The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study

IntroductionElectrical injuries exhibit significant acute and long-term sequelae. Amputation and neurological deficits are common in electrical injury survivors. There is a paucity of information on the long-term outcomes of this population. Therefore, this study examines the long-term outcomes of electrical injuries by comparing them to fire/flame injuries.MethodsData from the Burn Model System National Database collected between 1996 and 2015 was examined. Demographic and clinical characteristics for adult burn survivors with electrical and fire/flame injuries were compared. Satisfaction With Life Scale (SWLS), Short Form-12 Physical Composite Score (SF-12 PCS), Short Form-12 Mental Composite Score (SF-12 MCS), and employment status were examined at 24 months post-injury. Linear and logistic regression models were used to assess differences in outcome measures between groups, controlling for demographic and clinical variables.ResultsA total of 1147 adult burn survivors (111 with electrical injuries; 1036 with fire/flame injuries) were included in this study. Persons with electrical injuries were more likely to be male and injured at work (p < 0.001). SF-12 PCS scores were significantly worse for survivors with electrical injuries at 24 months post-injury than survivors with fire/flame injuries (p < 0.01). Those with electrical injuries were nearly half as likely to be employed at 24 months post-injury than those with fire/flame injuries (p = 0.002). There were no significant differences in SWLS and SF-12 MCS between groups.ConclusionsAdult survivors with electrical injuries reported worse physical health and were less likely to be employed at 24 months post-injury compared to survivors with fire/flame injuries. A more detailed understanding of return to work barriers and work accommodations is merited for the electrical injury population. Furthermore, the results of this study should inform future resource allocation for the physical health and employment needs of this population.     

The influence of fault on health in the immediate post-crash period following road traffic crashes

ObjectiveTo compare the early health status of people who sustained injuries during road traffic crashes (RTC) in which they were at fault (AF), with people who sustained injuries in RTC in which they were not at fault (NAF).DesignProspective cohort study.SubjectsPeople presenting to the emergency department with mild to moderate musculoskeletal injuries following RTC.Main outcome measuresPhysical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure; Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI) recorded immediately post-crash.Results193 people participated in the study and were enrolled a mean of 9.3 days following the crash. The mean age was 37 years and 60% were female. 71% were NAF. There was a significantly higher number of females in the NAF group (65% compared with 35% males; p < 0.001). Neck and back injuries were reported by 90.4% of the NAF group compared to 69.1% of the AF group (p < 0.001). There were no significant differences in PCS, FRI or pain intensity between the two groups at a mean of 9.3 days after the crash. The mean MCS for the NAF group was significantly worse than for the AF group (31.4 compared to 37.3; p = 0.005). The SF-36 domain revealed a significantly worse adjusted mean role emotional score for the NAF group (23.4 compared to 32.5, p = 0.002). Females had significantly worse MCS score than males (30.6 and 38.1 respectively; p < 0.001) and worse adjusted mean anxiety and depression scores (10 compared to 7.8; p = 0.002 and 7.6 compared to 5.5; p = 0.002 respectively).ConclusionsDespite there being no difference in physical health status, the NAF group demonstrated more emotional and mental disturbance than the AF group; and this was significantly worse for females. Treatment strategies should focus on addressing early pain and disability as well as providing appropriate psychological interventions, particularly for people not at fault following RTC.     

Cerebral state index versus Glasgow coma scale as a predictor for in-hospital mortality in brain-injured patients

Objective：To compare the value of Glasgow coma scale （GCS） and cerebral state index （CSI）on predicting hospital discharge status of acute braininjured patients.Methods：In 60 brain-injured patients who did not receive sedatives,GCS and CSI were measured daily during the first 10 days of hospitalization.The outcome of prognostic cut-off points was calculated by GCS and CSI using receiver operating characteristic （ROC） curve regarding the time of admission and third day of hospitalization.Sensitivity,specificity and other predictive values for both indices were calculated.Results：Of the 60 assessed patients,14 patients had mild,13 patients had moderate and 33 patients had severe injuries.During the course of the study,17 patients （28.3％） deteriorated in their situation and died.The mean GCS and CSI in patients who deceased during hospitalization was significantly lower than those who were discharged from the hospital.GCS＜4.5 and CSI＜64.5 at the time of admission was associated with higher mortality risk in traumatic brain injury patients and GCS was more sensitive than CSI to predict in-hospital death in these patients.For the first day of hospitalization,the area under ROC curve was 0.947 for GCS and 0.732 for CSI.Conclusion：GCS score at ICU admission is a good predictor of in-hospital mortality.GCS＜4.5 and CSI＜64.5 at the time of admission is associated with higher mortality risk in traumatic brain injury patients and GCS is more sensitive than CSI in predicting death in these patients.     

