Terms Of Patient-reported Outcome Measures Research Articles

PRP Injections for the Treatment of Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials.

ObjectiveTo evaluate effectiveness, in terms of patient-reported outcome measures, of platelet-rich plasma (PRP) injections for knee osteoarthritis compared to placebo and other intraarticular treatments.DesignPubMed, Cochrane Library, Scopus, Embase, Web of Science, as well as the gray literature were searched on January 17, 2020. Randomized controlled trials (RCTs) comparing PRP injections with placebo or other injectable treatments, in any language, on humans, were included. Risk of bias was assessed following the Cochrane guidelines; quality of evidence was graded using the GRADE guidelines.ResultsThirty-four RCTs, including 1403 knees in PRP groups and 1426 in control groups, were selected. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score favored PRP, with a statistically and clinically significant difference versus placebo at 12-month follow-up (P = 0.02) and versus HA (hyaluronic acid) at 6-month (P < 0.001) and 12-month (P < 0.001) follow-ups. A clinically significant difference favoring PRP versus steroids was documented for VAS (Visual Analogue Scale) pain (P < 0.001), KOOS (Knee Injury and Osteoarthritis Outcome Score) pain (P < 0.001), function in daily activities (P = 0.001), and quality of life (P < 0.001) at 6-month follow-up. However, superiority of PRP did not reach the minimal clinically important difference for all outcomes, and quality of evidence was low.ConclusionsThe effect of platelet concentrates goes beyond its mere placebo effect, and PRP injections provide better results than other injectable options. This benefit increases over time, being not significant at earlier follow-ups but becoming clinically significant after 6 to 12 months. However, although substantial, the improvement remains partial and supported by low level of evidence. This finding urges further research to confirm benefits and identify the best formulation and indications for PRP injections in knee OA.

Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials

Background: Injury-to-surgery time has been identified as a key point in anterior cruciate ligament (ACL) reconstruction, with early versus delayed treatment remaining a debated and controversial topic in the management of ACL tears. Purpose/Hypothesis: The aim was to quantitatively synthesize the best literature evidence by including only randomized controlled trials (RCTs) comparing early versus delayed ACL reconstruction, with a clear and univocal definition of cutoffs of early or delayed surgery. The hypothesis was that early treatment would lead to similar final clinical results compared with the delayed approach while providing a faster recovery without an increase in complications after ACL reconstruction. Study Design: Meta-analysis. Methods: A systematic literature search was performed on February 12, 2019, using PubMed, Web of Science, Cochrane Library, and gray literature databases. According to previous literature, 2 analyses with different cutoffs for injury-to-surgery time (3 weeks and 10 weeks) were performed to distinguish early and delayed reconstruction. The influence of timing was analyzed through meta-analyses in terms of patient-reported outcome measures (PROMs), risk of complications, range of motion (ROM) limitation, risk of retears, and residual laxity. Risk of bias and quality of evidence were assessed following the Cochrane guidelines. Results: Eight studies (5 in 3-week cutoff analysis and 3 in 10-week cutoff analysis) were included. No differences were found in terms of PROMs, risk of complications, ROM limitation, risk of retears, and residual laxity either in the 3-week cutoff analysis or in the 10-week cutoff analysis (P > .05). The level of evidence was moderate to low for the outcomes of the 3-week cutoff analysis and low to very low for the outcomes of the 10-week cutoff analysis. Conclusion: This meta-analysis did not confirm the previously advocated benefits of delaying ACL surgery to avoid the acute posttraumatic phase. In fact, RCTs demonstrated that timing of surgery after ACL tears has no influence on the final functional outcome, risk of retears, or residual instability. While no data were available about the recovery time, literature results showed that early ACL reconstruction could be performed without increasing the risk of complications. Study Registration: CRD42019119319 (PROSPERO).

Positive experience with treatment is associated with better surgical outcome in trapeziometacarpal osteoarthritis.

The aim of this study was to investigate the association between patients’ experiences with trapeziometacarpal arthroplasty and treatment outcomes in terms of patient-reported outcome measures, grip and pinch strength. We included 233 patients who received a Weilby procedure for trapeziometacarpal osteoarthritis. Before surgery and 12 months after surgery, patients completed the Michigan Hand Outcomes Questionnaire, and their pinch and grip strengths were measured. At 3 months after surgery, a patient-reported experience measure was completed. Using regression analysis, significantly positive associations were found between the Michigan Hand questionnaire and the patient-reported experience measure, with the strongest significant associations being for patients’ experiences with information provision. No significant associations were found between the patients’ experience and strength outcomes. The results highlight the potential importance of positive experience with the treatment process to improve treatment outcomes in patients undergoing surgery for trapeziometacarpal osteoarthritis.Level of evidence: IV

External Validity of the HOPE-Trial: Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians.

