Item reduction of the patient-rated wrist evaluation using decision tree modelling

Background: The aim of this study is to assess the viability of a decision tree version of an often used questionnaire to measure wrist pain and disability, the Patient Rated Wrist Evaluation. Methods: Patient Rated Wrist Evaluation scores were collected from a cohort of 10394 patients who are part of a routine outcome measurement system. A decision tree version of the Patient Rated Wrist Evaluation (PRWE) was created. The intraclass correlation was used to evaluate the inter-version reliability between the original PRWE and the decision tree version. Results: The decision tree reduced the number of questions from 5 to 3 for the pain subscale, and from 10 to 3 for the disability subscale. The intraclass correlation between the original PRWE and the decision tree version was 0.97. The mean difference between the Patient Rated Wrist Evaluation and the decision tree Patient Rated Wrist Evaluation total sumscore was 0.35 (95% CI 9.92–10.62). Conclusions: We found that the decision tree was successful at reducing the items of the Patient Rated Wrist Evaluation from fifteen to only six questions with very high similarity to the scores of the full questionnaire

Item reduction of the patient-rated wrist evaluation using decision tree modelling

© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Background: The aim of this study is to assess the viability of a decision tree version of an often used questionnaire to measure wrist pain and disability, the Patient Rated Wrist Evaluation. Methods: Patient Rated Wrist Evaluation scores were collected from a cohort of 10394 patients who are part of a routine outcome measurement system. A decision tree version of the Patient Rated Wrist Evaluation (PRWE) was created. The intraclass correlation was used to evaluate the inter-version reliability between the original PRWE and the decision tree version. Results: The decision tree reduced the number of questions from 5 to 3 for the pain subscale, and from 10 to 3 for the disability subscale. The intraclass correlation between the original PRWE and the decision tree version was 0.97. The mean difference between the Patient Rated Wrist Evaluation and the decision tree Patient Rated Wrist Evaluation total sumscore was 0.35 (95% CI −9.92–10.62). Conclusions: We found that the decision tree was successful at reducing the items of the Patient Rated Wrist Evaluation from fifteen to only six questions with very high similarity to the scores of the full questionnaire.Implications for rehabilitation The Patient Rated Wrist Evaluation can reliably be used with 6 instead of 15 questions. Decision trees are useful statistical tools to shorten lengthy questionnaires, especially when large amounts of data are available. Having a shortened Patient Rated Wrist Evaluation saves patients and clinicians time in answering this specific questionnaire

Factors Associated with Treatment Outcome Satisfaction Six Months after Upper Blepharoplasty:A Large Cohort Study

Background: Upper blepharoplasty is the most popular facial cosmetic surgery. Although there are a variety of reasons to undergo this procedure, all patients expect an optimal cosmetic result. However, little is known about the factors that influence satisfaction with treatment outcome. Objectives: We assessed to what extent patient characteristics, clinician-rated and postsurgical outcome measures, and patient-reported satisfaction with facial appearance and quality-of-life are associated with patient-reported satisfaction with treatment outcome after a primary upper blepharoplasty. Methods: This study was performed in 583 patients with an upper blepharoplasty between 2016 and 2021. The primary outcome was satisfaction with treatment outcome 6 months postoperatively using the FACE-Q. Determinants were baseline patient characteristics (demographics), preoperative and postoperative clinician-rated and surgical outcome measures, and preoperative and postoperative FACE-Q appearance and quality-of-life scales. Hierarchical linear regression analysis was used to determine how much of the variance in satisfaction with outcome could be explained by these groups of determinants. Results: A total of 63% of the variance could be explained by the five groups of determinants of which 8% was explained by the baseline patient characteristics and clinician-rated and patient-reported outcomes together, another 8% by the postoperative clinician-rated outcomes, and the remaining 47% by the postoperative patient-reported outcomes. Conclusions: Patient characteristics, clinician-rated outcome measures, and baseline FACE-Q appearance and quality-of-life scores were of limited value in explaining satisfaction with treatment outcome. However, the postoperative FACE-Q appearance scale and the decision to undergo a blepharoplasty were strongly associated with satisfaction with treatment outcome.</p

Explaining Personalized Activity Limitations in Patients With Hand and Wrist Disorders:Insights from Sociodemographic, Clinical, and Mindset Characteristics

