Visual Satisfaction Research Articles

Uniportal thoracoscopic treatment in bronchiectasis patients: preliminary experience.

IntroductionBronchiectasis is defined as a permanent and abnormal dilation of the bronchi due to destruction of the bronchial wall. The thoracoscopic approach is represented in the literature by a few reports, and multiple port incisions are observed in these studies.AimTo investigate the effectiveness and outcomes of the single port video-assisted thoracoscopic surgery (VATS) method in the surgical treatment of bronchiectasis. To our knowledge, this is the first study reporting surgical treatment of bronchiectasis via the uniportal thoracoscopic approach.Material and methodsThe medical records of 15 patients undergoing surgery for bronchiectasis between 2013 and 2017 were reviewed. The patients were evaluated with regard to age, gender, duration of symptoms, localization, types and duration of the surgery, presence of pleural adhesion, intraoperative complications, amount of intraoperative bleeding, conversion to open surgery, postoperative drainage amount, chest tube removal time, length of hospital stay, mortality and morbidity, follow-up period, duration of narcotic analgesic usage, pain according to visual analog scale evaluation and satisfaction score.ResultsA total of 15 patients initially underwent single port thoracoscopic resection and 14 procedures were completed thoracoscopically. In terms of anatomic resections, 6 patients underwent left lower lobectomy, 4 right lower lobectomy, 1 right upper lobectomy, 1 left lower lobectomy + lingulectomy, 1 right basal segmentectomy and 1 patient underwent lingulectomy. The mean operative time was 137.1 ±24.5 min and the mean length of hospital stay was 4.78 ±1.52 days. The mean postoperative analgesic requirement was 2.85 ±0.66 days.ConclusionsWe believe that uniportal VATS is a safe, feasible, and effective technique for selected bronchiectasis patients.

Carefully performing the phakic intraocular lens implantation for moderate and low myopia

The refractive surgery is improved and updated with time. In recent years, the phakic intraocular lens has been continuously modified and innovated in materials and design. With advantages such as less high-order aberrations, reversible lens and good visual quality, it has led to a new trend of refractive surgery, which attract an increasing number of high myopic persons received phakic intraocular lens implantation instead of corneal refractive surgery, particularly to further expand the applying for moderate and low myopia. This article focuses on the rational selection of moderate and low myopia to receive laser correction vision or phakic lens, and elaborates the different characteristics with advantages and disadvantages of corneal refractive surgery and phakic intraocular lens implantation, which suggest to perform the phakic intraocular lens implantation for moderate and low myopia cautiously and standardize surgical indications strictly. It is necessary to continuously strengthen the standardization and safety of laser corneal refractive surgery and phakic intraocular lens implantation in order to improve the visual quality and satisfaction further for myopic patients in clinic. (Chin J Ophthalmol, 2018, 54: 726-728).

Visual outcomes, spectacle independence and satisfaction after diffractive trifocal intraocular lens implantation

Abstract Purpose To investigate visual outcomes, spectacle independence, and patient satisfaction after trifocal intraocular lens implantation. Methods A retrospective study conducted on 5186 patients who underwent phacoemulsification and were implanted with a diffractive trifocal intraocular lens (FineVision Micro F, PhysIOL SA, Liege, Belgium). Results The mean pre-operative keratometry was 43.61 ± 1.55 D, and mean keratometric cylinder was −0.86 ± 0.66 D. At 3 months post-operatively, values changed to 43.59 ± 1.56 and −0.71 ± 0.46 D, respectively. Mean sphere varied from 2.04 ± 2.60 to 0.14 ± 0.38 D, and mean spherical equivalent from 1.64 ± 2.61 to −0.05 ± 0.36 D. More than 60% of the patients achieved better corrected distance visual acuity. The majority had a final residual refractive error (predictability) lower than 1 D (99.1%), with 14.3% needing optical adjustment (bioptics). Posterior capsulotomy was performed in 2.2%, and the lens was replaced in 5 patients. A high percentage of patients were satisfied in terms of vision and spectacle independence at all distances. Although 2% referred to worsening of night vision quality, only 2% were not very satisfied and 20 patients were dissatisfied. The causes were: blurred vision (7 cases), spectacle dependence (10), dysphotopsia (7), and dry eye (4). Conclusions The implantation of this model provided good visual performance in all distances, as well as high levels of spectacle independence and satisfaction.

