Search Results (183)

Patient-reported outcome measures (PROMs) are crucial within person-centered care. The use of electronic PROMs (ePROMs) is increasing and multiple advantages have been described. The Patient and Observer Scar Assessment Scale (POSAS) is a validated paper questionnaire to assess patient-reported scar quality in the burn and scar population. In burn and scar rehabilitation, quality of life questionnaires such as the Euroqol 5 Dimensions 5 level (EQ-5D-5L) and the Dermatology Life Quality Index (DLQI) allow us to measure physical and psychosocial impact. The goal of this research was to compare the equivalence of the electronic versions of the POSAS, the EQ-5D-5L, and the DLQI with their original paper counterparts. To ensure the psychometric properties of the electronic versions, we assessed the equivalence of scores, the differences in completion time, and patients’ preferred mode and ease of use. We used a randomized crossover design using a within-subject comparison of the formats of the questionnaires. Participants aged over 18 with a scar were recruited from an outpatient after-care and research center for burns and scars in Antwerp, Belgium. The equivalence of the electronic questionnaires POSAS, EQ-5D-5L, and DLQI is assumed based on the findings of this study. Completion times were faster for all the electronic versions but only statistically different (p = 0.002) for the electronic version of the EQ-5D-5L. The number of missing answers could be reduced to 0. The electronic assessment was preferred in >75% of the cases and subjects found it easy to use, and a tool that could improve the quality of care. Our findings support the electronic delivery of POSAS, EQ-5D, and DLQI, within the burn and scar population. Full article

Background/Objectives: Neurodevelopmental disorders (NDDs) include a wide range of conditions that develop during the formation of the central nervous system, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Tourette syndrome (TS) is another neurodevelopmental disorder characterised by motor and vocal tics, which often co-occurs with ASD and ADHD. This study explores the feasibility of assessing joint hypermobility in children with specific neurodevelopmental conditions by measuring both ankles’ passive range of motion (pROM). Methods: This study involved children diagnosed with ASD, ADHD, and TS, aged 5 to 15 years, who were compared with a control group of healthy children. The Beighton and Brighton scores and the pROM of the left and right ankles were measured. Data were analysed using SPSS version 22.0 for Windows (IBM SPSS Statistics, Chicago, IL, USA). A total of 102 subjects participated in this study (72.52% male, with a mean age of 10.7 ± 2.2 years). The sample included 24 children with ASD, 27 with ADHD, 26 with TS, and 25 healthy controls. Results: The pROM of the right and left ankles showed a significant positive correlation with the Beighton and Brighton scores in children with NDDs (ASD, ADHD, and TS combined). A trend towards higher Beighton scores (≥6) was observed in the ADHD and TS groups, with significance found in the TS group (p = 0.013). The pROM of the right ankle was significantly higher in the ADHD (p = 0.021) and TS (p = 0.013) groups compared to the controls. Although the left ankle followed a similar trend in the TS group, the difference was not statistically significant (p = 0.066). Controlling for age, the diagnosis of ASD, ADHD, and TS does not appear to impact any of the variables examined. Conclusions: There is a trend towards a higher prevalence of individuals with elevated Beighton scores in the ADHD and TS groups, suggesting greater general flexibility or hypermobility in these patients. However, the pROM of the right ankle is significantly higher in the ADHD and TS groups, with solid evidence in the TS group. These findings were not observed in children with ASD. However, it is necessary to consider the measurements obtained in relation to the patients’ age. Finally, given that the pROM of the ankles correlates with the Beighton and Brighton scores, it could be utilised for the initial screening, monitoring, and follow-up of JH in some children with NDDs. Further investigations are required. Full article

Background: This study reports the long-term survivorship of primary total hip arthroplasty (THA) for protrusio acetabuli. Methods: Patients undergoing THA utilising cement and bone graft acetabular reconstruction for protrusio acetabuli in a university teaching hospital during the period 2003 to 2014 were included. Kaplan–Meier survival estimates were calculated with 95% confidence intervals (CI) up to 15 years following surgery. PROMs were collected pre- and post-operatively for hip-specific function (Oxford Hip Score [OHS]) and health-related quality of life (HRQoL) using the EQ-5D-3L. Results: 129 consecutive THAs (96 patients) performed for protrusio acetabuli were identified (median age 69, IQR 61–75; female 115 [89.1%]; 38 [29.5%] inflammatory arthritis) with a mean follow-up of 15.7 years (range: 10.1–20.1 years). At the final follow-up, fifty-six (43.4%) patients had died and there were eleven (8.5%) reoperations, of which eight (6.2%) involved the revision of the acetabular component. The fifteen-year Kaplan–Meier any-reoperation survival estimate was 91.3% (95% CI 85.9–97.0). When considering all-cause acetabular revision only, the 15-year survival estimate was 93.1% (95% CI 88.2–98.3). The median pre-operative OHS improved significantly from baseline to 1 year post-THA, beyond the minimal important change (mean difference 28, 95% CI 25–30, p < 0.001). Similarly, there were clinically relevant improvements in HRQoL at 1 year post surgery (mean difference 0.10, 95% CI 0.06–0.15, p < 0.001). Conclusions: This study demonstrates that primary cemented THA utilising acetabular bone graft for reconstruction in patients with protrusio acetabuli was associated with 15-year survival rates of 93.1% and clinically relevant improvements in hip-specific function and HRQoL. Full article

