Older Patients' experiences of Shared Decision-making when choosing treatment for their distal radius fracture:A Qualitative Study

Objective: This study aims to understand how older patients experience shared decision-making (SDM) when making decisions about the treatment of their distal radius fracture (DRF). Methods: An exploratory qualitative study was designed using individual in-person and telephone interviews. Twelve DRF patients were recruited during their first follow-up visit to a Danish outpatient clinic, with ten of them participating in interviews. Data was analysed using content analysis. Results: Three themes emerged: 1) An acute situation, 2) Considerations influencing the treatment choice and 3) The treatment decision. Conclusion: In conclusion, our study represents a pioneering effort in reporting the use of Shared Decision Making in fracture management. The sudden onset of DRF proved to be highly distressing for the patients. Providing SDM material to patients in the Emergency department (ED) aimed to empower them and prepare them for their subsequent outpatient clinic visit. However, its effectiveness varied. The demeanour of doctors played a crucial role in shaping patient experiences.</p

Patient experiences with pre-amputation communication and shared decision-making:a national cross-sectional survey

Background Shared decision-making (SDM) can be crucial when making sensitive decisions, such as determining the appropriate level of major lower extremity amputation (MLEA). Despite clinicians aiming for SDM and patients wanting active participation, barriers persist to implementation. Aim To explore patients’ experiences with pre-amputation communication and shared decision-making and their attitudes towards a decision-support tool for future amputation decisions. Methods An electronic survey was distributed between November 2023 and January 2024 to individuals with MLEA, identified via social media, healthcare professionals working with MLEA patients, and a non-profit patient organisation. In total, 49 individuals responded (27% female, 47% living alone, mean age 63, SD=15). The questionnaire covered four themes: experiences of the pre-amputation communication, preferences for SDM, discussion of different amputation levels and respondents’ viewpoints on the potential use of a decision-support tool. Descriptive statistics were used to analyse the questionnaire responses. Results 43% (n=21) of the respondents felt unprepared for a possible amputation, and 80% (n=39) did not know the surgeon beforehand. More than half (59%, n=27) were satisfied with the pre-amputation conversation, while 22% (n=10) were not. Most respondents (73%, n=33) wanted to be involved in the decision about amputation level, and 68% (n=28) believed a decision-support tool would be beneficial. Conclusions Patients undergoing MLEA generally want to be involved in the complex decision-making process about amputation level and often are, but there is room for improvement. Discussing the risk of amputation earlier allows patients to prepare better and may facilitate easier engagement in SDM.</p

Shared decision-making when deciding on lower extremity amputation level:perceived facilitators and barriers among surgeons

Background A major lower limb amputation profoundly affects patients´ lives. Shared decision-making (SDM) can play a crucial role when a sensitive decision such as determining the appropriate level of amputation has to be made. Despite clinicians aiming for SDM and patients wanting active participation, barriers persist for implementation. Aim To explore facilitators and barriers to SDM among orthopaedic and vascular surgeons when deciding amputation levels. Methods An electronic survey was distributed November 2023 at 21 hospitals in Denmark, yielding responses from 28 vascular and 24 orthopaedic surgeons. The questionnaire covered four domains known to influence SDM and assessed respondents’ viewpoints on the potential use and implementation of an SDM tool. Descriptive statistics and inter-specialty comparisons were performed. Results More vascular surgeons than orthopaedic surgeons believed an SDM support tool would enhance patients’ decision-making experience (77% vs 48%); benefit their praxis (62% vs 35%); and that they would use such a tool (65% vs 48%). While both groups agreed on patients´ desire to participate in SDM (75%), 35% thought patients would find it difficult to understand the advantages and disadvantages of amputation at different levels. Vascular surgeons described being left out of the decision of amputation level and 63% of the orthopaedic surgeons reported a lack of a genuine choice of amputation level. Conclusions The study identified facilitators and barriers to SDM in amputation level decisions, emphasising the need for enhanced interdisciplinary collaboration between vascular and orthopaedic surgeons. Implementing a decision support tool could facilitate collaboration between surgeons in favour of patient treatment satisfaction.</p

Surgical or non-surgical treatment of plantar fasciopathy (SOFT):study protocol for a randomized controlled trial

BACKGROUND: Plantar fasciopathy is the most common reason for complaints of plantar heel pain and one of the most prevalent musculoskeletal conditions with a reported lifetime incidence of 10%. The condition is normally considered self-limiting with persistent symptoms that often last for several months or years. Multiple treatments are available, but no single treatment appears superior to the others. Heavy-slow resistance training and radiofrequency microtenotomy for the treatment of plantar fasciopathy have shown potentially positive effects on short- and long-term outcomes (> 3 months). However, the effect of heavy-slow resistance training compared with a radiofrequency microtenotomy treatment is currently unknown. This trial compares the efficacy of heavy-slow resistance training and radiofrequency microtenotomy treatment with supplemental standardized patient education and heel inserts in improving the Foot Health Status Questionnaire pain score after 6 months in patients with plantar fasciopathy. METHODS: In this randomized superiority trial, we will recruit 70 patients with ultrasound-confirmed plantar fasciopathy and randomly allocate them to one of two groups: (1) heavy-slow resistance training, patient education and a heel insert (n = 35), and (2) radiofrequency microtenotomy treatment, patient education and a heel insert (n = 35). All participants will be followed for 1 year, with the 6-month follow-up considered the primary endpoint. The primary outcome is the Foot Health Status Questionnaire pain domain score. Secondary outcomes include the remaining three domains of the Foot Health Status Questionnaire, a Global Perceived Effect scale, the physical activity level, and Patient Acceptable Symptom State, which is the point at which participants feel no further need for treatment. DISCUSSION: By comparing the two treatment options, we should be able to answer if radiofrequency microtenotomy compared with heavy-slow resistance training is superior in patients with plantar fasciopathy. TRIAL REGISTRATION: ClinicalTrials.gov NCT03854682. Prospectively registered on February 26, 2019. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13063-022-06785-w