Visual Outcomes of Monovision Keratorefractive Surgery in Presbyopic Patients

Purpose : To assess the change of binocular visual function and visual acuity in monovision surgery patients. Methods : The subjects were 58(49.57 ± 3.27 years) monovision patients who wear glasses and contact lens before monovision surgery. 100% and 10% contrast visual acuity, near stereoacuity, distance and near convergence fused amplitude, amplitude of accommodation were measured and visual satisfaction in the real life after surgery was evaluated using a Questionnaire. All measurements were conducted before and after 1, 3 and 6 months of surgery. The pre-operative measurements were performed with glasses or contact lenses on, and post-operative measurements were conducted in the naked eye. All measurements among groups were statistically analyzed with the SPSS 21.0. Results : Among 58 subjects, 5 subjects (10 eyes) were hyperopia, 53 subjects (106 eyes) were myopia. Binocular distance and near contrast visual acuity was decreased after surgery, especially the 10 % contrast visual acuity under mesopic condition was decreased and there was no difference according to the postoperative period. In the questionnaire survey, satisfaction of distance and near vision after surgery was getting better, and night glare was worsen compare to pre-operation, however, general satisfaction was high after surgery. The near stereoacuity and distance convergence fused amplitude were decreased, and no changes in near sensory suppression and near convergence fused amplitude, and the amplitude of accommodation was increased in binocular and non-dominant eye after monovision surgery. Conclusion : The visual acuity, near stereoacuity and distance convergence fused amplitude were decreased after monovision surgery compared to progressive glasses multifocal contact lens wear, however, visual satisfaction in real life was improved.

Comparison of cemented and uncemented hemiarthroplasty results in the treatment of comminuted displaced proximal humeral fractures

Aim: In this study, we aimed to compare the results of cemented and uncemented hemiarthroplasty results in elderly patients for the treatment of comminuted proximal humerus fractures. Material and Method: Between 2008 and 2014, patients who underwent hemiarthroplasty due to comminuted proximal humerus fracture were retrospectively investigated using the data system of two university hospitals. Patients who were followed for at least 2 years were included. Demographic information of the patients, fracture type, functional results at final follow-up, visual analog scale score and satisfaction status, radiological results, mean follow-up time and complications were noted. Results: A total of 22 patients (12 males, 10 females) (mean age: 76.4 years, range: 67-88)(8 cemented hemiarthroplasty, 14 uncemented hemiarthroplasty) were included. The mean follow-up time was 38 months. Although the mean forward elevation, external rotation and internal rotation were better in patients who underwent uncemented hemiarthroplasty, no significant difference was found between the two groups. The mean visual analog scale score in uncemented hemiarthroplasty group was 0.87 ± 1.12, whereas the mean visual analog scale score in cemented group was 1.28 ± 0.91 and no significant difference was found (p = 0.33). At radiologic evaluation, no significant difference was found. Periprosthetic fracture was seen in 1 patient of both groups. We have seen 1 shoulder stiffness in uncemented group and 1 deep tissue infection in cemented hemiarthroplasty group. Conclusion: The functional and radiological results of our cemented and uncemented HA patients were similar for the treatment of comminuted proximal humerus fractures in at least 2 years follow-up.

국내포털 모바일 웹 접근성을 위한 저시력자 만족도 평가 및 분석에 관한 연구

정보 기술 분야의 발전으로 인하여 PC중심에서 다양한 화면비율과 크기를 지닌 스마트 디바이스로 이동하는 있는 오늘날 화면에 제공되는 많은 견지적인 콘텐츠들로 이루어져 있는 웹 사이트 접근에 저시력자들은 정보 이용에 어려움을 받는다. 저시력인 입장에서 모바일 웹 접근성에 대한 문제는 단순히 이 한 가지 문제에 머무르지 않고 이에 파생되는 사람간의 정보격차 그리고 사회적, 경제적 격차가 심화된다. 따라서 본 연구는 저시력자에 대한 문제인식을 바탕으로 국내 모바일 웹 포털 사이트의 접근성의 문제점과 현황 그리고 요인을 UI 디자인 사용자 관점을 중심으로 접근하여 평가 및 분석하여 HCI 관점에서 저시력자의 요구사항에 대한 대안을 제시하였다. 연구방법은 저시력자 1급 1호에서 3급 1호의 장애등급을 가지는 총 5명을 선정 하여 국내 포털 사이트를 평가대상으로 선택하고 일반적으로 대중이 빈번이 사용하는 콘텐츠 항목을 선정하여 접근성과 사용성에 대한 문제에 대한 인터뷰를 진행하였다. 이러한 평가와 분석 그리고 인터뷰를 통하여 모바일 웹 포털 사이트에 대한 문제와 원이에 대한 개선 방안에 대한 방향을 제시하였다. 국내 포털 모바일 웹 접근성의 근본적인 문 제는 저시력자에 대한 모바일 웹 사용성과 접근성에 대한 인식과 교육제고와 사용성의 부족이다. 웹의 궁극의 목적은 어느 누구라도 웹에 쉽게 접근하여 다양한 사회 구성원들 간의 격차를 해소하고 원활한 커뮤니케이션이 이루어져야한다. 이에 본 연구는 저시력자들이 모바일 웹 접근성의 상황에 대한 문제점을 파악하여 개선에 도움이 되기를 기대한다.

