Patient-perceived Function Research Articles

Surgical procedures to improve hand function in tetraplegic patients: patient satisfaction and outcomes over a 20-year period.

The aim of the present study was to report our experience in the evolution in surgical strategy and patient satisfaction after upper limb reconstruction in tetraplegic patients. A total of 72 patients (114 upper limbs) underwent surgery between 1997 and 2017. Since April 2003, tenodesis of the extensor digitorum communis tendons was no longer performed because it limited wrist flexion, and two-stage operations to restore active grasp were replaced by one-stage procedures. In total, 34 patients (58 upper limbs) completed questionnaires about function and satisfaction at a mean follow-up of 14 years (range 4-24) since their first operation; 26 were satisfied, 30 would have the operation again and 31 benefitted from the surgery. Surgical procedures, such as tendon transfers, arthrodesis and tenodesis, can have a positive effect on patient-perceived function and satisfaction in the long term in most of these patients.Level of evidence: IV.

Minimizing Redislocation Rates and Restoring Function After Patella Dislocation: A Critically Appraised Topic.

Patella dislocation is a common knee injury resulting in decreased function, increased knee pain, and a higher risk of recurrent patella dislocation. Patients with patella instability are treated surgically or conservatively with physical therapy to minimize redislocation risk and restore function. In individuals with a patella dislocation, how does treatment (conservative therapy versus medial patellofemoral ligament [MPFL] surgery) affect redislocation rates and patient-perceived function? This critically appraised topic included 3 studies assessing outcomes in individuals with patella instability treated with MPFL surgery or conservative management. Outcomes included comparing redislocation rates and Kujala scale perceived knee function between participant groups. Surgery included MPFL reconstruction (MPFL-R) in 1 randomized controlled trial and 1 prospective controlled trial and MPFL repair in another randomized controlled trial. Conservative treatment included physical therapy and bracing. All 3 studies demonstrated significantly lower redislocation rates in individuals managed with surgery versus conservative treatment. Reported knee function was significantly higher in the MPFL-R group compared with individuals conservatively managed at 2-year follow-up but not at 1year. No significant difference in knee function was present between individuals receiving MPFL repair or conservative management at a 2-year follow-up. There is moderate-level evidence to support a significant decrease in patella redislocation rates in individuals managed with MPFL surgery compared with conservative treatment. The reviewed studies suggest a significant improvement in patient-perceived knee function at 2years following MPFL-R but no difference at 1year following MPFL-R or 2years after MPFL repair. Strength of Recommendations: Grade B evidence supports lower patella redislocation rates with MPFL surgery compared with nonsurgical treatment. Furthermore, this evidence suggests a potential benefit in perceived knee function 2years after MPFL-R compared with conservative management.

Pain Coping Skills Training: A Nurse Practitioner Delivered Telehealth Intervention to Enhance Self-Efficacy

Chronic pain is a national crisis requiring a multidisciplinary approach to engage patients in their care planning and treatment execution. The current biomedical model of pain care is inadequate due to the subjective and qualitative nature of pain. Current literature supports a biopsychosocial approach, empowering patients to explore self-care to enhance activities of daily living. Pain Coping Skills Training (PCST) delivers real-life strategies that improve quality of life and strengthen self-efficacy, which has been identified as a patient outcome measure that demonstrates improvement in patient-perceived function and quality of life despite pain intensity.