How are clinical outcomes related to the deviation severity of the tibiofemoral mechanical axis on coronal plane following knee arthroplasty?

ObjectiveTo analyze the effect of tibiofemoral mechanical axis (TFMA) deviation severity on clinical outcomes after total knee arthroplasty (TKA).MethodsWe retrospectively reviewed the patients who underwent primary TKA between January 2002 and December 2010. After applying inclusion/exclusion criteria, we evaluated 70 knees of 51 patients. The mean ± SD follow-up period was 7.08 ± 1.34 years. The knees were divided into 3 groups based on TFMAs. The first group, identified as “well aligned,” included the TFMAs that were neutral within 3° (0° ± 3°) of alignment. The second group, identified as “outliers 1,” included the slightly deviated TFMAs (−3° to −6° valgus and +3° to +6° varus). The third group, identified as “outliers 2,” included the severely deviated TFMAs of more than 6° from neutral alignment (<−6° valgus and > + 6° varus). The clinical outcomes of each group were compared by evaluating the Oxford Knee Score (OKS), visual analog scale (VAS), and Short Form-36 physical component summary (SF-36 PCS) and mental component summary (SF-36 MCS) scores.ResultsWe found that OKS, SF-36 PCS, and SF-36 MCS were nearly the same in the well-aligned and outliers 1 groups but worse in the outliers 2 group. VAS scores were nearly the same in all groups. (p > 0.05)ConclusionFunction scores were impaired when the TFMA deviated more than 6° from neutral. However, the differences in clinical outcomes between well-aligned knees and those of outliers were not found to be statistically significant in the medium term.     

Patient-reported outcome after hallux valgus surgery — a two year follow up

BackgroundPatients with hallux valgus deformity may require surgery but prospective patient-reported data is scarce.MethodsWe evaluated 53 patients with a mean age of 55.3 years (SD 14.1, 50 women), who underwent surgery due to hallux valgus. They completed the PROMs SEFAS, EQ-5D and SF-36 before and 6, 12 and 24 months after surgery.ResultsAll patient-reported outcomes improved at 6, 12 and 24 months compared with the preoperative status. The greatest improvement occurred at 6 months: SEFAS Δ 10.0 (95% confidence interval 7.8–12.2), EQ-5D Δ 0.22 (0.15–0.29), EQ-VAS Δ 8.4 (4.4–12.4), PF SF-36 Δ 22.0 (14.6–29.3) and BP SF-36 Δ 30.6 (23.1–38.1).ConclusionsHallux valgus surgery considerably reduced pain and improved function already within 6 months after surgery. The improvement between 6 and 24 months’ follow-up was minimal measured with PROMs.Level of clinical evidenceIII — prospective observational cohort study.     

Psychometric properties of the Dutch Short Musculoskeletal Function Assessment (SMFA) questionnaire in severely injured patients