Background: This study aimed to analyze the effect of cardiac rehabilitation programs on the health-related quality of life of patients after a coronary cardiac event using patient-reported outcome measures (PROMs) for up to 6 months of evaluation. Methods: A comprehensive search was carried out in the MEDLINE, CINAHL, CENTRAL, and Web of Science databases for randomized controlled trials comparing the cardiac rehabilitation program with usual care. Two independent reviewers assessed the studies for inclusion, risk of bias using the Cochrane tool, and quality of evidence through the GRADE system. A meta-analysis was performed on studies assessing health-related quality of life with the SF-12 (Physical Component Summary and Mental Component Summary) up to 6 months after the program. Results: Twelve studies encompassed 2260 patients who participated in a cardiac rehabilitation program after a coronary event, with a mean age of 60.06 years. The generic PROMs used to assess quality of life were the SF-12, SF-36, EQ-5D-3L, EQ-5D-5L, and GHQ, and the specific coronary heart disease PROMs were MacNew and HeartQoL. There was a positive effect of participation in cardiac rehabilitation on the physical component of health-related quality of life at 6 months (MD [7.02]; p = 0.04] and on the mental component (MD [1.06]; p = 0.82) after applying the SF-12. Conclusions: This study highlights the significant benefits of cardiac rehabilitation programs on health-related quality of life, particularly in the physical domain at 6 months. Assessing outcomes over time through PROMs after coronary heart events is essential, thus making it possible to personalize patients’ care and improve their health status. Full article

Renal colic is one of the most common non-obstetric causes of hospitalization in pregnant women. Its management is often a challenge for obstetricians/gynecologists, urologists and neonatologists due to the complexity of the problem. The aim of this study was to analyze the possible maternal–fetal complications in renal colic during pregnancy. The authors performed a scoping review of the current literature regarding the analyzed issues. The review was conducted using the PubMed/MEDLINE and Web of Science databases. The search generated a total of 237 articles, out of which 7 original studies were ultimately included in the scoping review. In the women affected by renal colic, the incidence of perinatal complications such as urinary tract infections (UTIs), premature rupture of membranes (pPROM), and preterm birth is markedly higher than reported in the general population of pregnant women. Data regarding the recurrence of other perinatal complications such as gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia (PE), and intrauterine growth restriction (IUGR) are scarce and ambiguous. Further research on these issues is needed to improve the perinatal outcomes of the affected pregnancies. Full article

(1) Background: Digitization is of the utmost importance in improving the transfer of medical data. In order to emphasize the need for the greater implementation of digital solutions, we compared analog PROMs (aPROMs) to electronic PROMs (ePROMs) to emphasize the time benefits for clinical everyday life. (2) Methods: This prospective, observational study compared the evaluation of SF-36 in patients between 18 and 80 years old with musculoskeletal pathologies. We performed an age-independent and age-dependent analysis. (3) Results: After the import of aPROMs data, ePROMs took significantly less time (11.97 ± 3.00 min vs. 9.41 ± 3.12 min, p = 0.002, d = 0.797). There were no significant differences associated with age for aPROMs (7.23 ± 2.57 min vs. 8.38 ± 2.71 min, p = 0.061, d = −0.607) or ePROMs (8.72 ± 2.19 min vs. 10.09 ± 3.80 min, p = 0.130, d = −0.436), respectively. (4) Conclusions: This study indicates that ePROMs are a time-feasible method for collecting data to guide patient-personalized treatment approaches. Full article

