analyzed text pathology reports from four hospitals between October and December 2023, focusing on malignant tumors. Using GPT-4, we developed templates for interpretive pathology reports (IPRs) to simplify medical terminology for non-professionals. We randomly selected 70 reports to generate these templates and evaluated the remaining 628 reports for consistency and readability. Patient understanding was measured using a custom-designed pathology report understanding level assessment scale, scored by volunteers with no medical background. The study also recorded doctor-patient communication time and patient comprehension levels before and after using IPRs.ResultsAmong 698 pathology reports analyzed, the interpretation through LLMs significantly improved readability and patient understanding. The average communication time between doctors and patients decreased by over 70%, from 35 to 10 min (P < 0.001), with the use of IPRs. The study also found that patients scored higher on understanding levels when provided with AI-generated reports, from 5.23 points to 7.98 points (P < 0.001), with the use of IPRs. indicating an effective translation of complex medical information. Consistency between original pathology reports (OPRs) and IPRs was also evaluated, with results showing high levels of consistency across all assessed dimensions, achieving an average score of 4.95 out of 5.ConclusionThis research demonstrates the efficacy of LLMs like GPT-4 in enhancing doctor-patient communication by translating pathology reports into more accessible language. While this study did not directly measure patient outcomes or satisfaction, it provides evidence that improved understanding and reduced communication time may positively influence patient engagement. These findings highlight the potential of AI to bridge gaps between medical professionals and the public in healthcare environments.

P1109 Evaluation of patient-reported outcome measures (PROMs) of IBD patients who completed upadacitinib induction period

Abstract Background Patient-reported outcome measures (PROMs) are used to assess the effectiveness of treatments received by patients in terms of clinical response in inflammatory bowel disease (IBD). We aimed to evaluate the perceived clinical response from the patient’s perspective using PRO2, IBD Control Questionnaire (ICQ) and Visual Analogue Scale (VAS) at the end of induction therapy in patients treated with upadacitinib. We also aimed to evaluate the correlation of PROMs with biochemical response. Methods We included IBD patients who underwent upadacitinib induction therapy from 01/07/2024 to 01/10/2024 in ten centers. ICQ and VAS assessments (Higher scores are better) were used in conjunction with CRP levels and PRO2 assessments (Lower scores are better) performed at baseline and at the end of induction treatment. Results A total of 75 patients who completed the induction phase were included, 52% were female and 50.7% were treated for Crohn’s disease (CD). Treatment was switched in 54.7% of patients due to uncontrolled chronic disease, in 42.7% for loss of response and in 2.7% for drug side effects. PRO2 mean scores were changed from 4.86 ± 3.06 to 1.67 ± 1.28 (p&amp;lt;0.05) and 18.61 + 10.42 to 7.36 + 5.10 (p&amp;lt;0.05) for ulcerative colitis (UC) and CD respectively. At the end of induction treatment, 47.2% of UC group and 66.7% in the CD group were classified as in clinical remission according to PRO2 scores. The rate of patients reporting side effects was 30.7%. Acne and skin rashes were reported more frequently (13.2 %). According to the visual analog scale, 80% of the patients reported improvement in their condition (p&amp;lt;0.05), and the mean VAS score and IBD control score were 71.9 and 13.7 (p&amp;lt;0.05) for patients in remission in the UC group and 70 and 14.7 (p&amp;lt;0.05) in the CD group compared to active patients. ICQ scores and VAS were negatively correlated with PRO2 scores and CRP levels (p&amp;lt;0.05 for both pairs). On the other hand both scores were not correlated with CDAI and mayo scores (p&amp;gt;0.05). Conclusion In this real-life cohort of patients treated with upadacitinib, 80% report a significant improvement in their condition. ICQ and VAS can be used to understand patients’ perspective on treatment efficacy. Conventional activity scores probably not helpful for early assessment of clinical activity compared to PROMs.