In this cross-sectional study the psychometric properties are examined of the adapted Dutch translation of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in severely injured patients (ISS > 15).Patients and methodsPatients (N = 173) completed the SMFA, the World Health Organization Quality of Life assessment instrument-BREF (WHOQOL-BREF), the Dutch Impact of Event Scale (IES), the Hospital Anxiety and Depression Scale (HADS) and the Cognitive Failure Questionnaire (CFQ). The Abbreviated Injury Score and the Injury Severity Score were established to determine the injured body area and the severity of the injuries. Exploratory factor analysis (method: PAF) was performed. Correlations were calculated between our SMFA factors and scores on the WHOQOL-BREF, IES, HADS and CFQ. The SMFA scores of the factors Upper extremity dysfunction and Lower extremity dysfunction were compared between subgroups of patients with and without injuries in respectively the upper extremities and the lower extremities. For responsiveness analysis, data were compared with the baseline SMFA measurement of a reference group.ResultsA three-factor structure was found: Lower extremity dysfunction, Upper extremity dysfunction, and Emotion. Strong correlations between the SMFA and the other questionnaires were found. Patients with injury of the lower extremities had significantly higher scores on the factor Lower extremity dysfunction than patients without injury of the lower extremities (p = 0.017). In none of the factors, a significant difference in mean scores was found between patients with and without injury of the upper extremities. Severely injured patients had significantly higher SMFA scores than the reference group (p < 0.001).ConclusionThe adapted Dutch translation of the SMFA showed good psychometric properties in severely injured patients. It appeared to be useful to get a general overview of patients’ Health Status as well as patients’ Health Related Quality Of Life.     

Health-Related Quality of Life in a National Cohort of Patients With Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension

BackgroundPatients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) experience impaired health-related quality of life (HRQL). The objective of this study was to evaluate HRQL in a nation-wide sample.MethodsThis is a prospective, multicenter, non-interventional study of HRQL including 139 (89%) PAH and 17 (11%) CTEPH patients (women 70.5%; mean age, 52.2) recruited from 21 Spanish hospitals. 55% had idiopathic PAH, 34% other PAH and 11% CTEPH. HRQL was measured using the Short Form 36 Health Survey (SF-36) and EuroQoL-5D (baseline and after 6 months).ResultsHRQL in the patients with PAH or CTEPH was impaired. The physical component of SF-36 and the EuroQol-5D correlated with the functional class (FC). Mean EuroQol-5D visual analogical scale (EQ-5D VAS) scores were 73.5 ± 18.4, 62.9 ± 20.7 and 51.3 ± 16.0 (P<.0001) in patients with FC I, II and III, respectively. Every increase of one FC represented a loss of 4.0 on the PCS SF-36 and a loss of 9.5 on the EQ-5D VAS. Eight patients who died or received a transplant during the study period presented poorer initial HRQL compared with the rest of the population. No significant changes in HRQL were observed in survivors after 6 months of follow-up.ConclusionsHRQL is impaired in this population, especially in PAH/CTEPH patients near death. HRQL measurements could help predict the prognosis in PAH and CTPH and provide additional information in these patients.     

Health-related quality of life improvement following surgical treatment of primary hyperparathyroidism in a United Kingdom population

ObjectiveThe aim of this study was to determine if parathyroidectomy for primary hyperparathyroidism produces improvement in health-related quality of life in a United Kingdom population.MethodsSince October 2002, patients undergoing parathyroidectomy for primary hyperparathyroidism were asked to complete the SF-36 questionnaire, a validated self assessment tool prior to surgery and at six months post surgery. The questionnaires were either mailed to the patients or given at the time of outpatient follow up.Results24 out of 29 patients completed the questionnaire pre- and postoperatively. Compared to the national average, the median pre-operative scores were worse in all 8 domains. At 6 months post surgery, there were significant improvements in six out of eight domains (p < 0.05); physical and social functioning, physical and emotional role limitations, energy and mental health. The median physical component summary score (PCS) and the mental component summary score (MCS) were also significantly improved postoperatively [Preop vs. Postop (PCS) = 28.16 vs. 35.40 (P = 0.03)] and Preop vs. Postop (MCS) = 41.50 vs. 56.23 (P = 0.005)]. The post-operative MCS was comparable with the national average.ConclusionThis study shows that parathyroidectomy for primary hyperparathyroidism improves health-related quality of life in a United Kingdom population.     