Pain coping skills training un-locks patient-centered pain care during the COVID- 19 lockdown

BackgroundIn 2020, the COVID-19 virus sparked a crisis constituting a nationwide public health emergency that rapidly altered the provision of healthcare services for all Americans. Infectious disease mitigation led to widespread lockdowns of perceived nonessential services, programs, and non-emergent healthcare interventions. This lockdown exacerbated the public health dyad of uncontrolled pain and the opioid epidemic, which was already in a crisis state. Current literature supports the management of uncontrolled pain with a biopsychosocial approach, empowering patients to explore self-care to enhance activities of daily living. Pain Coping Skills Training (PCST) delivers real-life strategies that improve quality of life and strengthen self-efficacy. Self-efficacy has been identified as a patient outcome measure that demonstrates improved patient-perceived function and quality of life despite pain intensity. Studies have shown that nurse practitioners (APRN) are well-positioned to provide PCST to chronic pain sufferers. MethodsA pretest-posttest design was utilized for this project to enhance pain self- efficacy through an APRN-led community-based intervention. InterventionCommunity-dwelling adults treated in a specialty pain management practice were self-selected to participate in a 6-week telehealth delivered PCST Program. This APRN delivered program presented basic pain education and a broad range of evidence-based nonpharmacologic pain management self-care tools. The primary outcome was improved Pain Self-efficacy measured with the pain self-efficacy questionnaire (PSEQ), with secondary outcomes of improved perceived pain intensity and function measured with the pain, enjoyment, and general activity (PEG) scale tracked weekly. ResultsBaseline PSEQ and weekly PEG scores were obtained and compared to scores after the program. Collateral data points included confidence in using complementary and alternative nonpharmacologic interventions, satisfaction with the program, and a qualitative patient statement regarding pre-and post-intervention participation. ConclusionsThis project concluded that a Nurse Practitioner delivered PCST program via telehealth technology could provide community-dwelling adults with an intervention that improves pain self-efficacy, enhances self-reported PEG measures, and meets the social distancing requirements that continue to impact patients during the COVID-19 pandemic.

Association Between Objective Ratings of Swallowing and Dysphagia-Specific Quality of Life in Patients Receiving (Chemo)radiotherapy for Oropharyngeal Cancer.

The pervasive nature of dysphagia in the head/neck cancer (HNC) population necessitates a comprehensive evaluation approach, including both objective assessment of dysphagia, and subjective patient-reported functional measures. However, the congruence between clinician-rated and patient-perceived function is still not well understood. The current study investigated the association between objective clinician-rated swallow physiology (using the MBSImP) and patient-reported measures of swallowing-related quality of life (using the MDADI) in a secondary analysis of patients with oropharyngeal HNC treated with (chemo)radiotherapy. Seventy-nine patients with oropharyngeal HNC receiving (chemo)radiotherapy completed a standardised videofluoroscopic swallow study (VFSS) rated using the MBSImP, and the MDADI, at pre-treatment (baseline), 6weeks and 3months post-treatment as per a previous prospective RCT. Data on n = 67 participants were analysed as part of the secondary analysis. Association between MBSImP oral and pharyngeal composite scores versus MDADI Global and subscale scores was examined using ordinary least squares regression and mixed-effects general linear modelling (GLM). Univariable analyses demonstrated significant associations between MBSImP oral composite scores and each of the MDADI subscales, as well as the MBSImP pharyngeal composite scores and all MDADI subscales. GLM analysis revealed significant associations were maintained between MBSImP pharyngeal scores and the MDADI global and emotional subscale scores at the multivariable level, with the physical subscale trending towards significance. No significant association was observed between the MBSImP oral composite scores and any of the MDADI subscales at the multivariable level. This study found significant associations between objective measures of pharyngeal swallow physiology and patient-perceived swallowing-related quality of life. These findings suggest a higher degree of concordance between clinician-rated and patient-reported measures up to 3months post-(C)RT than previously reported.