P0240 Cross-cultural adaptation and validation of the Crohn’s Anal Fistula – Quality of Life scale in Dutch patients with active perianal fistulizing Crohn’s disease

Abstract Background Perianal fistulizing Crohn’s disease (pCD) is associated with debilitating symptoms such as fecal incontinence and perianal pain, and can significantly impact a patient’s quality of life (QoL)1. The Crohn’s Anal Fistula Quality of Life (CAF-QoL) scale has recently been developed as the first disease-specific patient-reported outcome measure for patients with pCD2, but has yet to be validated in an independent cohort. Therefore, we aimed to adapt and validate the CAF-QoL scale in a Dutch cohort of patients with active pCD. Methods Patients with active pCD were retrieved from a prospective multicenter study performed in 41 Dutch (non-)academic hospitals between September 2022 and March 2023. Respondents of the CAF-QoL scale and other health-related QoL questionnaires (sIBDQ and EQ-5D-5L3,4) at baseline were included. After translation of the CAF-QoL scale to Dutch, patient representatives verified the questionnaire’s comprehensibility. Prospective validation comprised the assessment of construct validity, internal consistency, test-retest reliability and responsiveness. Item response theory (IRT) was used to investigate the discriminative power of individual CAF-QoL items and to test for differential item functioning (DIF), examining whether each item behaves equally across all respondents. Results Questionnaires were completed by 264 patients (response rate 64%; female 56%) (Table 1). The median pCD duration at inclusion was 3.0 years (IQR 1.0 – 8.0). Evaluation of construct validity found a moderate correlation between CAF-QoL and sIBDQ (r -0.61, p&amp;lt;0.01) and EQ-5D-5L (r -0.58 [utility] and r -0.42 [VAS], p&amp;lt;0.01) scores. Furthermore, the CAF-QoL scale demonstrated excellent internal consistency (Cronbach’s alpha 0.93), good stability (intraclass correlation coefficient 0.83) and responded well to improvement and worsening of pCD symptoms (p&amp;lt;0.01)(Table 2). Discrimination values revealed that most items (73%) possessed a moderate to high ability to predict poor QoL; items pertaining to the impact of pCD on daily life had the greatest predictive abilities. No clinically relevant DIF was found among patients of different ages, sexes or education levels. Conclusion In this prospective multicenter study, the CAF-QoL scale was validated as a robust tool to measure pCD-specific QoL among Dutch patients with active pCD. Therefore, this scale appears to be well suited for use in clinical practice. Further studies are required to establish a minimal clinically important difference for the CAF-QoL scale; this would determine the smallest change in test scores perceptible to the patient, enabling effective monitoring of treatment outcomes.

P0510 Evaluation of organizational and healthcare provider level readiness in European Inflammatory Bowel Disease centres for outcome-based quality improvement