Femoral neck shortening in adult patients under the age of 55 years is associated with worse functional outcomes: Analysis of the prospective multi-center study of hip fracture outcomes in China (SHOC)

IntroductionYoung femoral neck fracture patients require surgical fixation to preserve the native hip joint and accommodate increased functional demands. Recent reports have identified a high incidence of fracture shortening and this may have negative functional consequences. We sought to determine if fracture shortening is associated with poor functional outcome in young femoral neck fracture patients.Patients and methodsOne hundred and forty-two patients with femoral neck fractures age 18–55 were recruited in this prospective cohort study across three Level 1 trauma hospitals in Mainland China. Patient-reported and objective functional outcomes were measured with the Harris Hip Score (HHS), Timed Up and Go (TUG), and SF-36 Physical Component Summary (SF-36 PCS) at 12 months. Radiographic fracture shortening was measured along the long axis of the femoral neck and corrected for magnification. Severe shortening was defined as ≥10 mm. The primary analysis measured associations between severe radiographic shortening and HHS at one-year post-fixation.ResultsOne hundred and two patients had complete radiographic and functional outcomes available for analysis at one year. The mean age of participants was 43.7 ± 10.8 years and 53% were male. Fifty-five percent of fractures were displaced and 37% were vertically orientated (Pauwels Type 3). The mean functional outcome scores were: HHS 90.0 ± 10.8, TUG 12.0 ± 5.1 s, and PCS 48.5 ± 8.6. Severe shortening occurred in 13% of patients and was associated with worse functional outcome scores: HHS mean difference 9.9 (p = 0.025), TUG mean difference 3.2 s (p = 0.082), and PCS mean difference 5.4 (p = 0.055).ConclusionsSevere shortening is associated with clinically important decreases in functional outcome as measured by HHS following fixation of young femoral neck fractures, occurring in 13% of patients in this population. The principle of fracture site compression utilized by modern constructs may promote healing; however, excessive shortening is associated with worse patient-reported outcomes and objective functional measures.     

Missed injuries during the initial assessment in a cohort of 1124 level-1 trauma patients

IntroductionDespite the presence of diagnostic guidelines for the initial evaluation in trauma, the reported incidence of missed injuries is considerable. The aim of this study was to assess the missed injuries in a large cohort of trauma patients originating from two European Level-1 trauma centres.MethodsWe analysed the 1124 patients included in the randomised REACT trial. Missed injuries were defined as injuries not diagnosed or suspected during initial clinical and radiological evaluation in the trauma room. We assessed the frequency, type, consequences and the phase in which the missed injuries were diagnosed and used univariate analysis to identify potential contributing factors.ResultsEight hundred and three patients were male, median age was 38 years and 1079 patients sustained blunt trauma. Overall, 122 injuries were missed in 92 patients (8.2%). Most injuries concerned the extremities. Sixteen injuries had an AIS grade of ≥3. Patients with missed injuries had significantly higher injury severity scores (ISSs) (median of 15 versus 5, p < 0.001). Factors associated with missed injuries were severe traumatic brain injury (GCS ≤ 8) and multitrauma (ISS ≥ 16). Seventy-two missed injuries remained undetected during tertiary survey (59%). In total, 31 operations were required for 26 initially missed injuries.ConclusionDespite guidelines to avoid missed injuries, this problem is hard to prevent, especially in the severely injured. The present study showed that the rate of missed injuries was comparable with the literature and their consequences not severe. A high index of suspicion remains warranted, especially in multitrauma patients.     

A new foot and ankle outcome score: Questionnaire based,subjective, Visual-Analogue-Scale,validated and computerized

Our purpose was to construct and validate a new score taking into consideration the flaws of existing scores.MethodsA new score named Visual-Analogue-Scale Foot and Ankle (VAS FA) with the following features was constructed: questionnaire based on 20 subjective questions, Visual-Analogue-Scale (VAS) based rating, computerized evaluation. The score was validated in 121 subjects. For validation, SF-36^® and Hannover Questionnaire (Q) were obtained and correlated with VAS FA.ResultsThe correlation VAS FA versus SF-36^® and Q (Pearson, all p-values <0.001, r ≥ 0.5) was sufficient for the total score and all score categories (pain, function, other complaints).The time needed for evaluating the scores was significantly lower for VAS FA than for SF-36^® and Q (Oneway-ANOVA, p < 0.001).ConclusionsThe introduced score is the first validated (on SF-36^®), subjective, VAS based outcome score for foot and ankle. The VAS FA is computerized which enables faster evaluation than SF-36^® or Q.     