Effects of homogeneity management in elderly chronic pain nursing

Objective To explore the effects of homogeneity management in elderly chronic pain nursing. Methods In Mindong Hospital, Affiliated to Fujian Medical University, we selected 84 elderly patients with chronic pain by convenience sampling as observation group from June 2016 to May 2017 carrying out chronic pain nursing homogeneity management. And we selected 84 patients as control group from January 2015 to May 2016 implementing conventional nursing. The Visual Analogue Scale (VAS) , satisfaction questionnaire and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) were used to compare the pain, satisfaction with nursing and life quality of patients between two groups. Results The score of VAS of patients in observation group and control group was (2.09±0.55) and (3.47±0.53) respectively 30 days after intervention with a significant difference (t=16.559, P<0.01) . The satisfaction with nursing of observation group and control group was 92.86% and 67.86% respectively with a significant difference (χ2=16.630, P<0.01) . The dimensions scores of SF-36 of patients in observation group were significantly higher than those in control group three months after intervention (P<0.05) . Conclusions Application of homogeneity management has an ideal effect in elderly chronic pain nursing. It can effectively ease patients' pain and improve patients' satisfaction with nursing as well as life quality. Key words: Aged; Quality of life; Chronic pain; Homogeneity management

Managing Superficial Distal Medial Collateral Ligament Insufficiency in Primary Total Knee Arthroplasty Using Bone Staples.

Superficial medial collateral ligament (MCL) injury is an occasional intraoperative complication during total knee arthroplasty (TKA) that can lead to failure. Although previous studies have recommended complex repair or conversion to a constrained implant, the authors evaluated results of superficial distal MCL reapproximation using bone staples. Records of 31 patients who underwent staple reapproximation for superficial MCL avulsion from the tibial attachment during primary TKA from 2005 to 2015 were reviewed. They were compared with 685 patients who underwent uncomplicated TKA (primary control) and 18 who underwent revision TKA for instability (secondary control). Subjective knee instability was assessed with a patient questionnaire, and other end points included revision for instability or stiffness and manipulations under anesthesia. The authors prospectively collected Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analog scale satisfaction scores. The mean follow-up was 2.6 years. No patients treated with staple repair required revision for instability, whereas two patients were revised in the primary control. Subjective instability was reported in 19.2% of staple repair patients compared with 24.2 and 46.2% of patients in the primary and secondary controls. The mean KOOS for the staple group was 71.7 points, 77.3 for the primary control, and 49.3 for the secondary. KOOSs for the staple group were 5.6 points lower than the primary control, but 22.4 points higher than the secondary. Staple reapproximation is a simple and effective method for repairing the superficial distal MCL in primary TKA. The rate of instability and functional outcomes was comparable to uncomplicated primary TKA.

Analysis on the applicability of modified mono-vision for OPALs

We analyzed the effect of modified mono-vision prescription on the occupational progressive addition lenses (OPALs) in presbyopia for indoor use as a method to solve the inconvenience caused by the decrease in the intermediate and the near distances' vision when the PALs worn. To analyze the effect, 37 subjects (57.22 ± 5.18 years) were selected who were wearing PALs and had working hours over 6 h per day on average at intermediate and near distances. Entire tests were carried out with regard to three cases: subjects wearing PALs, occupational progressive addition lenses (OPALs), and prescription for modified mono-vision of OPALs. In order to compare visual performance of three cases, our study evaluated corrected visual acuity and subjective satisfaction at far, intermediate and near distances, stereo-acuity and phoria at far and near distances. The results showed that the prescription of modified mono-vision of OPALs could be useful when applied to the clinical practices for prescribing presbyopic correction.