Abstract Background Inflammatory bowel disease (IBD) affects quality of life and increases healthcare costs. Measuring patient outcomes for continuous quality improvement (QI) can optimize care, but resource limitations, infrastructure challenges, and strategic misalignments hinder progress. We assessed the readiness for outcome-based QI in European IBD centres at both the organizational and professional levels. Methods We employed a mixed-methods design, starting with a survey with follow-up interviews of IBD-specialized gastroenterologists. Dutch centres were approached through the Initiative of Crohn’s and Colitis (ICC) organization and other European centres were recruited through the European Crohn’s and Colitis Organization (ECCO). Eligible centres had a multidisciplinary care model with at least one dedicated gastroenterologist, nurse, and surgeon. Participants completed a web-based survey covering team characteristics, outcome-based monitoring for QI, resources, and attitudes toward outcome-based QI. Quantitative data were analysed using descriptive statistics, and follow-up interviews are ongoing. Results Of the 42 IBD centres surveyed, 69% were in the Netherlands (Figure 1). After exclusions, 36 centres were analysed (Table 1), mostly non-academic hospitals (58%) with 500-800 beds. Monitoring practices varied, with 25% monitoring outcomes annually, 25% monitoring outcomes biannually, or 28% more frequently, while 22% did not monitor outcomes. Manual or hybrid EHR data extraction was common, with few using fully automated methods. Doctors (100%) and specialized nurses (96%) consistently engaged in data discussions. Non-academic centres involved more data managers (53%) and patients (65%) than academic hospitals. Doctors led discussions in most cases (82%), particularly in academic centres (91%), with significant nurse involvement (64%). Non-academic centres had diverse leadership, including data managers (47%) and occasional patient involvement (12%). Frequently monitored outcomes included medication use (71%), clinician-reported measures (61%), healthcare utilization data (57%) and patient-reported outcomes (50%). Most centres (68%) had implemented 2-3 QI initiatives in the past year, with 48% regularly assessing their effectiveness, and most respondents recognized the value of outcome monitoring for providers and patients. Conclusion Outcomes monitoring is seen as an approach for QI in IBD care, yet practices varied across centres. Academic centres monitor outcomes more frequently and rely on care professionals to lead discussions, whereas non-academic centres often rely on data managers. These differences highlight the need for standardization in monitoring practices and team roles to support consistent, outcome-based QI across Europe.

Common Comorbidities and a Comparison of 4 Comorbidity Indices in Patients Undergoing Orthopaedic Oncology Surgery.

Comorbidity indices are used to help to estimate patients' length of hospital stay, care costs, outcomes, and mortality. Increasingly, they are considered in reimbursement models. The applicability of comorbidity indices to patients undergoing orthopaedic oncology surgery has not been studied. The purpose of this study was to determine the predominant comorbidities in patients undergoing orthopaedic oncology surgery and to evaluate the predictive value of these indices. Patient demographic characteristics, diagnoses, and preoperative comorbidities were collected retrospectively on 300 patients undergoing orthopaedic oncology surgery between January 2014 and March 2023. In this study, 3 subsets of 100 patients each with malignant primary bone tumors, malignant primary soft-tissue tumors, or osseous metastatic disease were randomly selected. Comorbidities were tabulated and weighted according to the guidelines of the Charlson Comorbidity Index (CCI), the National Institute on Aging/National Cancer Institute (NIA/NCI) index, the van Walraven Index, and the Agency for Healthcare Research and Quality (AHRQ) Index. Two-tailed bivariate Pearson correlations were performed to assess the relationship between the indices and between each index and patient outcomes. Comorbidities in our patient population were compared with those published in other studies. The predominant comorbidities in patients undergoing orthopaedic oncology surgery were hypertension, deficiency anemias, metastatic disease, recent unintended weight loss or being underweight, and fluid or electrolyte disorders. The percentage of patients with certain comorbidities exceeded those reported in other cancer, orthopaedic, and inpatient populations. The 4 comorbidity indices had variable correlation when assessing our patient population. The number of comorbidities and the weighted scores from all indices demonstrated little to no correlation with length of stay and survival in our patient sample. The prevalence of many comorbidities in patients undergoing orthopaedic oncology surgery is greater than those reported in other patient populations. Commonly utilized indices demonstrate variable correlation with one another. With these tools, there was little to no correlation between comorbidities and patient outcomes in our patient population. The comorbidities deemed protective in these tools may underestimate the true assessment of the comorbidities in patients undergoing orthopaedic oncology surgery. This highlights the importance of developing tools to properly assess the comorbidities in defined patient populations, especially as these models are used to set benchmarks for measuring patient outcomes; assessing quality, efficiency, and safety; and determining reimbursement criteria. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Patient-Reported Outcome Measures in Patients with Diabetes Mellitus: Findings from the Diabetes Landeck Cohort.