Background: Anterior cruciate ligament reconstruction (ACLR) using double adjustable fixation gained popularity in the last decade due to its minimally invasive technique. However, suspensory fixation devices could be related to recurrent instability, poor clinical outcomes, and patient dissatisfaction. The present study aims to evaluate the clinical outcomes following ACLR using double adjustable-loop suspensory fixation devices in the demanding population of young patients. Methods: Between 2019 and 2022, 95 patients with knee post-traumatic anterior cruciate ligament insufficiency were treated with primary ACLR using semitendinosus quadrupled graft and double adjustable-loop suspensory fixation devices and followed for at least two years. Concomitant lesions were also treated at the same surgical time. The knee examination form of the International Knee Documentation Committee (IKDC) was used to assess clinical evaluation, and the return to physical activities using the Tegner Activity Scale was recorded. Patient-reported objective measures (PROMs) were also evaluated, including the IKDC subjective and Lysholm scores. Results: Sixty-six males and twenty-nine females with a mean age of 23.8 (range 18–37) and a mean BMI of 24.9 (SD ± 2.42) kg/m² were included in this study. All patients were evaluated clinically as normal or nearly normal at the final follow-up. PROMs also significantly improved postoperatively (p < 0.05) compared to the preoperative values. The Tegner Activity Scale increased from 2 to 7, the IKDC mean score improved from 43.9 (±8.9) to 93.3 (±12.3), and the modified Lysholm from 47.3 (±11.1) to 92.9 (±16.6). No complications or adverse events were recorded. Conclusions: Anterior cruciate ligament reconstruction utilizing double adjustable-loop suspensory fixation devices provides good clinical and functional outcomes in young patients at a two-year follow-up. Full article

Background and Objectives: Neglected patellar dislocation in the presence of end-stage osteoarthritis (OA) is a rare condition characterized by the patella remaining laterally dislocated without reduction. Due to the scarcity of reported cases, the optimal management approach is still uncertain. However, primary total knee arthroplasty (TKA) can serve as an effective treatment option. This study aimed to present the clinical and radiological outcomes achieved using our surgical technique. Materials and Methods: A retrospective review of 12 knees in 8 patients with neglected patellar dislocation and end-stage OA who underwent primary TKA was conducted. The surgical procedure involved conventional TKA techniques (e.g., medial parapatellar arthrotomy) and additional procedures specific to the individual pathologies of neglected patellar dislocation (e.g., lateral release, medial plication, and quadriceps lengthening). Clinical outcomes, including patient-reported outcome measures (PROMs) (Knee Society Scores and the Western Ontario and McMaster Universities Osteoarthritis Index) and knee range of motion (ROM), were assessed preoperatively and two years postoperatively. Radiological measures including mechanical femorotibial angle and patellar tilt angle were assessed preoperatively and until the last follow-up examinations. Any complications were also reviewed. Results: There were significant improvements in all PROMs, knee ROM, and radiological outcomes, including mechanical femorotibial angle and patellar tilt angle (all p < 0.05). At a mean follow-up of 68 months, no major complications requiring revision surgery, including patellar dislocation, were reported. Conclusions: Primary TKA is an effective procedure for correcting various pathologies associated with neglected patellar dislocation in end-stage OA without necessitating additional bony procedures. Satisfactory clinical and radiological outcomes can be expected using pathology-specific procedures. Full article

Introduction: Over the past few decades, tumor arthroplasty has evolved into an established therapeutic approach for addressing bone defects following tumor resection in the extremities. As the diagnosis has a significant impact on patients’ lives, it is important to give clear expectations for functional recovery. Therefore, we investigated both the functional outcomes and the quality of life (QoL) after tumor arthroplasty for malignant hip tumors. Methods: This retrospective study included patients who had undergone resections of malignant hip tumors with consecutive modular hip arthroplasty between 2010 and 2018. Demographics, tumor entity, and complications stemming from both tumors and treatments were evaluated through the analysis of medical records and perioperative records. The assessment of functional outcomes was conducted with the following patient-reported outcome measures (PROMs): the Harris Hip Score (HHS), Musculoskeletal Tumor Society Score (MSTS), and the Short Form Survey 36 (SF-36). Furthermore, we performed subgroup analysis in two groups: one divided into survivors and non-survivors, as well as younger individuals (<57 years) and older individuals (>57 years). Results: A total of 30 patients were included in the study. At the time of follow-up, 19 patients were deceased. The average duration of follow-up was 3.2 (±2.51) years. The average age at the time of surgery was 60.3 (±15.20) years. Notably, there were no cases of amputation reported (0%). Five cases of implant failure were identified (16.67%). Among these, one was attributed to infection (3.3%), while four resulted from aseptic loosening (13.3%). In terms of functional outcomes, MSTS indicated good results (18 ± 7; range: 7–28; 60%), and the HHS demonstrated moderate outcomes (75.3%). Younger survivors (<57 years) exhibited notably superior results in terms of both the MSTS and physical functioning in the SF-36 (p = 0.03). Conclusion: In summary, this study shows declining tumor arthroplasty-related complications and satisfying functional outcomes as well as QoL. Noteworthy aspects include the relatively low rates of amputation and local tumor recurrences, which significantly favor the selection of appropriate therapeutic options. Moreover, the findings underscore the substantial impact of patients’ age on overall functionality and engagement in daily activities. Full article