Staged abdominal repairs reduce long-term quality of life

IntroductionDamage control surgery increasingly requires serial operations and a staged abdominal repair (STAR) for ultimate abdominal closure. The effects of multiple operations on quality of life are unknown. We hypothesized that this population of patients had a lower quality of life than the general U.S. population.MethodsPatients requiring STAR for general surgical and trauma diagnoses during a 5-year period from January 2002 to December 2006 were identified from the operative database of a single institution. Demographic, illness, and injury information were obtained from record review. Survivors were 3–7 years from their hospitalization for STAR when they were contacted and the SF-12v2 was administered by phone. The physical (PCS) and mental component (MCS) scores were calculated and compared to US population norms and a population of trauma patients. The non-STAR trauma population completed the SF-12v2 six months after injury.ResultsA total of 27 patients with a mean age of 46.5 years (SD = 15.9) participated in the survey. The participants were interviewed a median of 4.7 years after injury. The mechanism of injury included 8 (29.6%) general surgical causes including 4 perforated viscus, 3 intra-abdominal infections, and 1 wound dehiscence from a urological procedure. The remaining 19 (70.4%) were trauma-related, including 13 blunt and 6 penetrating injuries. Patients who had undergone a STAR procedure reported lower levels of physical quality of life [z = ?15.42, p < 0.001] and mental quality of life [z = ?6.79, p < 0.001] compared to population norms for healthy adults. Also, STAR patients reported lower physical [z = ?2.22, p < 0.05] and mental [z = ?2.59, p < 0.05] quality of life as the non-STAR trauma group.DiscussionThe number of patients undergoing STAR for a variety of reasons is increasing. Measurements of quality of life of STAR patients show that quality of life is reduced compared to a healthy U.S. adult population and to non-STAR trauma patients.ConclusionsThe significant impact of severe abdominal injuries continues to affect the physical and mental health of patients years later. Injuries of this type are associated with lower quality of life than those observed in patients experiencing non-STAR trauma.     

Neck Disability Index,short form-36 physical component summary,and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion

Background ContextThe Neck Disability Index (NDI), the short form-36 (SF-36) physical component summary (PCS), and pain scales for arm and neck pain are increasingly used to evaluate treatment effectiveness after cervical spine surgery. The minimum clinically important difference (MCID) is a threshold of improvement that is clinically relevant to the patient. However, the true goal is to provide the patient with a substantial clinical benefit (SCB).PurposeThis study determines the MCID and SCB using common anchor-based methods for NDI, PCS, and pain scales for arm and neck pain in patients undergoing cervical spine fusion for degenerative disorders.Study Design/SettingThe study setting is a longitudinal cohort in a multisurgeon spine specialty clinic.Patient sampleThe sample comprises 505 patients who underwent a cervical fusion for degenerative spine conditions and who have prospectively collected outcome scores with a minimum 1-year follow-up.Outcome MeasuresThe outcome measures of the study were NDI, SF-36, and numeric rating scales for arm and neck pain.MethodsThe MCID and SCB values for NDI, PCS, and pain scales for arm and neck pain were determined using receiver operating characteristic (ROC) curve analysis with the Health Transition Item of the SF-36 as an anchor. The Health Transition Item asks a patient “Compared to one year ago, how would you rate your health in general now?” with answers ranging from “Much Better,” “Somewhat Better,” “About the Same,” “Somewhat Worse,” to “Much Worse.” An ROC curve was constructed for each measure. The ROC curve–derived MCID was the change score with equal sensitivity and specificity to distinguish the “Somewhat Better” from the “About the Same” patients. The ROC curve–derived SCB was the change score with equal sensitivity and specificity to distinguish the “Much Better” from the “Somewhat Better” patients. Distribution-based methods including the standard error of the mean and the minimum detectable change were also used to calculate MCID.ResultsThe calculated MCID is 7.5 for the NDI, 4.1 for SF-36 PCS, and 2.5 for arm and neck pain. The calculated SCB is 9.5 for the NDI, 6.5 for SF-36 PCS, and 3.5 for arm and neck pain.ConclusionsPatients with an eight-point decrease in NDI, a 4.1-point increase in PCS, and a three-point decrease in arm or neck pain can detect a minimally clinically important change. Patients with a 10-point decrease in NDI, a 6.5-point increase in PCS, and a four-point decrease in arm or neck pain can detect an SCB after cervical spine fusion.     