Objectives: To investigate the association of sociodemographic, clinical, and mindset characteristics on outcomes measured with a patient-specific patient-reported outcome measure (PROM); the Patient Specific Functional Scale (PSFS). Secondly, we examined whether these factors differ when a fixed-item PROM, the Michigan Hand Outcome Questionnaire (MHQ), is used as an outcome. Design:Cohort study, using the aforementioned groups of factors in a hierarchical linear regression. Setting: Twenty-six clinics for hand and wrist conditions in the Netherlands. Participants: Two samples of patients with various hand and wrist conditions and treatments: n=7111 (PSFS) and n=5872 (MHQ). Interventions: NA. Main Outcome Measures:The PSFS and MHQ at 3 months. Results:The PSFS exhibited greater between-subject variability in baseline, follow-up, and change scores than the MHQ. Better PSFS outcomes were associated with: no involvement in litigation (β[95% confidence interval=-0.40[-0.54;-0.25]), better treatment expectations (0.09[0.06;0.13]), light workload (0.08[0.03;0.14]), not smoking (-0.07[-0.13;-0.01]), men sex (0.07[0.02;0.12]), better quality of life (0.07[0.05;0.10]), moderate workload (0.06[0.00;0.13]), better hand satisfaction (0.05[0.02; 0.07]), less concern (-0.05[-0.08;-0.02]), less pain at rest (-0.04[-0.08;-0.00]), younger age (-0.04[-0.07;-0.01]), better comprehensibility (0.03[0.01;0.06]), better timeline perception (-0.03[-0.06;-0.01]), and better control (-0.02[-0.04;-0.00]). The MHQ model was highly similar but showed a higher R2 than the PSFS model (0.41 vs 0.15), largely due to the R2 of the baseline scores (0.23 for MHQ vs 0.01 for PSFS). Conclusions:Health care professionals can improve personalized activity limitations by addressing treatment expectations and illness perceptions, which affect PSFS outcomes. Similar factors affect the MHQ, but the baseline MHQ score has a stronger association with the outcome score than the PSFS. While the PSFS is better for individual patient evaluation, we found that it is difficult to explain PSFS outcomes based on baseline characteristics compared with the MHQ. Using both patient-specific and fixed-item instruments helps health care professionals develop personalized treatment plans that meet individual needs and goals.</p

Patient’s satisfaction beyond hand function in Dupuytren’s disease: analysis of 1106 patients

This study investigates the outcomes of 1106 patients with Dupuytren’s disease treated with limited fasciectomy or percutaneous needle fasciotomy over 16 years according to the different domains of patient-reported hand function. These patients completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery. Scores for the various outcome parameters were calculated and linear regression analyses were used to examine associations between the changes in digital extension d

Better patients’ treatment experiences are associated with better postoperative results in Dupuytren’s disease

This prospective study investigates the extent to which a better experience with healthcare delivery is associated with better postoperative treatment outcomes after surgery for Dupuytren’s contracture. Patients undergoing limited fasciectomy or percutaneous needle fasciotomy for Dupuytren’s contractures completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery, together with a patient reported experience measu

The Ultrashort Mental Health Screening Tool Is a Valid and Reliable Measure With Added Value to Support Decision-making

BACKGROUND: Mental health influences symptoms, outcomes, and decision-making in musculoskeletal healthcare. Implementing measures of mental health in clinical practice can be challenging. An ultrashort screening tool for mental health with a low burden is currently unavailable but could be used as a conversation starter, expectation management tool, or decision support tool.QUESTIONS/PURPOSES: (1) Which items of the Pain Catastrophizing Scale (PCS), Patient Health Questionnaire (PHQ-4), and Brief Illness Perception Questionnaire (B-IPQ) are the most discriminative and yield a high correlation with the total scores of these questionnaires? (2) What is the construct validity and added clinical value (explained variance for pain and hand function) of an ultrashort four-item mental health screening tool? (3) What is the test-retest reliability of the screening tool? (4) What is the response time for the ultrashort screening tool?METHODS: This was a prospective cohort study. Data collection was part of usual care at Xpert Clinics, the Netherlands, but prospective measurements were added to this study. Between September 2017 and January 2022, we included 19,156 patients with hand and wrist conditions. We subdivided these into four samples: a test set to select the screener items (n = 18,034), a validation set to determine whether the selected items were solid (n = 1017), a sample to determine the added clinical value (explained variance for pain and hand function, n = 13,061), and a sample to assess the test-retest reliability (n = 105). Patients were eligible for either sample if they completed all relevant measurements of interest for that particular sample. To create an ultrashort screening tool that is valid, reliable, and has added value, we began by picking the most discriminatory items (that is, the items that were most influential for determining the total score) from the PCS, PHQ-4, and B-IPQ using chi-square automated interaction detection (a machine-learning algorithm). To assess construct validity (how well our screening tool assesses the constructs of interest), we correlated these items with the associated sum score of the full questionnaire in the test and validation sets. We compared the explained variance of linear models for pain and function using the screening tool items or the original sum scores of the PCS, PHQ-4, and B-IPQ to further assess the screening tool's construct validity and added value. We evaluated test-retest reliability by calculating weighted kappas, ICCs, and the standard error of measurement.RESULTS: We identified four items and used these in the screening tool. The screening tool items were highly correlated with the PCS (Pearson coefficient = 0.82; p &lt; 0.001), PHQ-4 (0.87; p &lt; 0.001), and B-IPQ (0.85; p &lt; 0.001) sum scores, indicating high construct validity. The full questionnaires explained only slightly more variance in pain and function (10% to 22%) than the screening tool did (9% to 17%), again indicating high construct validity and much added clinical value of the screening tool. Test-retest reliability was high for the PCS (ICC 0.75, weighted kappa 0.75) and B-IPQ (ICC 0.70 to 0.75, standard error of measurement 1.3 to 1.4) items and moderate for the PHQ-4 item (ICC 0.54, weighted kappa 0.54). The median response time was 43 seconds, against more than 4 minutes for the full questionnaires.CONCLUSION: Our ultrashort, valid, and reliable screening tool for pain catastrophizing, psychologic distress, and illness perception can be used before clinician consultation and may serve as a conversation starter, an expectation management tool, or a decision support tool. The clinical utility of the screening tool is that it can indicate that further testing is warranted, guide a clinician when considering a consultation with a mental health specialist, or support a clinician in choosing between more invasive and less invasive treatments. Future studies could investigate how the tool can be used optimally and whether using the screening tool affects daily clinic decisions.LEVEL OF EVIDENCE: Level II, diagnostic study.</p

Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study

Objective: To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment. Design: Prospective cohort study. Setting: A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands. Participants: A consecutive sample of patients with symptomatic CMC-1 instability (N=431). Intervention: Nonsurgical treatment including exercise therapy and an orthosis. Main Outcome Measures: Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y). Results: VAS scores for pain during the last week, at rest, and during physical load improved with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and 19 (97.5% CI, 12-27), respectively (P<.001). No difference was present at 3 months for MHQ total score, but the subscales activities of daily living, work, pain, and satisfaction improved by 7 (97.5% CI, 1-14), 10 (97.5% CI, 4-16), 5 (97.5% CI, 2-9), and 12 (97.5% CI, 2-22) points, respectively (P<.001-.007). After median follow-up of 2.8 years, only 59 participants (14%) were surgically treated. Both in the subgroups that did and did not convert to surgery, VAS pain scores decreased at 3 months compared with baseline (P<.001-.010), whereas MHQ total score did not improve in both subgroups. However, VAS and MHQ scores remained worse for patients who eventually converted to surgery (P<.001). Conclusions: In this large sample o

Response to Conservative Treatment for Thumb Carpometacarpal Osteoarthritis Is Associated With Conversion to Surgery: A Prospective Cohort Study

Background. The current guidelines for treatment of carpometacarpal osteoarthritis recommend starting with conservative treatment before a surgical procedure is considered. Objective. The objective was to investigate how response to conservative treatment, in terms of pain and hand function, influences the hazard that patients convert to surgical treatment. Design. This was a multicenter, prospective cohort study. Methods. Participants comprised 701 patients who received 3 months of hand therapy and an orthosis. Pain and function were measured with the Michigan Hand Questionnaire (MHQ) at baseline and at 6 weeks and 3 months follow-up. Conversion to surgical treatment was recorded from clinical records. Joint modeling (a statistical method of combining prediction models) was used to perform the analysis and to calculate hazard ratios (HRs). Results. The joint analytical model showed that both MHQ pain score at a certain point (HR = 0.93; 95% confidence interval [CI] = 0.92–0.94) and change in MHQ pain score (HR = 1.07; 95% CI = 1.06–1.09) during conservative treatment was significantly associated with conversion to surgical treatment. The joint analytical model between functional outcome and conversion to surgical treatment showed only a significant association between MHQ function at a certain point (HR = 0.97; 95% CI = 0.95–0.99), and no significant association between the change in MHQ score for function (HR = 1.0; 95% CI = 1.0–1.0) and conversion to surgical treatment. Limitations. Missing data might have resulted in biased estimates. Conclusions. Self-reported pain and function, as well as change in self-reported pain during treatment, were associated with the hazard of conversion to surgical treatment, whereas change in self-reported functioning was not associated with conversion. Because a reduction in pain during conservative treatment appears to decrease the rate of conversion to surgical treatment, it is advised to structurally monitor pain levels during treatment