Background and Objectives: The Foot Function Index (FFI) is a widely recognized patient-reported outcome measure (PROM) for assessing foot functionality and its impact on quality of life in individuals with rheumatoid arthritis (RA). This study aimed to observe the behavior of the tool in the Spanish population with RA, optimize the tool, and check its functionality. Materials and Methods: A total of 549 RA patients, with a predominant female participation (75.6%). This study involved a comprehensive statistical analysis, leading to a refined version of the FFI for a Spanish-speaking population. Results: The original 23-item FFI was revised, resulting in a 15-item version by excluding items that caused confusion or were considered redundant. This modified version maintained the original’s subscales of pain, disability, and activity limitation, but with an adjusted item distribution. The construct validity was confirmed through exploratory factor analysis, demonstrating excellent fit indices (Kaiser–Meyer–Olkin test = 0.926, Bartlett’s test of sphericity = 4123.48, p < 0.001). The revised FFI demonstrated good internal consistency (Cronbach’s alpha = 0.96) and test–retest reliability (ICC = 0.89). Conclusions: This study highlights the applicability of the FFI in Spanish-speaking RA populations, offering a valid and reliable tool for clinicians and researchers. The modifications enhance the FFI’s relevance for RA patients, facilitating better assessment and management of foot-related functional impairments. Full article

Various nutritional supplements are available over the counter, yet few have been investigated in randomized controlled trials. The rationale for using the specific mix of nutritional substances including collagen type II, hyaluronic acid, n-acetyl-glucosamine, bamboo extract, L-lysine, and vitamin C is the assumption that combining naturally occurring ingredients of the intervertebral disc would maintain spine function. This double-blinded, placebo-controlled randomized trial aimed to evaluate the efficacy of a nutraceutical supplement mix in the management of lumbar osteochondrosis. Fifty patients were randomly assigned to either the supplement or placebo group in a 1:1 ratio. Patient-Reported Outcome Measures (PROMs) included the Oswestry Disability Index (ODI), the visual analogue scale for pain (pVAS), short form-12 (SF-12) physical and mental component summary subscale scores (PCS and MCS, respectively), and global physical activity questionnaire (GPAQ). Magnetic resonance imaging (MRI) was used to evaluate degenerative changes of intervertebral discs (IVD) including Pfirrmann grades as well as three-dimensional (3D) volume measurements. Data were collected at baseline and after the 3-month intervention. None of the PROMs were significantly different between the supplement and placebo groups. Disc degeneration according to Pfirrmann classifications remained stable during the 3-month intervention in both groups. Despite no significance regarding the distribution of Pfirrmann grade changes (improvement, no change, worsening; p = 0.259), in the supplement group, one patient achieved a three-grade improvement, and worsening of Pfirrmann grades were only detected in the placebo group (9.1%). Furthermore, in-depth evaluations of MRIs showed significantly higher 3D-measured volume changes (increase) in the supplement (+740.3 ± 796.1 mm³) compared to lower 3D-measured volume changes (decrease) in the placebo group (−417.2 ± 875.0 mm³; p < 0.001). In conclusion, this multi-nutrient supplement might not only stabilize the progression of lumbar osteochondrosis, but it might also potentially even increase IVD volumes as detected on MRIs. Full article

This study investigated whether differences in survival rates and clinical outcomes exist in patients undergoing TKA by insurance type: National Health Insurance (NHI) vs. Medical Aid Program (MAP). This study conducted a retrospective analysis of 762 TKAs (NHI, n = 505; MAP, n = 257) with a mean follow-up of 8.4 ± 1.8 years. Patient-reported outcomes (PROMs) were evaluated using the American Knee Society’s (AKS) score at the final follow-up. The survival rate of each group was analyzed using Kaplan–Meier survival analysis. Any postoperative complications and readmissions within 90 days of discharge were recorded and compared between the groups. There were no between-group differences in pre- to postoperative improvement in AKS scores. The estimated 10-year survival rates were 98.5% in the NHI group and 96.9% in the MAP group, respectively, with no significant differences (p = 0.48). However, the length of hospital stay (LOS) was significantly longer in the MAP group than in the NHI group (13.4 days vs. 13.1 days, p = 0.03), and the transfer rate to other departments was significantly higher in the MAP group than in the NHI group (3.9% vs. 1.4%, p = 0.04). Readmission rates for orthopedic complications for 90 days were 3.0% in the NHI group and 3.5% in the MAP group, respectively (p = 0.67). Patients’ insurance type showed similar survival rates and clinical outcomes to those of primary TKA at a mean follow-up of 8.4 years, but the LOS and rate of transfer to other departments during hospitalization were influenced by insurance type. Full article