Single Assessment Numeric Evaluation Correlates with American Shoulder and Elbow Surgeons Score for Common Elbow Pathology: A Retrospective Cohort Study

Background: There are currently a variety of patient-reported outcomes (PROs) for elbow pathology, without any established gold standard. The Single Assessment Numeric Evaluation (SANE) is a single question assessment of the patient’s perceived overall function compared with normal. The SANE score has been correlated with PROs from the shoulder and knee literature. Purpose: To correlate the SANE score for a variety of elbow pathologies with a traditionally reported elbow outcome measure, the American Shoulder and Elbow Surgeons–Elbow score (ASES-E). Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A retrospective review was performed of all patients identified at a single center between April 2016 and January 2019 who presented as a new patient with elbow pathology. All patients prospectively completed the ASES-E along with the SANE score for elbow (SANE-E) at the time of initial consultation. Spearman correlations (r) were performed to evaluate the correlation between the ASES-E and the SANE-E score for specific elbow pathology, along with descriptive data such as age, sex, and chronicity of the problem. Results: A total of 555 patients (166 women, 29.9%) with a mean ± SD age of 51.0 ± 11.7 years with the diagnoses of medial epicondylitis (n = 72; 13.0%), lateral epicondylitis (n = 224; 40.4%), biceps tendon rupture (n = 139; 25.0%), triceps tendon rupture (n = 21; 3.8%), and elbow arthritis (n = 99; 17.8%) were included in this analysis. There was moderate correlation between the SANE-E and the ASES-E (r = 0.623; P < .001), with strongest correlation with the visual analog scale (VAS) (r = −0.518; P < .001) compared with any individual question and moderate to strong correlations based on specific diagnoses. SANE-E and ASES-E scores for the entire cohort were 42.9 ± 26.7 and 56.9 ± 21.4, respectively (P < .001). Age (r = 0.027; P = .526), sex (r = 0.026; P = .555), VAS (r = −0.106; P = .013), and chronicity of the problem (r = −0.037; P = .384) were not found to be correlated with differences in ASES-E and SANE-E. Conclusion: The SANE-E score is a simple way to assess patient-perceived function relative to normal. The findings of this study demonstrated moderate to strong correlation between the ASES-E and the SANE-E score for a variety of commonly encountered elbow conditions.

Dysphagia, trismus and speech impairment following radiation-based treatment for advanced stage oropharyngeal carcinoma: a one-year prospective evaluation.

The objective was to assess swallowing, mouth opening and speech function during the first year after radiation-based treatment (RT(+)) after introduction of a dedicated preventive rehabilitation program for stage III-IV oropharyngeal carcinoma (OPC). Swallowing, mouth opening and speech function were collected before and at six- and twelve-month follow-up after RT(+) for OPC as part of ongoing prospective assessments by speech-language pathologists . Objective and patient-perceived function deteriorated until 6months and improved until 12months after treatment, but did not return to baseline levels with 25%, 20% and 58% of the patients with objective dysphagia, trismus and speech problems, respectively. Feeding tube dependency and pneumonia prevalence was low. Despite successful implementation, a substantial proportion of patients still experience functional limitations after RT(+) for OPC, suggesting room for improvement of the current rehabilitation program. Pretreatment sarcopenia seems associated with worse functional outcomes and might be a relevant new target for rehabilitation strategies.

Multidisciplinary programme for rehabilitation of chronic low back pain \u2013 factors predicting successful return to work

BackgroundThere are no clear indicators for predicting return to work for patients with chronic low back pain (LBP). We aim to report the outcomes of a 14-week multidisciplinary programme targeting patients with chronic LBP who failed conventional physiotherapy to provide functional rehabilitation. Also, this study will identify factors predicting successful return to work (RTW).MethodsA collected cohort of patients with chronic LBP was consecutively enrolled into the programme from 1996 to 2014. All recruited patients failed to RTW despite at least 3 months of conservative treatment. Patient underwent weekly multidisciplinary sessions with physiotherapists, occupational therapists and clinical psychologists. Patient perceived function was considered the primary outcome of the programme. Patients were assessed for their sitting, standing and walking tolerance. Oswestry Disability Index (ODI) and Spinal Function Sort Score (SFSS) were used to assess patient perceived disability.ResultsOne hundred and fifty-eight patients were recruited. After the programme, statistically significant improvement was found in ODI (47.5 to 45.0, p = 0.01) and SFSS (98.0 to 109.5, p < 0.001). There was statistically significant improvement (p < 0.01) in sitting, standing, walking tolerance and straight leg raise tests. 47.4% of the patients were able to meet their work demand. Multivariate logistic regression model (R2 = 59.5%, χ2 (9) = 85.640, p < 0.001) demonstrated that lower initial job demand level and higher patient-perceived back function correlated with greater likelihood of returning to work.ConclusionThe results of this study may support the use of this multidisciplinary programme to improve patient function and return to work.