The Clinical Outcomes and Their Associated Factors in Staged Bilateral Arthroscopic Rotator Cuff Repair

To compare perioperative characteristics and postoperative outcomes of both shoulders in patients who underwent arthroscopic bilateral rotator cuff repair sequentially and to assess the associated factors that would affect the anatomic healing in staged bilateral rotator cuff repair. The study enrolled 64 patients who underwent bilateral rotator cuff repair with follow-up imaging at least 12months postoperatively. We allocated the shoulders operated on first to the surgery I group and those operated on second to the surgery II group. Visual analog scale (VAS) pain and satisfaction scores, range of motion, the American Shoulder and Elbow Surgeons score, the Simple Shoulder Test score, and healing failure were evaluated. Range of motion improved with no significant between-group differences (all P > .05). In the surgery II group, VAS pain and VAS satisfaction scores were significantly worse at 6months postoperatively (P=.048 and P= .041, respectively) but were comparable at final follow-up (P= .598 and P= .065, respectively). American Shoulder and Elbow Surgeons and Simple Shoulder Test scores at 6months were worse in the surgery II group (P= .038 and P= .048, respectively) but similar at final follow-up (P= .786 and P= .087, respectively). Tear size was similar between the 2 surgical procedures (κ= 0.537, P < .001). Of the 11 patients with nonhealing in the surgery I group, 7 (63.6%) had subsequent failure in the other shoulder, and if one shoulder had healing failure, the other shoulder had ahigh possibility of healing failure as well (κ= 0.373, P= .004). Bilateral arthroscopic rotator cuff repair showed good outcomes at final follow-up on both sides. Tear size was closely related in both shoulders, and healingfailureafter the first rotator cuff repair was an associated factor with healing failure after the second operation. Level IV, case series.

Predicting Short-Term Subjective Vision Performance of Contact Lenses Used in Myopia Control.

To investigate whether initial assessment of contact lenses prescribed for myopia control (MC) predicts short-term visual performance. Retrospective analysis of 43 participants in a double-masked, randomized, cross-over trial wearing at least one lens: single-vision (SV) lens (1-DAY ACUVUE MOIST) or MC lenses (MiSight or Proclear Multifocal-Distance +2.00D). Participants completed questionnaires at the fitting visit, a take-home questionnaire (THQ) 3 days after fitting and finally at the assessment visit (≥5 days after fitting). Questions comprised vision clarity and lack of ghosting (distance, intermediate, near at day/night time); vision stability; driving vision; overall vision satisfaction and comfort (1-10 scale, 1-point steps); and willingness to purchase based on vision and MC benefit of lens (yes/no response). Visual acuity was measured at fitting and assessment visits. Vision clarity (intermediate and near) was significantly worse at assessment compared with fitting while wearing MC lenses (P<0.001), as was overall vision satisfaction (P<0.001), comfort (P<0.001), and vision stability (P=0.001) while wearing either SV or MC lenses. Participants willing to purchase at assessment visit was 84% with SV and 36% with MC lenses, increasing to 88% (SV, P=1.00) and 61% (MC, P<0.001) if the lenses slowed myopia progression. Visual acuity was no different with either MC or SV lenses at fitting or assessment (P≥0.251). Initial performance at fitting did not predict short-term performance for SV or MC lenses. A significant increase in willingness to purchase if lenses slowed myopia progression was observed while wearing MC lenses. Educating patients on the benefits might increase acceptability of MC lenses.

Clinical Trials: Meeting patient needs

Linked to their article on visual satisfaction, Philippe Jubin, John Buch and Derek Nankivil report on a clinical trial looking at this approach to investigating vision with the Acuvue Oasys lenses

Secondary school classrooms daylighting evaluation in Negeri Sembilan, Malaysia

Natural daylight is a renewable energy source that is important in photobiology study which looks into the effect of light to living organism. Students’ visual comfort satisfaction due to efficient daylight in a classroom are highlighted in the physical of the building and learning space such as windows and openings. One of the factor that influences the design of classrooms environmental condition. Environmental condition consideration includes the daylighting requirement for classrooms. Various standards and guidelines on daylighting consideration have been developed in Malaysia including the recommendation on Window-to-Floor Ratio (WFR) and illuminance level. However, the recommended WFR may not achieve the recommended illuminance level. This paper evaluates whether the recommended WFR design achieve the recommended acceptable illuminance level. Two classrooms in Kolej Permata Insan, Nilai, Negeri Sembilan with different orientation were selected for the study. Integrated Environmental Solution (IESVE) simulation software is used for daylight evaluation. The WFR of the two selected classrooms were set to the recommended 20%. Simulation results shows that the illuminance level for both classrooms are higher than recommended. The simulation also shows that the daylight distribution in the classrooms are not uniform, thus creating inefficient daylight condition. Therefore, the WFR recommends further studies with additional of daylighting design strategy considerations.