Measurement of Health-related Quality of Life with the Dutch Translated Aberdeen Varicose Vein Questionnaire before and after Treatment

ObjectiveThis clinical trial evaluated the use of the Dutch translated Aberdeen Varicose Vein Questionnaire (AVVQ) and SF-36 before and after treatment in patients with clinical-severity classes 1–6 venous disease of the lower limb.MethodsA total of 145 patients with symptomatic venous disease of the leg were included. Numbers of patients were evenly distributed among the six clinical-severity classes 1–6 (clinical, aetiology, anatomy and pathophysiology; CEAP). Patients completed two preoperative AVVQ questionnaires and one short-form health survey with 36 items (SF-36) questionnaire to evaluate test–re-test reliability of the AVVQ. Patients completed one postoperative AVVQ and SF-36 to evaluate the effect of treatment.ResultsThe test (99%) and re-test responses (97%) of the AVVQ were sufficient. Internal consistency of the Dutch translated AVVQ showed a Cronbach's α of 0.76. Correlation of test and re-test of the AVVQ was high (ρ = 0.86, P < 0.001). A significant negative association, by Spearman's correlation coefficient, was found between the preoperative baseline Dutch translated AVVQ score and all eight domains of the preoperative SF-36 (P < 0.001). These significant associations were also found in the postoperative scores.The mean preoperative AVVQ score of 19.5 (SD 11.8) and mean postoperative AVVQ score of 16.1 (SD 12.0) differed significantly (P < 0.01). Analysis of three subgroups of clinical-severity classes (C1–2, C3–4 and C5–6) showed significant score changes before and after surgery (P < 0.01). Preoperative and postoperative SF-36 scores were not significantly different.ConclusionsThis study established the use of the Dutch translated AVVQ as a valid, health-related quality of life (QOL) questionnaire for measuring QOL before and after treatment in patients with clinical-severity classes 1–6 venous disease of the leg.     

The impact of residual angulation on patient reported functional outcome scores after non-operative treatment for humeral shaft fractures

PurposeTo determine if residual angular deformity following non-operative treatment of humeral diaphyseal fractures correlates with patient reported outcomes.MethodsSkeletally mature patients treated by one of three orthopaedic trauma surgeons at a level 1 trauma centre with humeral shaft fractures treated without surgery were retrospectively identified over a 7 year period. After inclusion and exclusion criteria, 42 patients were eligible for the study. Disabilities of the Arm, Shoulder, and Hand (DASH); Simple Shoulder Test (SST); General health questionnaire SF-12 physical component summary (SF-12 PCS) and mental component summary (SF-12 MCS) were obtained from study participants. Healed angular deformity was obtained from patient charts.ResultsThirty two subjects were successfully recruited (32/42 or 76%). Average age was 45 ± 22 with average study follow up being 47 ± 29 months. Average outcome scores were DASH 12 ± 16, SST 10 ± 2.7, SF-12 PCS 50 ± 7.9, and SF-12 MCS 54 ± 8.8. Healed sagittal plane deformity averaged 8 ± 5.7° [range 0−18], and 15 ± 7.9° [range 2−27] in the coronal plane. There was no correlation between residual sagittal or coronal plane deformity and outcome scores (DASH and SST for both p > 0.05). Patients with at least 20° (n = 7; 22%) of healed coronal deformity had similar outcomes to those with <20° ([DASH (13.2 ± 18.7 vs 11.7 ± 16.1; p = 0.83]; [SST (10.3 ± 2 vs 10.0 ± 2.9; p = 0.81]). Higher SF-12 PCS and MCS scores correlated with better DASH and SST scores (p < 0.05 for all).ConclusionResidual angular deformity ranging from 0 to 18° in the sagittal plane and from 2 to 27° in the coronal plane after non-operative treatment for humeral shaft fractures had no correlation with patient reported DASH scores, SST scores, or patient satisfaction. Instead, overall physical and mental health status as measured by the SF-12 significantly correlated with patient reported outcomes.     