Surgery and Conservative Management of Camptodactyly in Pediatric Patients: A Systematic Review.

Camptodactyly is a pediatric hand condition, the treatment of which remains controversial. The authors' aim was to improve patient care through clarifying the definition of camptodactyly and indications for surgical and/or conservative management, summarizing outcomes, and defining risks. A systematic review was conducted of articles in all languages on outcomes following surgical and/or conservative management of idiopathic camptodactyly in children using MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, EMBASE (Excerpta Medica database), AMED (Allied and Complementary Medicine), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) (until January 2017). The primary outcome was posttreatment flexion contracture, and the secondary outcomes were indications for surgery, complications, and patient satisfaction. Database searching generated 16 final articles, with 7 case series and 9 retrospective cohort studies. There was a lack of consistency on the definition of camptodactyly and in outcome reporting. All 16 studies received a "Weak" global rating and demonstrated low-quality evidence, suggesting that treatment of camptodactyly with operative or nonoperative measures reduces the degree of flexion contracture in most patients (from pretreatment averages of 20°-85° to posttreatment averages of 5°-37°). There was general agreement that surgery should be reserved for contracture >30° or failure to respond to conservative management. Surgery generally led to more complications compared with conservative management. Only one study reported on functional limitations, and another reported on patient-reported outcomes. Current evidence of the effectiveness of camptodactyly treatment in addressing both joint-specific deformity and patient-perceived function and appearance is insufficient to guide patient care. Future research may consider the development of decision aids to guide patients and families through selecting management strategies and to promote shared decision making.

Shoulder Complex Mechanics in Adolescent Idiopathic Scoliosis and Their Relation to Patient-perceived Function.

Proper contribution of the scapulothoracic joint is necessary for adequate shoulder complex function. Associations between trunk shape and abnormal scapular kinematics and subsequent shoulder dysfunction have been established; however, the extent of shoulder dysfunction in adolescent idiopathic scoliosis (AIS) is still poorly understood. The purpose of this study was to perform a comprehensive analysis of scapular kinematics during multiplanar arm motion in patients with AIS and compare kinematics and patient-reported function with that of a typically developing cohort. Typically developing adolescents (n=33) and patients with AIS (n=26) with no history of spine or shoulder surgery were recruited for this study. A 3-dimensional optoelectronic motion capture system was used to analyze scapular kinematics in 4 positions: rest, full abduction, forward reach, and hand to spine. Subjects in each group also completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a measure of patient-reported function. The convex shoulders of the patients with AIS exhibited deficits in scapular upward rotation and posterior tilt in all positions and reduced protraction range of motion during reaching. The AIS group also reported worse patient-perceived shoulder function than the typically developing group; however, this dysfunction was not related to specific scapular kinematic patterns. Patients with AIS show alterations in scapular kinematics that are associated with shoulder pathology. Despite displaying an unaffected ability to place the hand in space, the underlying joint mechanics place these adolescents at risk for future pathology. Accordingly, consideration of scapulothoracic and glenohumeral joint function is warranted in the treatment of AIS. Level III-cross-sectional comparison.

Patient-Reported and Objectively Measured Function Before and After Reverse Shoulder Arthroplasty.

