Psychometric properties of questionnaires evaluating health-related quality of life and functional status in polytrauma patients with lower extremity injury

BACKGROUND: Long term disability is common among polytrauma patients. However, as yet little information exists on how to adequately measure functional status and health-related quality of life following polytrauma. AIMS: To establish the unidimensionality, internal consistency and validity of two health-related quality of life measures and one functional status questionnaire among polytrauma patients. METHODS: 186 Patients with severe polytrauma including lower extremity injury completed the Sickness Impact Profile-136 (SIP-136), the Medical Outcomes Study 36-Item Short Health Survey (SF-36) and the Groningen Activity Restriction Scale (GARS) 15 months after injury. Unidimensionality and internal consistency was assessed by principal components analysis and Cronbach's alpha (alpha). To test the construct validity of the questionnaires, predetermined hypotheses were tested. RESULTS: The unidimensionality and internal consistency of the GARS and the SF-36, but not the SIP-136 were supported. The construct validity of the SF-36, GARS and to a lesser extent the SIP-136 was confirmed. CONCLUSION: The SF-36 and the GARS appear to be preferable for use in polytrauma patients over the SIP-136

A modified passive-dynamic ankle-foot orthosis:can it prevent amputation and arthrodesis in patients with ankle-foot trauma?

Introduction High-energy lower extremity trauma (HELET) may cause severe damage within the foot-ankle complex. Occasionally, arthrodesis or amputation are the only remaining options to increase activity levels. The modified passive dynamic ankle-foot orthosis (PDAFO) may prove to be a nonsurgical alternative. This study evaluated the effect of a modified PDAFO with a 6-week training program on pain and performance in patients after HELET. Materials and methods A retrospective cohort study was conducted on seventeen patients who considered an arthrodesis or an amputation after HELET. In an attempt to avoid surgery, the modified PDAFO with a 6-week training program was provided. Pain scores was measured with the Numeric Rating Scale and administered at the start of testing, immediately after the two performance tests and at the end of the day of testing. Performance was evaluated with the 6-min walk test (6MWT) and the Comprehensive high-level activity mobility predictor (CHAMP). Results A significant pain reduction was achieved after the treatment procedure. At the start of the test days (p = 0.002), after the 6MWT (p = 0.001), after the CHAMP (p < 0.001) and at the end of the day (p < 0.001). In addition, a significant improvement on performance was observed in the 6MWT (p < 0.001) and the CHAMP (p = 0.01). None of the patients considered a surgical intervention anymore. Conclusions Patients after HELET show a decrease in pain and an improvement in performance after a 6-week training program with modified PD-AFO. The results suggest that the modified PDAFO is an effective alternative for a surgical approach

Health-related quality-of-life measures for long-term follow-up in children after major trauma

Objective: Our objective was to review measures of health-related quality of life (HRQL) for long-term follow up in children after major trauma and to determine the measures that are suitable for a large age range, reliable and valid, and cover a substantial amount of the domains of functioning using the International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO). Methods: The Medline and EMBASE databases were searched in all years up to October 2007 for generic HRQL measures suitable for children aged 5-18 years old and validated in English or Dutch. Measures were reviewed with respect to the age range for which the measure was suitable and reliability, validity, and content related to the ICF. Results: The search resulted in 1,235 hits and 21 related articles. Seventy-nine papers met the inclusion criteria, describing in total 14 measures: Child Health and Illness Profile Adolescent and Child Edition (CHIP-AE/CE), Child Health Questionnaire Child and Parent Forms (CHQCF87/PF50/PF28), DISABKIDS, Functional Status II (FS II)(R), Health Utilities Index Mark 2 (HUI 2), KIDSCREEN 52/27, KINDL, Pediatric Quality of Life Inventory (PedsQL), TNO Institute of Prevention and Health and the Leiden University Hospital (TNO-AZL), TNO-AZL Children’s Quality Of Life (TACQOL), and Youth Quality of Life Instrument-Research Version (YQOL-R). Measures that were suitable for a large age range were CHQ-PF50/PF28, DISABKIDS, FS II(R), HUI 2, KIDSCREEN, PedsQL, and TACQOL. All measures had moderate to good psychometric properties, except for CHQ-PF50/PF28, KINDL, and TACQOL, which had either low internal consistency or bad test-retest reliability. The measures that covered more than six chapters of the ICF domains were CHIP-AE/CE, CHQ-CF87/PF50, DISABKIDS, KIDSCREEN-52, PedsQL, and TACQOL. Conclusions: DISABKIDS, KIDSCREEN 52, and Peds-QL are suitable for long-term follow-up measurement of HRQL in children after major trauma. They cover a large age range, have good psychometric properties, and cover the ICF substantially