Maintaining and optimizing quality of life (QoL) is a central issue and one of the most important goals in therapy for patients with chronic diseases, such as diabetes mellitus (DM). Despite its importance, there is little data on the QoL of patients with DM in Austria. The objective of this study was to extend an established population-based cohort, the Diabetes-Landeck cohort, by including patient-reported outcomes. We performed a survey on quality of life (QoL) and treatment satisfaction in patients from the Diabetes-Landeck cohort using the EQ-5D-5L, the problem areas in diabetes survey (PAID), and the diabetes treatment satisfaction questionnaire (DTSQ). Mean sum scores were calculated and compared between patient characteristic subgroups. In total 58 patients were recruited, with a mean age of 63 years and a mean hemoglobin A1c (HbA1c) of 7.1%. The mean sum score of EQ-5D-5L was 92 (SD=10.6), and that of DTSQ and PAID were 32.2 (SD=6.6) and 10.8 (SD=11.6), respectively. Patients with obesity (body mass index ≥ 30 kg/m2) showed a statistically significant decreased mean sum score of EQ-5D-5L and a statistically significant increased mean sum score of DTSQ. Patients with HbA1c ≥7.5% showed a statistically significant decreased mean sum score of DTSQ. We observed patient-reported outcomes significantly associated with obesity and HbA1c, which could be used for targeted patient monitoring. Limited by small sample size and questions in generalizability, we strongly suggest the rollout of a larger study.

Chronic kidney disease progression in patients with previous type 2 diabetes and/or hypertension: a population-based cohort study from primary care in Spain

ObjectivesTo evaluate whether between hypertension and type 2 diabetes (T2D)—established drivers of chronic kidney disease (CKD) progression—one might be more strongly associated with CKD progression than the other.DesignCohort study using...

Psychometric validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) and Oxford Hip Score (OHS) in patients with hip-abductor tendon pathology

ObjectiveValidated patient-reported outcome measures for patients with hip-abductor tendon pathology are lacking. Recent studies indicate that the Copenhagen Hip and Groin Outcome Score (HAGOS), in the original or the revised...

Association Between Surgeon Stress and Major Surgical Complications

Surgeon stress can influence technical and nontechnical skills, but the consequences for patient outcomes remain unknown. To investigate whether surgeon physiological stress, as assessed by sympathovagal balance, is associated with postoperative complications. This multicenter prospective cohort study included 14 surgical departments involving 7 specialties within 4 university hospitals in Lyon, France. Exclusion criteria consisted of patient age younger than 18 years, palliative surgery, incomplete operative time-stamping data, procedures with a duration of less than 20 minutes, and invalid surgeon heart rate variability (HRV) data. Data were accrued between November 1, 2020, and December 31, 2021, with 30-day follow-up completed on May 8, 2022. Analyses were performed from January 1 to May 31, 2024. Sympathovagal balance of the attending surgeon in the first 5 minutes of surgery. Major surgical complications, extended intensive care unit stay, and mortality within 30 days, after adjustment via mixed-effects multivariable logistic regression for surgeon age, professional status, the time of incision, the random effect of the surgeon, and a composite risk score incorporating patient comorbidities and surgery characteristics. Sympathovagal balance was quantified by the low frequency to high frequency (LF:HF) ratio derived from HRV data measured by chest monitors worn intraoperatively. The LF:HF ratio was normalized at the surgeon level to the median value observed for each surgeon during the study period to control for baseline differences. A total of 793 surgical procedures performed by 38 attending surgeons were included in the analysis. Median patient age was 62 (IQR, 47-72) years, and 412 (52.0%) were female, with a median of 2 (IQR, 1-4) comorbidities. Median surgeon age was 46 (IQR, 39-52) years, 39 (78.9%) were male, and 22 (57.9%) were professors. Median surgeon heart rate was 88 (IQR, 77-99) beats per minute. Median surgeon LF:HF ratio was 7.16 (IQR, 4.52-10.72) before and 1.00 (IQR, 0.71-1.32) after normalization. Increased surgeon sympathovagal balance during the first 5 minutes of surgery was associated with significantly reduced major surgical complications (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.98; P = .04), though not with reduced intensive care unit stay (AOR, 0.34; 95% CI, 0.11-1.01; P = .05) or mortality (AOR, 0.18; 95% CI, 0.03-1.03; P = .05). Increased surgeon stress at the beginning of a procedure was associated with improved clinical patient outcomes. The results are illustrative of the complex relationship between physiological stress and performance, identify a novel association between measurable surgeon human factors and patient outcomes, and may highlight opportunities to improve patient care.