Construct validity and responsiveness of commonly used patient reported outcome instruments in decompression for lumbar spinal stenosis

BackgroundValidity and responsiveness of Oswestry disability index (ODI), Roland Morris disability questionnaires (RMDQ), Short Form-12 Physical Component Score (SF-12 PCS) and Short Form-12 Mental Component Score (SF-12 MCS) in patients undergoing open decompression for lumbar canal stenosis has not been previously reported.MethodsOutcome assessment was prospectively evaluated using the ODI, RMDQ, SF-12 PCS and SF-12 MCS pre-intervention and at average follow-up of three months post-intervention. Pearson correlation coefficient was used to evaluate the association between change in values of ODI, RMDQ, SF-12 PCS and SF-12 MCS. Distribution based methods (Effect size [ES], standardised response mean [SRM]) and anchor based method (Area under the curve [AUC] of receiver operating curve [ROC]) were used to determine responsiveness. AUC value ≥ 0.70 is considered as adequate level of responsiveness and the outcome instrument with the largest AUC is considered to be the most responsive outcome instrument.ResultsThis study included 77 participants. Responsiveness was assessed at a mean follow-up of 12 weeks postoperatively. There was significant strong correlation between ODI and RMDQ (r = 0.65, p < 0.0001). The ES of ODI, RMDQ, SF-12 PCS and SF-12 MCS were 1.54, 1.48, 1.85 and 0.51 respectively. The SRM of RMDQ, ODI, SF-12 PCS and SF-12 MCS were 1.22, 1.17, 1.0 and 0.47 respectively. AUC of ODI, RMDQ, SF-12 PCS and SF-12 MCS were 0.83–0.88, 0.82 to 0.86, 0.78 to 0.81 and 0.69 to 0.70 respectively.ConclusionIt is recommended to use either ODI or RMDQ as region specific patient reported outcome instrument and SF-12 PCS as a health related quality of life outcome instrument to evaluate outcome after decompressive laminectomy for lumbar canal stenosis.     

Systemic anticoagulation in the setting of vascular extremity trauma

IntroductionThere is conflicting data regarding if patients with vascular extremity trauma who undergo surgical treatment need to be systematically anticoagulated. We hypothesized that intraoperative systemic anticoagulation (ISA) decreased the risk of repair thrombosis or limb amputation after traumatic vascular injury of the extremities.MethodsWe analyzed a composite risk of repair thrombosis and/or limb amputation (RTLA) between patients who did and did not undergo ISA during arterial injury repair. Patient data was collected in the American Association for the Surgery of Trauma PROspective Vascular Injury Treatment (PROOVIT) registry. This registry contains demographic, diagnostic, treatment, and outcome data.ResultsBetween February 2013 and August 2015, 193 patients with upper or lower extremity arterial injuries who underwent open operative repair were entered into the PROOVIT registry. The majority were male (87%) with a mean age of 32.6 years (range 4–91) and 74% injured by penetrating mechanism. 63% of the injuries were described as arterial transection and 37% had concomitant venous injury. 62% of patients underwent ISA. RTLA occurred in 22 patients (11%) overall, with no significant difference in these outcomes between patients who received ISA and those that did not (10% vs. 14%, p = 0.6). There was, however, significantly higher total blood product use noted among patients treated with ISA versus those that did not receive ISA (median 3 units vs. 1 unit, p = 0.002). Patients treated with ISA also stayed longer in the ICU (median 3 days vs. 1 day, p = 0.001) and hospital (median 9.5 days vs. 6 days, p = 0.01).DiscussionIn this multicenter prospective cohort, intraoperative systemic anticoagulation was not associated with a difference in rate of repair thrombosis or limb loss; but was associated with an increase in blood product requirements and prolonged hospital stay. Our data suggest there is no significant difference in outcome to support use of ISA for repair of traumatic arterial injuries.     