Background:Randomized controlled trials (RCTs) are the most reliable way of evaluating the effect of new treatments by comparing them with previously accepted treatment regimens. The results obtained from an RCT are extrapolated from the study environment to the general health care system. The ability to do so is called external validity. We sought to evaluate the external validity of an RCT comparing the results of total hip arthroplasty with those of hemiarthroplasty for the treatment of displaced femoral neck fractures in patients ≥80 years of age.Methods:This prospective, single-center cohort study included 183 patients ≥80 years of age who had a displaced femoral neck fracture. All patients were screened according to the inclusion and exclusion criteria for an RCT comparing total hip arthroplasty and hemiarthroplasty. The population for this study consisted of patients who gave their informed consent and were randomized into the RCT (consenting group, 120 patients) as well as those who declined to give their consent to participate (non-consenting group, 63 patients). The outcome measurements were mortality, complications, and patient-reported outcome measures. Follow-up was carried out postoperatively with use of a mailed survey that included patient-reported outcome questionnaires.Results:We found a statistically significant and clinically relevant difference between the groups, with the non-consenting group having a higher risk of death compared with the consenting group. (hazard ratio, 4.6; 95% confidence interval, 1.9 to 11.1). No differences were found between the groups in terms of patient-reported outcome measures or surgical complications.Conclusions:This cohort study indicates a higher mortality rate but comparable hip function and quality of life among eligible non-consenters as compared with eligible consenters when evaluating the external validity of an RCT in patients ≥80 years of age with femoral neck fracture.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Immediate loading vs. early/conventional loading of immediately placed implants in partially edentulous patients from the patients' perspective: A systematic review.

This systematic review aimed at answering the following PICO question: In patients receiving immediate (Type 1) implant placement, how does immediate compare to early or conventional loading in terms of Patient-Reported Outcome Measures (PROMs)? Following search strategy development, the OVID, PubMed, EMBASE, and Cochrane Database of Systematic Reviews databases were search for the relevant literature. All levels of evidence including randomized controlled trials, prospective and retrospective cohort studies, and case series of at least five patients were considered for possible inclusion. An additional manual search was performed by screening the reference lists of relevant studies and systematic reviews published up to May 2017. The intervention considered was the placement of immediate implant. Study selection and data extraction were performed independently by two reviewers. The search yielded a list of 1,102 references, of which nine were included in this systematic review. The limited number of studies included and the heterogeneity of the data identified prevented the performance of a meta-analysis. Three studies, one of which was a randomized controlled trial, allowed the extraction of comparative data specific to the aim of the present systematic review. The remaining studies allowed only data extraction for one single treatment modality and were viewed as single cohort studies. Overall, irrespective of the PROMs chosen, patients' satisfaction was overall high with little difference between the two loading protocols. Moreover, studies indicated a positive impact on oral health-related quality of life following immediate implant placement and loading. Within the limitations of the present systematic review, immediate implant placement and loading in single tooth edentulous space seems to be a well-accepted treatment modality from the patients' perspective and is worthy of consideration in clinical practice. However, the paucity of comparative data limits any definitive conclusions as to which loading protocol; immediate or early/conventional, should be given preference based on PROMs.

Patient‐based outcome measures of mandibular implant assisted removable partial dentures in Kennedy Class I patients‐ A systematic review and meta‐analysis

Background Distal-extension removable partial dentures (RPDs) were associated with several problems related to its limited stability, retention, and masticatory efficiency. The placement of a distal implant associated with a RPD has been reported to make this rehabilitation more stable. It has been suggested that it may overcome some of the common problems. However, no reports have proved the superiority of one treatment option over the other, especially in terms of patient-centric outcome measures. Aim/Hypothesis The purpose of this systematic review was to evaluate the evidence supporting the placement of a distal implant associated with a RPD to improve patient-based treatment outcome by meta-analysis. Material and Methods We used multiple comprehensive databases to find literature. This study is based on the Cochrane Review Methods. The focus question is “ Are implant assisted removable partial dentures (ISRPD) superior to conventional removable partial denture (CRPD) on mandibular Kennedy class I partial edentulous patients in terms of patient-reported outcome measures (patient quality of life and patient satisfaction) (PROMs)?” We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Scopus in May 2017. The inclusion of all studies was independently decided by two reviewers (J.P. and H.K.) based on the selection criteria. The following studies were included in our meta-analysis – (1) Clinical studies (before and after study) of ISRPD reporting a comparison of patient-reported outcome measures, (2) patient with mandibular Kennedy class I PRDPs, and (3) articles to allow mining of quantitative data. Results In total, 5603 non-duplicate articles were identified from database searches. Of which 29 were eligible for full-text searching. The 24 articles that did not meet the inclusion criteria were excluded. Therefore a total of five studies were used for meta-analysis, including 4 studies reporting VAS and 2 studies reporting OHIP. As a result, general patient satisfaction (VAS) and the total OHIP index showed better results in ISRPD compared to conventional RPD. As for the detailed items, there were no statistical differences for esthetics and cleaning, but patient satisfaction was improved in comfort, chewing, and speaking. There was also a significant statistical improvement in the quality of life in terms of physical pain and physical disability. Conclusions and Clinical Implications The implant assisted removable partial dentures group performed better in regards to patient satisfaction as measured using the VAS and OHIP questionnaire. Further studies are required to identify superiority between the two treatment options. Acknowledgement This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number – HI17C2218).