Assessment tools for evaluating body structure-function and activity in dyskinetic cerebral palsy: a systematic review of instrumented assessments according to ICF-CY

Dyskinetic cerebral palsy (CP) is one of the most severe forms of CP, characterized by dystonia or choreoathetosis and can be classified into dystonic and choreoathetosis subgroups. The International Classification of Functioning, Disability, and Health-Child and Youth Version (ICF-CY) provides a framework for physical therapists to understand the health, functioning, activity, participation, and impact of dystonia and choreoathetosis. This review aimed to examine the clinical use of ICF-CY tools to assess body structure, function, and activity in children with dyskinetic CP. A systematic search was conducted in June 2024 using PubMed, Embase, Scopus, and Google Scholar databases. The search included terms related to cerebral palsy, dyskinesia, choreoathetosis, dystonia, body structure, function, and activity. After removing duplicates, 11,800 articles remained and 34 met the inclusion criteria. The review found that ICF-CY activity assessments focused primarily on fine-motor, communication, eating-drinking, bimanual fine motor, and speech functions following gross motor function. Some studies have evaluated ICF-CY body structure and function. Most studies used the Dyskinesia Impairment Scale. This review presents evaluations using instrumented assessments as objective outcome measures in patients with dyskinetic CP. Future studies should develop measurements that are applicable outside the laboratory by using new technologies.

Computerized adaptive testing for PRWHE measurements using domains of pain and motor function.

The Patient-Rated Wrist and Hand Evaluation is an outcome measure for patients with conditions affecting the wrist or hand. We evaluated the structural validity of the Patient-Rated Wrist and Hand Evaluation using psychometric techniques, then developed computerized adaptive testing algorithms. Factor analysis found two health constructs consistent with 'Pain' and 'Motor Function'. Two computerized adaptive tests were developed, which reduced the number of items from five to a median of one ('Pain'), and from 10 to two ('Motor Function'). Both computerized adaptive tests achieved high levels of precision (standard error of measurement <0.3) and similar scores to the full-length measure, demonstrated by Bland-Altman analysis. Dividing the Patient-Rated Wrist and Hand Evaluation into two subscales could reduce the response burden, improve standardization of outcome measurement for clinicians and provide precise insight into patient symptoms.Level of evidence: N/A.

The Effectiveness of Cervical Sensorimotor Control Training for the Management of Chronic Neck Pain Disorders: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to evaluate the effectiveness of cervical sensorimotor control training for the management of chronic neck pain (NP) disorders compared to no treatment, or other conservative or non-conservative treatments. The review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42022381714). A comprehensive database search was performed (until November 2023) for randomized controlled trials (RCTs) and clinical trials evaluating the effects of cervical sensorimotor control training on several subjective and objective outcomes in adults with chronic NP (traumatic or non-traumatic origin). Data on study and patient characteristics, outcome measures, and effects on primary and secondary outcomes were extracted. Seven RCTs (409 participants) were included, of which 6 qualified for meta-analysis. Low-certainty evidence suggests that cervical sensorimotor control training is more effective for reducing pain (standardized mean difference (SMD): 0.48; 95% confidence interval (CI): 0.07 to 0.89) and improving cervicocephalic kinesthesia at short term than no treatment, and for reducing kinesiophobia at intermediate term compared to other treatment modalities. No significant between-group differences were found for other outcomes and follow-ups (very low-to-moderate-certainty evidence). Considering the significant improvements in cervicocephalic kinesthesia, cervical sensorimotor control training could be an important element in the rehabilitation of patients with chronic NP disorders. However, the current evidence in the literature is scarce to draw conclusions regarding its effectiveness as a stand-alone rehabilitation program.

Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer.

Radical gastrectomy is generally prefered for gastric cancer but has postoperative complications. The objectives of the study are to evaluate the effectiveness of three different models of preoperative counseling and postoperative follow-up care in patients who underwent radical gastrectomy for gastric cancer. In retrospective medical record analyses, patients received nurse-led preoperative counseling and postoperative follow-up care (NC cohort, n = 105) or surgeon-led preoperative counseling and surgeon-led follow-up (SC cohort, n = 140), or did not receive counseling and aftercare (RC cohort, n = 160). Patients had a postoperative intensive care unit (PICU) stay of 24 (26-22) h/patient and postoperative pain of 6 (6-5)/ patient. The frequencies of nausea, vomiting, medical intensive care unit admission(s), dizziness, length of PICU stay, and intensity of postoperative pain were lower among patients in the NC cohort, followed by those in the SC and RC cohorts. A higher number of patients in the RC cohort died when compared to the NC (25 [16%) vs 2 [2%], p = 0.0458) and the SC (25 [16%] vs 11 [8%], p = 0.0001) cohorts in follow-up. Patients who undergo radical gastrectomy for gastric cancer require healthcare professional-led preoperative counseling and postoperative aftercare. Nurse-led preoperative counseling and postoperative aftercare, could improve outcome measures in patients who underwent radical gastrectomy for gastric cancer.

Comparison of four Patient Reported Outcome Measures in patients with ankle fracture: A study on patient preferences and psychometric properties

The aim was to assess psychometric properties of Manchester Oxford Foot Questionnaire (MOXFQ), the Self-reported Foot and Ankle Score (SEFAS), the Olerud Molander Ankle Score (OMAS), and the Forgotten Joint Score (FJS) in adults with ankle fractures. Patients received all four questionnaires 6, 12, 14, 24, 52, and 104 weeks following an ankle fracture. According to COSMIN guidelines, statistical tests were performed to assess floor- and ceiling effects, structural validity, construct validity and reliability. Cognitive interview was performed with 9 patients. MOXFQ showed best model fit in Confirmatory Factor Analysis. When testing construct validity, all hypotheses were accepted except for OMAS and FJS. All questionnaires had an almost perfect test-retest reliability (Interclass Correlation Coefficient 0.81 to 0.91) and Cronbach's alpha ranged from 0.76 to 0.95. MOXFQ was the best rated questionnaire. All questionnaires performed well and we recommend MOXFQ for future use in ankle fracture studies. Level IV.

Preferred labels and language to improve communication about lesions at low risk of progressing to cancer: qualitative interviews with patients and physicians

ObjectivesWe explored how to improve communication about low-risk lesions including labels, language and other strategies.DesignQualitative description and thematic analysis to examine the transcripts of telephone interviews with patients who had...

Concomitant multiple sclerosis and cervical myelopathy: A propensity-matched QOD analysis of patient-reported outcomes and return to work after cervical spine surgery.

The diagnosis of degenerative cervical myelopathy (CM) in multiple sclerosis (MS) patients is challenging due to overlapping symptomatology and radiological findings. Minimal literature reports patient reported outcomes measures (PROMs) for MS patients undergoing surgery for CM. Given the diagnostic difficulty, we aimed to determine if patients with MS have worse outcomes after elective cervical spine surgery. 126 patients who underwent surgery for CM were retrospectively obtained from the Quality Outcomes Database (QOD). 63 MS patients were age and gender matched to 63 without MS. Postoperative PROMs including Visual Analogue Scale for neck/arm pain (VAS), Neck Disability Index (NDI), and satisfaction were compared at 3 and 12 months. Postoperative complications and return to work were studied as secondary outcomes. The average age of both cohorts was 57.9 years, and 63.5 % were female. Baseline functional status and symptomatology were similar, although fewer MS patients could independently ambulate (p = .014). The operative time and length of stay were similar. MS patients had a greater average ASA grade (p = 0.018), however there were no significant differences in VAS, NDI, or satisfaction. MS patients had a higher 3-month readmission rate (p = .044), however returned to work at a similar rate greater than 70 %. PROMs do not significantly differ for CM patients with concomitant MS. Patients with MS had a higher 3-month complication rate, although readmissions were largely unrelated to the procedure. Thus, despite the diagnostic challenge of CM in MS patients, the surgical outcomes are comparable to those without MS.