Gevolgen van ernstige en zeer ernstige letsels

The effects of severe injuries can be charted using the International Classification of Functioning, Disability and Health (ICF) model and the burden of disease model, in which the burden of disease is expressed in 'disabilityadjusted life years' (DALYs). Severe accidents cause 10 DALYs per 1000 people, which is comparable with the burden of disease of mood disorders and lung cancer. In the Netherlands, severe injury victims are often males aged < 40 years, who are often injured in road traffic accidents. The average hospital stay after a severe injury is one month, after which almost 75% of the patients are discharged home, while one quarter subsequently stay in rehabilitation facilities for 36 months. More than half return to their original employment. Patients with thoracic and abdominal injuries recover relatively well, whereas injuries of the lower extremities, brain and spinal cord give a relatively poor prognosis. Comorbidity increases the chance of a less good recovery. Older people who survive an accident recover relatively well

The effects of severe and very severe injuries

The effects of severe injuries can be charted using the International Classification of Functioning, Disability and Health (ICF) model and the burden of disease model, in which the burden of disease is expressed in 'disabilityadjusted life years' (DALYs). Severe accidents cause 10 DALYs per 1000 people, which is comparable with the burden of disease of mood disorders and lung cancer. In the Netherlands, severe injury victims are often males aged &lt; 40 years, who are often injured in road traffic accidents. The average hospital stay after a severe injury is one month, after which almost 75% of the patients are discharged home, while one quarter subsequently stay in rehabilitation facilities for 36 months. More than half return to their original employment. Patients with thoracic and abdominal injuries recover relatively well, whereas injuries of the lower extremities, brain and spinal cord give a relatively poor prognosis. Comorbidity increases the chance of a less good recovery. Older people who survive an accident recover relatively well.</p

Degloved foot sole successfully reconstructed with split thickness skin grafts

Introduction The current opinion is that split thickness skin grafts are not suitable to reconstruct a degloved foot sole. The tissue is too fragile to carry full bodyweight; and therefore, stress lesions frequently occur. The treatment of choice is the reuse of the avulsed skin whenever possible, or else the use of a full thickness fascio-cutaneus flap. Presentation of the case A young male sustained a crush injury to his right foot with deglovement of the plantar surface and part of the dorsum. Discussion Split thickness skin grafts are not suitable for full weight bearing, but in special circumstances, certain patients, a lot of time and patience, early mobilization and gradual increasing partial weight bearing it is worthwhile to try. To toughen the foot sole pressure distribution is necessary and can be reached in several ways, soft and springy materials of the inlay, but also socks, orthopedic shoes, casting, orthotics or walking aids. Conclusion This case-report illustrates that the reconstruction of a degloved foot sole with split-thickness skin grafts can be successful; a silicon inner sole was used to prevent stress lesions

Bag-of-steps : Predicting lower-limb fracture rehabilitation length

This paper presents bag-of-steps, a new methodology to predict the rehabilitation length of a patient by monitoring the weight he is bearing in his injured leg and using a predictive model based on the bag-of-words technique. A force sensor is used to monitor and characterize the patient's gait, obtaining a set of step descriptors. These are later used to define a vocabulary of steps that can be used to describe rehabilitation sessions. Sessions are finally fed to a support vector machine classifier that performs the final rehabilitation estimation

Real-time visual biofeedback during weight bearing improves therapy compliance in patients following lower extremity fractures

BACKGROUND: Individuals with lower extremity fractures are often instructed on how much weight to bear on the affected extremity. Previous studies have shown limited therapy compliance in weight bearing during rehabilitation. In this study we investigated the effect of real-time visual biofeedback on weight bearing in individuals with lower extremity fractures in two conditions: full weight bearing and touch-down weight bearing. METHODS: 11 participants with full weight bearing and 12 participants with touch-down weight bearing after lower extremity fractures have been measured with an ambulatory biofeedback system. The participants first walked 15m and the biofeedback system was only used to register the weight bearing. The same protocol was then repeated with real-time visual feedback during weight bearing. The participants could thereby adapt their loading to the desired level and improve therapy compliance. RESULTS: In participants with full weight bearing, real-time visual biofeedback resulted in a significant increase in loading from 50.9±7.51% bodyweight (BW) without feedback to 63.2±6.74%BW with feedback (P=0.0016). In participants with touch-down weight bearing, the exerted lower extremity load decreased from 16.7±9.77kg without feedback to 10.27±4.56kg with feedback (P=0.0718). More important, the variance between individual steps significantly decreased after feedback (P=0.018). CONCLUSIONS: Ambulatory monitoring weight bearing after lower extremity fractures showed that therapy compliance is low, both in full and touch-down weight bearing. Real-time visual biofeedback resulted in significantly higher peak loads in full weight bearing and increased accuracy of individual steps in touch-down weight bearing. Real-time visual biofeedback therefore results in improved therapy compliance after lower extremity fractures