Reliability, validity, and responsiveness of the Japanese version of the patient-rated elbow evaluation

BackgroundThe patient-rated elbow evaluation (PREE) is a joint-specific, self-administered questionnaire consisting of a pain scale (PREE-P) and a functional scale (PREE-F), the latter consisting of specific function (PREE-SF) and usual function (PREE-UF). The purpose of this study was to cross-culturally adapt the PREE into Japanese (PREE-J) and to test its reliability, validity, and responsiveness.MethodsA consecutive series of 74 patients with elbow disorder completed the PREE-J, the Japanese version of the disabilities of the arm, shoulder, and hand (DASH–JSSH) questionnaire, and the official Japanese version of the 36-Item Short-Form Health Survey (SF-36). Of the 74 patients, 53 were reassessed for test–retest reliability 1 or 2 weeks later. Reliability was investigated in terms of reproducibility and internal consistency. The validity of the PREE-J was examined by factor analysis, and correlation coefficients were obtained using the PREE-J, DASH-JSSH, and SF-36. Responsiveness was examined by calculating the standardized response mean (SRM) and effect size after elbow surgery in 53 patients.ResultsCronbach’s α coefficients for PREE-P, PREE-F, and PREE were 0.92, 0.97, and 0.97, respectively, and the corresponding intraclass correlation coefficients were 0.92, 0.93, and 0.94, respectively. Unidimensionality of PREE-P and PREE-F was confirmed by factor analysis. The coefficients of correlation between PREE-P and PREE-F or DASH–JSSH were 0.81 and 0.74, respectively; that between PREE-F and DASH–JSSH was 0.86, and those between DASH–JSSH and PREE-SF or PREE-UF were 0.85 and 0.82, respectively. Moderate correlation was observed in “physical functioning” for SF-36 and PREE-F (r = ?0.69) or PREE (r = ?0.68). The SRMs/effect sizes of PREE-P (1.31/1.32) or PREE (1.28/1.12) were more responsive than the DASH–JSSH (0.99/0.85), “bodily pain” (?1.15/?1.43), and “physical functioning” (?0.70/?0.44) in SF-36.ConclusionThe PREE-J represents a reliable, valid, and responsive instrument and has evaluation capacities equivalent to those of the original PREE.     

Potential efficacy of sensorimotor exercise program on pain,proprioception, mobility,and quality of life in diabetic patients with foot burns: A 12-week randomized control study

BackgroundBoth diabetes mellitus (DM) and burn injuries lead to physical and psychological impairments. Foot burns are still a challenging health condition because of its important sensory role. No previous studies have assessed the physical therapy intervention on diabetic patients with foot burns. Therefore, this study aimed to assess the potential efficacy of sensorimotor exercise on pain, proprioception, mobility, balance, and quality of life in diabetic patients with foot burns.MethodsBetween July 2019 and February 2020, thirty-three diabetic patients with foot burns, aged 32 to 46 yrs, were enrolled in this randomized control study, and randomized consecutively into two groups, study group (n = 16) and control group (n = 17). The study group underwent a sensorimotor exercise program thrice a week for 12 consecutive weeks, however the control group did not undergo the exercise intervention. Both groups were instructed to conduct home exercises. Visual analogue scale (VAS), proprioceptive responses, time-up and go (TUG) values, and short form-36 (SF-36) have been assessed prior and subsequent to the study intervention.ResultsNo significant differences were observed between groups regarding baseline data (p ? 0.05). Subsequent to 12 wk intervention, the study group showed significant improvements in outcome measures (proprioceptive responses, p ? 0.05, VAS, p ? 0.001, TUG, p = 0.003, and SF-36, p ? 0.001) and the control group exhibited significant changes in VAS and SF-36 (p = 0.004, p = 0.043 respectively) however, no significant changes were found in proprioceptive responses and TUG values (p ? 0.05). Between groups, the post-intervention comparison demonstrated statistical differences with tending toward the study group (proprioceptive responses, p ? 0.05, VAS, p ? 0.001, TUG, p = 0.013, and SF-36, p = 0.046).ConclusionsSensorimotor exercise training may improve, pain, proprioceptive responses, mobility, balance, and quality of life in diabetic patients with foot burns. Physiotherapists and rehabilitation providers should include the sensorimotor exercise in their protocols in the treatment of diabetic patients with foot burns.