Treatment of first metatarsophalangeal joint arthritis using hemiarthroplasty with a synthetic cartilage implant or arthrodesis: A comparison of operative and recovery time

Background

First metatarsophalangeal joint (MTPJ1) hemiarthroplasty using a novel synthetic cartilage implant was as effective and safe as MTPJ1 arthrodesis in a randomized clinical trial. We retrospectively evaluated operative time and recovery period for implant hemiarthroplasty (n = 152) and MTPJ1 arthrodesis (n = 50).

The Effect of Transradial Coronary Catheterization on Upper Limb Function

ObjectivesThe aim of this study was to analyze the change of upper limb function when percutaneous coronary procedures were performed through the radial artery.BackgroundIt is currently unknown if upper limb function is affected by transradial (TR) catheterization.MethodsBetween January 2013 and February 2014, upper limb function was assessed in a total of 338 patients undergoing coronary catheterization in an ambulatory setting (85% radial approach, 15% femoral approach). Upper limb function was assessed with the self-reported shortened version of the Disabilities of Arm, Shoulder, and Hand questionnaire. The presence and severity of upper extremity cold intolerance was assessed with the self-reported Cold Intolerance Symptom Severity questionnaire. Both questionnaires were completed before the catheterization and at 30-day follow-up. Higher scores represent worse upper limb functionality or symptoms. The nonparametric Wilcoxon signed-rank test was used to assess the change of upper limb function and symptoms over time.ResultsUpper limb function did not change significantly over time when catheterization was performed through the radial artery (p = 0.06). The number of procedure-related extremity complaints that persisted during 30-day follow-up were not different between both access groups (TR access 10.5%, transfemoral access 11.5%; p = 0.82). The upper extremity was not affected by cold intolerance after TR access at 30-day follow-up (p = 0.91).ConclusionsUpper limb function was not affected when coronary catheterizations and interventions were performed through the radial artery.     

THE MINIMUM CLINICALLY IMPORTANT DIFFERENCE ON THE VISA‐A AND LEFS FOR PATIENTS WITH INSERTIONAL ACHILLES TENDINOPATHY

Study Design

Cohort study of subjects with insertional Achilles tendinopathy (IAT).

Objectives

The purpose of this study was to establish the minimum clinically important difference (MCID) on the Victorian Institute of Sport Assessment ‐ Achilles Questionnaire (VISA‐A) and the Lower Extremity Functional Scale (LEFS) for patients with IAT.

Background

The VISA‐A and LEFS are two measures commonly utilized for patients with IAT. Previous authors have estimated the MCID for the VISA‐A, but a MCID has not been formally established. The MCID for the LEFS has been established for patients with lower extremity conditions in general, but it is not clear if this MCID is applicable to patients with IAT.

Methods

Fifteen subjects participating in a randomized controlled trial studying the effectiveness of intervention for IAT over a 12‐week period were included in this study. Subjects completed the VISA‐A and LEFS forms at baseline and 12 weeks after the initiation of treatment. All subjects also completed a 15‐point global rating of change (GROC) questionnaire at 12 weeks after the initiation of treatment. Subjects were classified as improved or stable based on their GROC scores.

Results

The area under the curve (AUC) for the VISA‐A was 0.97 and a MCID of 6.5 points was identified. The AUC for the LEFS was 0.97 and a MCID of 12 points was identified.

Conclusion

The VISA‐A and LEFS are both useful outcome measures to assess response in patients with IAT.

Level of Evidence

3     

Clinical Benefits of Joint Mobilization on Ankle Sprains: A Systematic Review and Meta-Analysis

Objective

To assess the clinical benefits of joint mobilization for ankle sprains.

Minimal clinically important difference in myasthenia gravis: Outcomes from a randomized trial

Introduction: The minimal clinically important difference (MCID) is the smallest outcome change that has clinical significance. Its use has not been established in the study of myasthenia gravis (MG). Methods: Patients from a published intravenous immunoglobulin (IVIg) vs. placebo study were studied. One anchor‐based and 3 distribution‐based techniques were used to identify quantitative myasthenia gravis score (QMGS), repetitive nerve stimulation (RNS), and single‐fiber electromyography (SFEMG) MCID cut‐offs. Patients with a change‐score exceeding MCID cut‐offs were compared. Results: MCID cut‐offs were below a QMGS change of 3.0. Anchor‐based and 1 × SEM cut‐offs showed 58.3% vs. 30.7% responders (P = 0.017), ½ SD 54.2% vs. 19.2% responders (P = 0.018), and effect size 0.519 vs. 0.164 (P = 0.011) in IVIg vs. placebo. Anchor‐based (P = 0.73) and effect‐size (P = 0.41) MCID cut‐offs did not show a difference between IVIg and placebo. MCID methods did not produce meaningful RNS cut‐offs. Conclusions: QMGS MCID values provide clinically relevant information and are recommended in MG trials. MCID analysis shows that improvement in MG patients treated with IVIg reflects clinically meaningful changes. Muscle Nerve 49 : 661–665, 2014     

Minimal Clinically Important Differences in COPD: Body Mass Index and Muscle Strength

Weight loss, muscle wasting, as well as muscle dysfunction are recognized as important problems in COPD, contributing to morbidity and mortality. This paper discusses body weight and muscle function as possible outcome parameters in the management of COPD. The relationship between these outcome measures and COPD-related management goals is discussed. Minimal clinically important differences (MCID) in the approach of patients suffering from COPD for these measures are discussed.     

Class III Obesity Increases Risk of Failure to Achieve the 1-Year Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form Minimal Clinically Important Difference Following Total Hip Arthroplasty

BackgroundThe relationship between obesity and failure to achieve a minimal clinically important difference (MCID) following total hip arthroplasty (THA) has not been well defined. The aims of this study are to determine whether increasing body mass index (BMI) is associated with failure to achieve the 1-year Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS) MCID and to determine a threshold BMI beyond which this risk is significantly increased.MethodsA multi-institutional arthroplasty registry was queried for THA patients from 2016 to 2018 with completion of preoperative and 1-year postoperative HOOS-PS. A previously defined anchor-based MCID threshold of 23 was used. Variables collected included demographics and patient-reported outcome measures. BMI was analyzed continuously and categorically. The association was analyzed via logistic regression. A BMI threshold was determined using the Youden index and receiver operating characteristic curve.ResultsA total of 1256 THAs were included. The average HOOS-PS improvement was 27.6 ± 18 points. The area under the receiver operating characteristic curve for BMI and risk of failure to achieve HOOS-PS MCID was 0.54 (95% confidence interval [CI], 0.50-0.57). Increasing BMI assessed continuously was a significant risk factor (odds ratio [OR], 1.03; 95% CI, 1.01-1.05; P value = .010). When BMI was analyzed categorically, this association was only observed for obese class III patients (>40 kg/m²) (OR, 2.5; 95% CI, 1.21-5.3; P value = .010).ConclusionThis study found an association between increasing BMI and failure to achieve the 1-year HOOS-PS MCID. Obese class III patients (>40 kg/m²) face a near 3-fold increased risk of suffering this adverse outcome.