Background/Objectives: Intra-amniotic infection (IAI) is a rare but serious condition with potential complications such as preterm labor and intrauterine fetal death. Diagnosing IAI is challenging due to varied clinical signs. Oxidative stress and mitochondrial dysfunction have been hypothesized to evolve around IAI. This study focused on measuring circulating mtDNA levels, a proposed biomarker for mitochondrial dysfunction, in maternal serum and placenta of women with confirmed IAI and healthy controls. Methods: 12 women with confirmed IAI (IAI group) were enrolled following premature preterm rupture of the membranes (PPROM) and compared to 21 healthy women (control group). Maternal blood was obtained two weeks pre-partum and peripartum; furthermore, postpartum placental blood was taken. In the IAI group, maternal blood was taken once weekly until delivery as well as peripartum, as was placental blood. Circulating cell-free mtDNA was quantified by real-time quantitative PCR. Results: Upon admission, in the IAI group, mean plasma mtDNA levels were 735.8 fg/μL compared to 134.0 fg/μL in the control group (p < 0.05). After delivery, in the IAI group, mean mtDNA levels in the placenta were 3010 fg/μL versus 652.4 fg/μL (p < 0.05). Conclusions: Circulating cell-free mtDNA could serve as a valuable biomarker for IAI prediction and diagnosis. Future research should establish reference values for sensitivity in predicting IAI. Full article

In patients with spinal cord injury (SCI), patient-reported outcomes (PROMs) and experience of care measures (PREMs) are extremely relevant for the prognosis. However, there is a paucity of research on these topics. We conducted a cross-sectional study to investigate the relationships between these patient outcomes and other demographic and clinical variables in adult SCI patients discharged from the intensive care unit of an Italian tertiary rehabilitation hospital. We administered the Consultation and Relational Empathy (CARE) for perceived relational empathy, the Spinal Cord Independence Measure III self-report (SCIM-SR) for functional autonomy, the Numeric Rating Scale (NRS) for pain, and the Connor–Davidson Resilience Scale (CD-RISC-10) for resilience. Study participants consisted of 148 adults with SCI; 82.4% were male, with a mean age of 49.9 years (SD = 16.6). The lesion was traumatic in 82.4% and complete in 74.3% of cases. The median length of hospital stays was 35 days (interquartile range—IQR = 23–60). Perceived relational empathy was positively associated with resilience (r = 0.229, p = 0.005) and negatively associated with the length of the stay and lesion completeness. Resilience had a weak negative association with pain (r = −0.173, p = 0.035) and was unrelated to other variables. Clinicians should consider the routine assessment of PREMs and PROMs in order to personalize post-discharge therapeutic plans and identify appropriate measures to ensure continuity of care. Full article

Objective: The direct anterior approach (DAA) is a recognized technique for total hip arthroplasty (THA) that spares soft tissue. Functional and clinical outcomes following THA via the DAA in patients with complex acetabular deformities, specifically coxa profunda (CP) and protrusio acetabuli (PA), have yet to be determined. Methods: A retrospective analysis was conducted on 188 primary THA cases, including 100 CP hips and 88 PA hips, performed via the DAA. Functional and clinical outcomes were evaluated by means of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Harris Hip Score (HHS) preoperatively and at a mean follow-up of 46 ± 14 months. Furthermore, potential complications were assessed. Results: From the preoperative to the latest postoperative visit, a significant improvement in the WOMAC total score was observed (CP: −34.89 ± 20.66; PA: −40.38 ± 21.11). The length of stay (LOS) was the only parameter predictive of the postoperative WOMAC total score, with each day of LOS increasing the postoperative WOMAC by a mean of 1.77 points (p < 0.01). The HHS improved by 38.37 ± 14.23 (PA-group) and 32.79 ± 14.89 points (CP-group). No significant difference in the patient-reported outcome measures (PROMs) between the CP- and PA-group was found. The survival rate for any revision was 97.70% (PA-group) and 92.80% (CP-group). Conclusion: The results of this study indicate that the minimally invasive DAA was not predictive of the functional and clinical outcome following DAA-THA in patients with CP and PA. Improvements in the mean WOMAC and HHS scores were above or within the reported MCID. Additionally, revision rates were well below those reported in the literature for short and intermediate follow-up periods. Full article