Current Role of Computer Navigation in Total Knee Arthroplasty

BackgroundComputer-assisted surgical (CAS) navigation has been developed with the aim of improving the accuracy and precision of total knee arthroplasty (TKA) component positioning and therefore overall limb alignment. The historical goal of knee arthroplasty has been to restore the mechanical alignment of the lower limb by aligning the femoral and tibial components perpendicular to the mechanical axis of the femur and tibia. Despite over 4 decades of TKA component development and nearly 2 decades of interest in CAS, the fundamental question remains; does the alignment goal and/or the method of achieving that goal affect the outcome of the TKA in terms of patient-reported outcome measures and/or overall survivorship? The quest for reliable and reproducible achievement of the intraoperative alignment goal has been the primary motivator for the introduction, development, and refinement of CAS navigation. Numerous proprietary systems now exist, and rapid technological advancements in computer processing power are stimulating further development of robotic surgical systems. Three categories of CAS can be defined: image-based large-console navigation; imageless large-console navigation, and more recently, accelerometer-based handheld navigation systems have been developed. ConclusionA review of the current literature demonstrates that there are enough well-designed studies to conclude that both large-console CAS and handheld navigation systems improve the accuracy and precision of component alignment in TKA. However, missing from the evidence base, other than the subgroup analysis provided by the Australian Orthopaedic Association National Joint Replacement Registry, are any conclusive demonstrations of a clinical superiority in terms of improved patient-reported outcome measures and/or decreased cumulative revision rates in the long term. Few authors would argue that accuracy of alignment is a goal to ignore; therefore, in the absence of clinical evidence, many of the arguments against the use of large-console CAS navigation center on the prohibitive cost of the systems. The utilization of low-cost, handheld CAS navigation systems may therefore bridge this important gap, and over time, further clinical evidence may emerge.

The management of prosthetic joint infection in the community: a guide for general practice.

More than 180 000 hip and knee joint replacements are performed annually in the UK,1 and this number will rise with an increasing ageing population. Hip and knee replacements are largely considered successful in terms of patient-reported outcome measures, survivorship, and low complication rates. However, even a 1% average infection rate after prosthetic replacement represents an increasing burden to the NHS.2 Infected prostheses can present early or late3 and the treatment for each differs. As a general rule the acute (early) infections are much more clinically apparent than the ‘never been right’ chronic infection. ### Early infections Defined as occurring less than 3 months post-surgery,3 these tend to present with cellulitis and symptoms of sepsis. The wound may have discharged since the time of surgery or after the wound had healed initially. A persistent serous, haemo-serous, or purulent discharge may indicate infection. The knee is tender and swollen, with evidence of inflammation. As swelling, tenderness, pain, and minor serous wound discharge can be normal early after knee replacement, this may pose a diagnostic challenge in differentiating normal from infected. ### Late infections Defined as occurring more than 3 months post-surgery,3 late infections present more insidiously (Figure 1). The patients often report the knee has ‘never been right’ or that their preoperative arthritic …

Factors That Impact Rehabilitation Strategies After Rotator Cuff Repair

Multiple factors influence rehabilitation strategies after rotator cuff repair. These variables may also impact the overall success of the surgical intervention. Physicians and rehabilitation specialists should be aware of prognostic indicators that can provide therapeutic guidance and offer insights into eventual clinical outcomes. The success of surgical and rehabilitative interventions is often evaluated in terms of patient-reported outcome measures, return to activity, and pain. Although these factors are somewhat interdependent, each of them independently influences the final result. This article presents a comprehensive overview of the recent literature in this area to provide insight as to the short- and long-term outcomes that patients should expect based on their unique presentations. This article examines both intrinsic and extrinsic patient factors to help therapists develop customized rehabilitation programs that optimize surgical outcomes.