The impact of an online, lifestyle intervention program on the lives of patients with a rheumatic and musculoskeletal disease: a pilot study

Abstract Objectives To evaluate the short and long term effects of an online, interactive, multifactorial lifestyle intervention program (Leef! Met Reuma) on health risk and all ICHOM-recommended patient reported outcome measures(PROMs) in patients with an Inflammatory Arthritis(IA), OsteoArthritis(OA) or FibroMyalgia(FM). Methods Patients with an IA, OA or FM, could register for the lifestyle intervention program. The program consists of a 3-month intensive part followed by a 21-month aftercare period and focuses on 4 pillars, namely nutrition, exercise, relaxation and sleep. Health risk and PROMs are collected 3-monthly during the first 6 months and 6-monthly during the next 18 months. Health risk includes self-reported weight, waist circumference and BMI. Following PROMs were included: pain, morning stiffness severity, fatigue, Health Assessment Questionnaire, quality of life, perceived stress, sleep disturbance and impact on life. Descriptive statistics were used to assess the change in health risk and PROMs during the intensive part of the program and aftercare period. Results Of the 264 patients studied, 88, 105 and 71 were diagnosed with IA, OA and FM, respectively. Health risk significantly improved in all three diagnosis groups during the intensive part of the program. The mean BMI reduction was -1.36 (0.26), -1.22 (0.23) and -1.48 (0.33), whereafter it stabilized in the aftercare period. All PROMs showed a similar trend. Conclusion An online, interactive lifestyle intervention program has a positive long-term effect, even after 2-years of follow-up, on health risk and all PRO domains in patients with an inflammatory arthritis, osteoarthritis and fibromyalgia.

Incidence and Outcomes of Vertebral Compression Fracture Among Patients Infected with COVID-19.

Background/Objectives: Early studies have suggested that the SARS-CoV-2 virus has a deleterious effect on bone mineral density and may increase the risk of pathological fractures. This study characterized vertebral compression fractures in patients with and without a prior diagnosis of COVID-19. Methods: Using a nationwide claims database, this retrospective study used ICD-10 billing codes to identify patients with a diagnosis of vertebral compression fracture from January 2020 to April 2022. Two cohorts were created based on whether the patients had a concurrent diagnosis of COVID-19. Patient demographics, comorbidities, and outcome measures were characterized by descriptive analysis. Results: In total, 413,425 patients met the inclusion criteria. Among them, a total of 23,148 patients (5.60%) had a diagnosis of COVID-19 at the time of their compression fracture. Among the COVID-19 patients, the incidences of vertebral compression fracture were 0.42% in 2020 and 0.33% in 2021, in comparison to the historical average yearly incidence of 0.17% across all patients. The patients with COVID-19 at the time of compression fracture diagnosis had a higher rate of vitamin D deficiency (OR: 1.25) and a lower rate of routine healing (OR: 0.61). The patients without COVID-19 were more likely to be osteoporotic (OR: 0.88), experience additional compression fractures (OR: 0.38), and have kyphoplasty or vertebroplasty (OR: 0.73). Conclusions: Despite lower rates of osteoporosis, patients with a concomitant COVID-19 diagnosis exhibited a higher incidence of compression fractures. Although more research is needed, these results support increasing bone health surveillance in patients with a history of COVID-19 infection.