Quality of Vision of Presbyopic via Progressive Additional Lens (PALs)

The number of presbyopia with inadequate correction is increasing worldwide which surely decreased the visual satisfaction. A survey was conducted to study the level of vision satisfaction between the quality of vision and symptoms reported by progressive addition lens (PALs). Sixty questionnaires were mailed to the (PALs) wearers aged between 40 years and above from Universiti Teknologi Mara (UiTM) Vision Care. The strongest correlation was between the quality of vision at intermediate viewing with total satisfaction on seeing grocery shelves and computer screen p&lt;0.001. PALs wearers priority and needs should be considered in selecting the appropriate lens design for required tasks.

The effect of gender in hallux valgus surgery. A propensity score matched study

BackgroundMales and females who undergo hallux valgus (HV) surgery have different expectations. MethodsData from 439 patients, with 26 males, were prospectively collected between 2007–2015. Propensity score matching (PSM) of one male to two females was performed using logistic regression of six variables to minimize selection bias. Hallux visual analogue scale (VAS) scores, AOFAS scores, SF-36, satisfaction and expectation scores were analysed at two years. ResultsThere were no significant differences in patient demographics after PSM. At two years, males and females attained similar VAS and AOFAS scores but males had significantly lower SF-36 general health score (males 68.7, females 79.3). 26.9% of males and 21.2% of females were not satisfied after surgery. Higher proportion of males did not have their expectations fulfilled (males 19.2%, females 5.8%) although this was not statistically significant. ConclusionsBoth genders attain similar outcome at two years. There is a trend towards lower expectation fulfilment in males after surgery.

The Impact of Music Therapy in the Postoperative Setting on Overall Patient Satisfaction Using Validated Outcome Scores

Previous studies have examined music therapy (MT) as a potential modality to relieve negative postoperative symptoms such as pain. This randomized control trial examined the use of MT on patient satisfaction in the postanesthesia care unit. Fifty patients undergoing outpatient orthopaedic surgery were enrolled and randomized into two groups, those receiving MT postoperatively and a control group who did not. After hospital discharge, subjects were assessed with two validated outcome measurements for overall patient satisfaction, the visual analog satisfaction scale and the Patient Judgment of Hospital Quality survey. The results showed no statistically significant differences between the MT and control group on the Patient Judgment of Hospital Quality survey (MT=3.42, standard therapy = 3.41, P = .94) and the visual analog satisfaction scale (MT=91.20, standard therapy=91.65, P=.88). MT given in the postoperative setting has no impact on overall patient satisfaction.

Visual performance of myopia control soft contact lenses in non-presbyopic myopes.

PurposeTo compare the visual performance of soft contact lenses reported to reduce myopia progression.MethodsIn a double-blind, randomized, crossover trial, 30 non-presbyopic myopes wore MiSight™, center-distance Proclear® Multifocal (+2.00 D add), and two prototype lenses for 1 week each. High- and low-contrast visual acuities at 6 m, and 70 and 40 cm; stereopsis at 40 cm; accommodative facility at 33 cm; and horizontal phoria at 3 m and 33 cm were measured after 1 week. Subjective performance was assessed on a numeric rating scale for vision clarity, lack of ghosting, vision stability, haloes, overall vision satisfaction, and ocular comfort. Frequency of eye-strain symptoms and willingness to purchase lenses were also reported with categorical responses. Participants reported wearing times (total and visually acceptable). Linear mixed models and chi-square tests were employed in analysis with level of significance set at 5%. Theoretical optical performance of all lenses was assessed with schematic myopic model eyes (−1.00, −3.00, and −6.00 D) by comparing the slope of the edge spread function (ESF), an indicator for optical performance/resolution and the blur patch size of the line spread function, an indicator for contrast, between the lenses.ResultsProclear Multifocal and MiSight provided the best distance acuities. However, the prototype lenses were rated significantly higher for many subjective variables, and there were no subjective variables where commercial lenses were rated significantly higher than the prototypes. Theoretical optical performance showed steeper slopes of the ESF and greater blur patch sizes of the LSP with commercial lenses, supporting the clinical findings of better visual acuities but reduced subjective performance. Participants wore prototypes longer and reported their vision acceptable for longer each day compared to MiSight. Both prototypes had the highest willingness-to-purchase rate.ConclusionsThe prototypes were better tolerated by myopes compared to the commercial soft contact lenses currently used for slowing myopia progression.