Documenting functional outcomes after reverse shoulder arthroplasty (RSA) is critical to advancing patient care. The interplay been self-reported and objectively measured outcome measures has not been widely described. The utilization of wearable devices to document upper extremity limb activity is a new approach for objectively measuring outcomes. Therefore, the purpose of this study was to evaluate changes in pain, and self-reported function and objectively measured limb activity after RSA. We also assessed the influence of pain on self-reported function and objectively measured limb activity to determine the impact of pain on outcomes after RSA. This study implemented a prospective, repeated-measures design. Fourteen patients undergoing RSA underwent testing before surgery, and 2 and 12 months after surgery. Patient-reported instruments included pain, Disabilities of Arm, Shoulder and hands (DASH), and physical component summary (PCS) of the 36-Item Short Form Health Survey. Objective limb activity (mean activity value, m/s/min epoch; inactive time, %; low activity, %; and high activity, %) was captured with triaxial accelerometers worn on the upper and lower arm. A repeated-measures ANOVA tested for differences across time. The Spearman rank-order correlation was calculated to evaluate the influence of pain on DASH, PCS scores, and mean limb activity. Patient-reported measures improved after surgery (pain, P < .01; DASH, P < .01; PCS, P = .01). No change in limb activity was found at 1 year compared with preoperative values for mean (forearm, P = 1.00; arm, P = .36), inactivity (forearm, P = .33; arm, P = .22), low (forearm, P = .77; arm, P = .11) or high (forearm, P = 1.00; arm, P = .20) activity. There was a relationship between pain and DASH scores 1 year after surgery (P = .04) but not before surgery (P = .16), or 2 months after surgery (P = .30). There was no relationship between pain and PCS scores at any time point (preoperative, P = .97; 2 months, P = .21; 1 year, P = .08) nor pain and limb activity (forearm: preoperative, P = .36; 2 months, P = .67; 1 year, P = .16; arm: preoperative, P = .97; 2 months, P = .59; 1 year, P = .51). RSA reduced pain and enhanced patient-perceived function. Objectively measured upper extremity limb activity is not different 1 year after surgery compared with preoperative levels. III.

Range of Motion Changes in Female Elite Swimmers Throughout a Competitive Season

Upper extremity injuries are the most common injury in swimming athletes specifically in the collegiate setting. Females in particular, are more likely to suffer these injuries when comparing to male collegiate swimmers. “Swimmer Shoulder”, a generic term for overuse shoulder injuries in the swimming population occurs with high rate and intensity of training. Significant factors that have been found to contribute to this pathology are deficits in internal rotation, lack of stability, and increased demands on the shoulder. The aim for this clinical outcomes project was to evaluate changes in range of motion (ROM) total arc of the shoulder, and patient-perceived function in female elite swimmers throughout a competitive season. Shoulder total arc ROM was measured passively with the student-athlete supine. A digital inclinometer was used to make it simpler for the clinician to assess ROM on their own. The Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Score (KJOC) was used to measure self-perceived upper extremity function in sport. It consisted of a set of demographic and participation questions followed by 10 visual analogue scale questions about upper extremity function during sport. Upper extremity stability was also measured using the closed-kinetic chain upper extremity stability test (CKCUE). Results showed shoulder ROM (total arc) restrictions occurred during times of increased training intensity and volume. When patients had smaller total arc measurements, the student-athletes reported lower KJOC scores for sport related function. There was an increase in ROM at a time where intensity, and distance of training were decreased. Overall upper extremity stability gradually improved over the course of a competitive season.

Thresholds for the Oxford Hip Score after total hip replacement surgery: a novel approach to postoperative evaluation

BackgroundThis is a prospective cohort study to define the thresholds to distinguish patients with a satisfactory or unsatisfactory outcome after total hip replacement (THR) based on patient-reported outcome measures (PROMs) including the Oxford Hip Score (OHS), and using patient satisfaction and patient-perceived function as global transition items. The thresholds are intended to be used as a tool in the process of determining which patients are in need of postoperative outpatient evaluation.MethodsOne hundred and three THR patients who had completed a preoperative questionnaire containing the OHS questionnaire were invited to complete the same questionnaire and supplementary questions at a mean of 6 (4–9) months after surgery. Correlations between outcome measures and anchors were calculated using Pearson’s correlation coefficient. Thresholds were established by receiver operating characteristic (ROC) analysis, using multiple anchors.ResultsSignificant correlations were found between outcome measures and anchors. Thresholds were determined for outcome measures coupled with satisfaction, patient-perceived function and a combination thereof using a cut-off of 50 and 70.ConclusionsWe have established a set of thresholds for Oxford scores that may help determine which THR patients are in need of postoperative evaluation. These thresholds can be implemented in clinical practice.Level of evidenceLevel 3.

