What are we measuring? A critique of range of motion methods currently in use for Dupuytren's disease and recommendations for practice

Background: Range of motion is the most frequently reported measure used in practice to evaluate outcomes. A goniometer is the most reliable tool to assess range of motion yet, the lack of consistency in reporting prevents comparison between studies. The aim of this study is to identify how range of motion is currently assessed and reported in Dupuytren’s disease literature. Following analysis recommendations for practice will be made to enable consistency in future studies for comparability. This paper highlights the variation in range of motion reporting in Dupuytren’s disease. Methods: A Participants, Intervention, Comparison, Outcomes and Study design format was used for the search strategy and search terms. Surgery, needle fasciotomy or collagenase injection for primary or recurrent Dupuytren’s disease in adults were included if outcomes were monitored using range of motion to record change. A literature search was performed in May 2013 using subject heading and free-text terms to also capture electronic publications ahead of print. In total 638 publications were identified and following screening 90 articles met the inclusion criteria. Data was extracted and entered onto a spreadsheet for analysis. A thematic analysis was carried out to establish any duplication, resulting in the final range of motion measures identified. Results: Range of motion measurement lacked clarity, with goniometry reportedly used in only 43 of the 90 studies, 16 stated the use of a range of motion protocol. A total of 24 different descriptors were identified describing range of motion in the 90 studies. While some studies reported active range of motion, others reported passive or were unclear. Eight of the 24 categories were identified through thematic analysis as possibly describing the same measure, ‘lack of joint extension’ and accounted for the most frequently used. Conclusions: Published studies lacked clarity in reporting range of motion, preventing data comparison and meta-analysis. Percentage change lacks context and without access to raw data, does not allow direct comparison of baseline characteristics. A clear description of what is being measured within each study was required. It is recommended that range of motion measuring and reporting for Dupuytren’s disease requires consistency to address issues that fall into 3 main categories:- Definition of terms Protocol statement Outcome reportin

Optimal functional outcome measures for assessing treatment for Dupuytren's disease: A systematic review and recommendations for future practice

This article is available through the Brunel Open Access Publishing Fund. Copyright © 2013 Ball et al.; licensee BioMed Central Ltd.Background: Dupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment. Methods: A literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures. Results: Ninety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years. Conclusions: There is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes

Adverse Drug Reactions in Children—A Systematic Review

Adverse drug reactions in children are an important public health problem. We have undertaken a systematic review of observational studies in children in three settings: causing admission to hospital, occurring during hospital stay and occurring in the community. We were particularly interested in understanding how ADRs might be better detected, assessed and avoided

Match-Play and Performance Test Responses of Soccer Goalkeepers: A Review of Current Literature.

Goalkeepers are typically the last defensive line for soccer teams aiming to minimise goals being conceded, with match rules permitting ball handling within a specific area. Goalkeepers are also involved in initiating some offensive plays, and typically remain in close proximity to the goal line while covering ~ 50% of the match distances of outfield players; hence, the competitive and training demands of goalkeepers are unique to their specialised position. Indeed, isolated performance tests differentiate goalkeepers from outfield players in multiple variables. With a view to informing future research, this review summarised currently available literature reporting goalkeeper responses to: (1) match play (movement and skilled/technical demands) and (2) isolated performance assessments (strength, power, speed, aerobic capacity, joint range of motion). Literature searching and screening processes yielded 26 eligible records and highlighted that goalkeepers covered ~ 4-6 km on match day whilst spending ~ 98% of time at low-movement intensities. The most decisive moments are the 2-10 saves·match-1 performed, which often involve explosive actions (e.g. dives, jumps). Whilst no between-half performance decrements have been observed in professional goalkeepers, possible transient changes over shorter match epochs remain unclear. Isolated performance tests confirm divergent profiles between goalkeepers and outfield players (i.e. superior jump performance, reduced [Formula: see text]2max values, slower sprint times), and the training of soccer goalkeepers is typically completed separately from outfield positions with a focus primarily on technical or explosive drills performed within confined spaces. Additional work is needed to examine the physiological responses to goalkeeper-specific training and match activities to determine the efficacy of current preparatory strategies

The Palaeontological Heritage of Santa Maria Island (Azores: NE Atlantic): a Re-evaluation of Geosites in GeoPark Azores and Their Use in Geotourism

The application of geoconservation concepts and methodologies to the Azores archipelago led to the implementation of the Geopark Azores, recognized as such by the European and Global Geoparks Network. The current work re-evaluates and stresses the scientific and touristic value of the palaeontological sites of Santa Maria Island. Two new geosites (the Ponta do Castelo tempestite deposit and the Pedra-que-pica coquina) are proposed for classification as ‘Regional Natural Monuments’ by the Regional Government of the Azores, due to their international relevance. The tempestite deposit of Ponta do Castelo was overlain by a contemporary coastal lava delta, which enables the inference of the precise water depth of the geosite at the time of deposition, a very rare condition worldwide; and Pedra-que-pica is the most extensive multispecific fossiliferous coquina ever reported in the literature from the shelf of any of the ∼20,000 known volcanic oceanic islands in the world. Relevant geosites reported for this island are increased from 15 to 26. Additional palaeontological heritage contributions to the sustainable tourism of Santa Maria are suggested, with a focus on two recent projects: the ‘Fossil Trail’ and the future ‘PalaeoPark Santa Maria’

The Palaeontological Heritage of Santa Maria Island (Azores: NE Atlantic): a Re-evaluation of Geosites in GeoPark Azores and Their Use in Geotourism

The application of geoconservation concepts and methodologies to the Azores archipelago led to the implementation of the Geopark Azores, recognized as such by the European and Global Geoparks Network. The current work re-evaluates and stresses the scientific and touristic value of the palaeontological sites of Santa Maria Island. Two new geosites (the Ponta do Castelo tempestite deposit and the Pedra-que-pica coquina) are proposed for classification as ‘Regional Natural Monuments’ by the Regional Government of the Azores, due to their international relevance. The tempestite deposit of Ponta do Castelo was overlain by a contemporary coastal lava delta, which enables the inference of the precise water depth of the geosite at the time of deposition, a very rare condition worldwide; and Pedra-que-pica is the most extensive multispecific fossiliferous coquina ever reported in the literature from the shelf of any of the ∼20,000 known volcanic oceanic islands in the world. Relevant geosites reported for this island are increased from 15 to 26. Additional palaeontological heritage contributions to the sustainable tourism of Santa Maria are suggested, with a focus on two recent projects: the ‘Fossil Trail’ and the future ‘PalaeoPark Santa Maria’

MOESM1 of A framework for stakeholder engagement during systematic reviews and maps in environmental management

Additional file 1. Description of interviews with key informants