Clinical outcomes following trifocal diffractive intraocular lens implantation for age-related cataract in China.

PurposeThe aim of this study was to evaluate visual, refractive and patient satisfaction outcomes following implantation of a trifocal diffractive intraocular lens (IOL).Patients and methodsThis prospective, consecutive study included patients undergoing lens phacoemulsification of cataract and implantation of a trifocal diffractive IOL (AT LISA tri 839MP). Visual outcomes, including near, intermediate and distance visual acuity (VA), refractive error, contrast sensitivity, defocus curve and patient satisfaction were assessed preoperatively and postoperatively.ResultsThirty IOLs were implanted in 26 patients. Distance VA improved significantly from 0.70±0.45 to 0.08±0.11 logMAR (p<0.0001) 1 week postoperatively, and to 0.07±0.13 logMAR (p<0.0001) at 1 month and 0.05±0.10 logMAR (p<0.0001) at 3 months. Uncorrected near and intermediate VA, as well as corrected near, intermediate and distance VA, were stable and maintained during the follow-up period. Preoperative anterior chamber depth demonstrated an association with effective adjustment of postoperative spherical equivalent using a regression formula (p=0.007). No significant differences were observed for VA at defocus curves of 0 to −3 D. Contrast sensitivity at each spatial frequency improved significantly at 1 week, 1 month and 3 months under photopic and photopic with glare conditions. Under mesopic and mesopic with glare conditions, significant differences were observed postoperatively at low and medium spatial frequencies. Patients reported a high level of satisfaction and an absence of glare or halo 3 months postoperatively.ConclusionIn this study, the trifocal diffractive IOL provided excellent visual performance at all distances and improved contrast sensitivity under different conditions, resulting in high levels of patient satisfaction and spectacle independence in Chinese patients.

Discharged but not dissatisfied: outcomes and satisfaction of patients discharged from the Edinburgh Trauma Triage Clinic.

The Edinburgh Trauma Triage Clinic (TTC) streamlines outpatient care through consultant-led 'virtual' triage of referrals and the direct discharge of minor fractures from the Emergency Department. We compared the patient outcomes for simple fractures of the radial head, little finger metacarpal, and fifth metatarsal before and after the implementation of the TTC. A total of 628 patients who had sustained these injuries over a one-year period were identified. There were 337 patients in the pre-TTC group and 289 in the post-TTC group. The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) or Foot and Ankle Disability Index (FADI), EuroQol-5D (EQ-5D), visual analogue scale (VAS) pain score, satisfaction rates, and return to work/sport were assessed six months post-injury. The development of late complications was excluded by an electronic record evaluation at three years post-injury. A cost analysis was performed. Outcomes were as good or better post-TTC, compared with pre-TTC scores. At three years, the pre-TTC group required a total of 496 fracture clinic appointments compared with 61 in the post-TTC group. Mean cost per patient was nearly fourfold less after the commencement of the TTC. Management of minor fractures through the Edinburgh TTC results in clinical outcomes that are comparable with the previous system of routine face-to-face consultation. Outpatient workload for these injures was reduced by 88%. Cite this article: Bone Joint J 2018;100-B:959-65.

Repeated botulinum toxin injections effects on children with cerebral palsy

The main aim of this study was to show the efficiency of botulinum toxin A (BT-A) injections not only on spasticity and functional capacities but also on the quality of life in children with cerebral palsy, and to describe their long-term evolutivity profile while précising our developing country particularities. Sixty children were included in this study aged from 2 to 18 years old; who received repeated injections of BT-A (Dysport®). An evaluation was done before and after these injections. It included an evaluation of the spasticity using the Modified Ashworth Scale (MAS), the functional evaluation using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS), an evaluation of satisfaction (Visual analogical Scale) and an evaluation of the quality of life using the Child Health Questionnaire Parent Form 50 (CHQ-PF50). The change from baseline of MAS ranged from 2.25 to 3 for the muscles of the lower limbs and ranged from 2 to 2.86 for the upper limb muscles. The average number of injection sessions was of 3.18 (1 to 6). The percentage of children improved (in GMFCS and MACS) and the average of the visual analogical satisfaction scale as well, increased from one injection to another reaching a constant level in the last two injections (P < 0.001). Our study proved the efficiency of repeated BT-A injections on the spasticity. It also revealed an improvement in both the gross function and the motor skills of children suffering from cerebral palsy. The quality of life of these children was significantly enhanced after injections.