CELSR2 is a candidate susceptibility gene in idiopathic scoliosis

A Swedish pedigree with an autosomal dominant inheritance of idiopathic scoliosis was initially studied by genetic linkage analysis, prioritising genomic regions for further analysis. This revealed a locus on chromosome 1 with a putative risk haplotype shared by all affected individuals. Two affected individuals were subsequently exome-sequenced, identifying a rare, non-synonymous variant in the CELSR2 gene. This variant is rs141489111, a c. G6859A change in exon 21 (NM_001408), leading to a predicted p. V2287I (NP_001399.1) change. This variant was found in all affected members of the pedigree, but showed reduced penetrance. Analysis of tagging variants in CELSR1-3 in a set of 1739 Swedish-Danish scoliosis cases and 1812 controls revealed significant association (p = 0.0001) to rs2281894, a common synonymous variant in CELSR2. This association was not replicated in case-control cohorts from Japan and the US. No association was found to variants in CELSR1 or CELSR3. Our findings suggest a rare variant in CELSR2 as causative for idiopathic scoliosis in a family with dominant segregation and further highlight common variation in CELSR2 in general susceptibility to idiopathic scoliosis in the Swedish-Danish population. Both variants are located in the highly conserved GAIN protein domain, which is necessary for the auto-proteolysis of CELSR2, suggesting its functional importance.Peer reviewe

The heritability of coronal and sagittal phenotype in idiopathic scoliosis:a report of 12 monozygotic twin pairs

Purpose: One of the pathways through which genetics may act in the causation of idiopathic scoliosis is inheritance of a specific sagittal profile that predisposes for its development. In this study, coronal and sagittal parameters were compared in an international collection of monozygotic twins with idiopathic scoliosis. Methods: Twelve monozygotic twin pairs who underwent biplanar radiography for idiopathic scoliosis were systematically identified in existing scoliosis databases in The Netherlands, Sweden, and Denmark. On the first available radiographs, the coronal and sagittal curve parameters (Roussouly and Abelin types, thoracic kyphosis, lumbar lordosis and length of the posteriorly inclined segment) were determined. Results: In all 12 monozygotic twin pairs, both twins were affected by AIS. Four (33%) twin pairs had similar coronal and sagittal spinal phenotype, whereas two (17%) had different coronal phenotype and similar sagittal profiles, and six (50%) pairs had different coronal as well as sagittal phenotype. Conclusions: Analysis of biplanar curve characteristics in monozygotic twins showed that all twin pairs were affected by idiopathic scoliosis. However, only 33% of the pairs had similar coronal and sagittal spinal phenotypes. Based on this limited dataset, the hypothesis can be formulated that besides genetic pre-disposition, the individual (inherited) sagittal profile plays a role in the development of different coronal curve type.</p

The efficacy of coccygectomy in patients with persistent coccydynia:a retrospective cohort study of 134 consecutive patients with a minimum follow-up of one year

AIMS: The aim of this study was to investigate the efficacy of coccygectomy in patients with persistent coccydynia and coccygeal instability. METHODS: The Danish National Spine Registry, DaneSpine, was used to identify 134 consecutive patients who underwent surgery, performed by a single surgeon between 2011 and 2019. Routine demographic data, surgical variables, and patient-reported outcomes, including a visual analogue scale (VAS) (0 to 100) for pain, Oswestry Disability Index (ODI), EuroQol five-dimension questionnaire (EQ-5D), and the Physical Component Score (PCS) and Mental Component Score (MCS) of the 36-Item Short-Form Health Survey questionnaire (SF-36) were collected at baseline and one-year postoperatively. RESULTS: A total of 112 (84%) patients with a minimum follow-up of one year had data available for analysis. Their mean age was 41.9 years, and 15 (13%) were males. At 12 months postoperatively, there were statistically significant improvements (p &lt; 0.001) from baseline for the mean VAS for pain (70.99 to 35.34), EQ-5D (0.52 to 0.75), ODI (31.84 to 18.00), and SF-36 PCS (38.17 to 44.74). A total of 78 patients (70%) were satisfied with the outcome of treatment. CONCLUSION: Patients with persistent coccydynia and coccygeal instability resistant to nonoperative treatment may benefit from coccygectomy. Cite this article: Bone Joint J 2021;103-B(3):542-546.</p