Thresholds for Oxford Knee Score after total knee replacement surgery: a novel approach to post-operative evaluation

BackgroundIn a prospective cohort study, we wanted to detect thresholds distinguishing between patients with a satisfactory and an unsatisfactory outcome after total knee replacement (TKR) based on Patient-Reported Outcome Measures (PROMs), namely the Oxford Knee Score (OKS), using patient satisfaction and patient-perceived function as global transition items.MethodsSeventy-three TKR patients completed the OKS questionnaire before surgery and were invited to complete the same questionnaire again 6 (4 to 9) months after surgery. Correlations between outcome measures and anchors were calculated using Pearson’s correlation coefficient. Thresholds were established by receiver operating characteristics (ROC) analysis, using multiple anchor-based approaches.ResultsPatients showed a mean increase of 16.5 (SD 9.5) in OKS following TKR. Significant positive correlations were found between outcome measures and anchors. Six different thresholds were determined for outcome measures coupled with satisfaction, patient-perceived function and a combination thereof using a cut-off of 50 and 70.ConclusionsThis study has established a set of clinically meaningful thresholds for Oxford Knee scores that may help to detect TKR patients who might be in need of post-operative evaluation.

Midterm Results of Semiconstrained Distal Radioulnar Joint Arthroplasty and Analysis of Complications.

Range of motion and stability are important outcome parameters to assess function of the distal radioulnar joint (DRUJ), in particular pronation, supination, and weight-lifting capacity. The DRUJ semiconstrained implant developed by Scheker et al is intended to reproduce all the functions of the triangular fibrocartilage complex and the DRUJ. The aim of the study was to investigate the subjective, clinical, and radiographic results in 10 patients after primary implantation of the semiconstrained DRUJ arthroplasty following DRUJ derangement and painful instability, with an average follow-up of 3 years with a special focus on the complications. Standardized preoperative and postoperative evaluation included assessment of pain by a visual analog scale, radiographic examination, range of motion measurements, lifting capacity, and grip strength. The patient-perceived function was investigated using clinical score charts. Compared with the preoperative status, range of motion showed little change, while grip strength, lifting capacity, pain score, and patient-perceived functions improved significantly. One patient developed an ulna stem loosening, while two patients had to be reoperated because of an irritation of the extensor tendons and the superficial radial nerve at the first dorsal compartment of the wrist. In this study, arthroplasty of the DRUJ using the semiconstrained DRUJ arthroplasty was found to result in satisfactory outcome. Level of evidence: Level IV.

Patient-perceived long-term communication and swallow function following cerebellopontine angle surgery

Evaluation of long-term patient-perceived functional outcomes and quality of life (QOL) related to communication and eating with an emphasis on voice, speech production, and swallowing after cerebello-pontine angle (CPA) surgery. Prospective cross-sectional study. The MD Anderson Dysphagia Inventory (MDADI), Voice Handicap Index (VHI), and Facial Clinimetric Evaluation (FaCE) surveys were distributed to patients who underwent CPA surgery between January 2008 and December 2010. Immediate postoperative cranial nerve function extracted from medical records was compared to long-term patient-perceived function and associated QOL. There was a 61% response rate with a mean postoperative period of 31.6 months (range 15-49). The presence of facial palsy in the postoperative period and the corresponding House-Brackmann (H-B) score were the strongest predictors of patient-perceived long-term function and QOL in all three domains (P < .005). Postoperative vagal palsy by comparison was not associated with long-term disturbance of voice or speech function. Postoperative dysphagia had a particularly large association with perceived long-term facial function and related QOL (P < .0005), with a smaller but significant impact on perceived swallow outcome (P < .05). After adjusting for other variables, the postoperative H-B score remained a significant predictor of perceived long-term facial and voice function and related QOL. Patients with severe facial dysfunction following surgery to the CPA are at increased risk for long-term self-reported difficulties with communication and eating, even with improvement of vagal function. Speech and swallow therapy should therefore be provided to these patients whether or not they also have pharyngeal dysphagia or voice disturbance. 2b.

Constrained Implant Arthroplasty as a Secondary Procedure at the Distal Radioulnar Joint: Early Outcomes

To evaluate the clinical and radiological outcomes for the Scheker total joint endoprosthesis when used for previously failed surgeries of the distal radioulnar joint (DRUJ). Eight patients with DRUJ derangement with painful instability and 1 patient with DRUJ synostosis received a Scheker DRUJ total joint endoprosthesis between 2006 and 2010. All patients had at least 1 procedure previously performed on the distal ulna (mean, 3.6 procedures). The follow-up time was on average 3.7 years (range, 2-5 y). Standardized preoperative and postoperative assessments included radiographic examination, evaluation of pain by a visual analog scale, and measurements of range of motion and grip strength. We evaluated patient-perceived function with the Disabilities of the Arm, Shoulder, and Hand questionnaire. There was significant improvement in pain and Disabilities of the Arm, Shoulder, and Hand scores. Grip strength was improved but not significantly. Range of motion was not impaired. We encountered no major complications. Radiographic evaluation showed bone resorption at the distal ulna for most patients and at the tip of a screw in 1 patient, but we found no evidence of implant loosening. Our short-term results in a limited patient series show that in selected cases, the Scheker total joint endoprosthesis is a safe and efficient treatment option for previously failed surgeries of the DRUJ. Therapeutic IV.

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition, and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1-T3 oropharyngeal squamous cell carcinoma (SCC) have not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition, and patient-perceived functional impact assessments were conducted pretreatment, at 4-6weeks post-treatment, and at 6months post-treatment. Deterioration from pretreatment to 4-6weeks post-treatment in swallowing, nutrition, and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing, and overall function, consistent with recovery from acute toxicity. However, weight and patient perception of physical function and side effects remained significantly worse than pretreatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6months revealed that this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB.

Predictors of functional ambulation and patient perception following total knee replacement and short-term rehabilitation

Purpose. To investigate whether measured and patient-perceived function 6 months after total knee replacement (TKR) can be predicted from factors measured during post-operative rehabilitation.Method. Retrospective analysis of data from a randomised clinical trial involving 100 patients after TKR. High- and low-performing subjects for pain, WOMAC score and 6-min walk test (6MWT) at 2, 8 and 26 weeks post-TKR were partitioned and analysed. Multiple stepwise regression analysis was applied to the contributing factors to determine associations with outcome.Results. Prediction of outcome was unconvincing based upon variables recorded at 2 weeks; however, status at 8 weeks was a better indicator of functional performance and perception at 26 weeks. 6MWT at 26 weeks could be predicted from VAS pain scores and 6MWT at 8 weeks (r = 0.789; p < 0.001). Prediction of pain and patient perceived function at 26 weeks was also dependent on performance in 6MWT at 8 weeks (r = 0.51; p < 0.05). Males and those with lower body mass index values demonstrated better functional outcomes.Conclusion. Functional status at 2 weeks post-surgery gives few indicators of ultimate status, possibly because of pain, joint swelling and other immediate post-operative factors. However, measurements taken at 8 weeks, following an outpatient-based exercise programme, provides a reasonable estimate of performance and response 26 weeks after surgery. Patient and clinician expectations for longer-term recovery could be informed by these findings.