Socioeconomic inequalities in patient-reported outcome measures of Dutch primary hip and knee arthroplasty patients for osteoarthritis

Objective:To study socio-economic inequalities in patient-reported outcomes in primary hip and knee arthroplasty (THA/TKA) patients for osteoarthritis, using two analytical techniques. Methods: We obtained data from 44,732 THA and 30,756 TKA patients with preoperative and 12-month follow-up PROMs between 2014 and 2020 from the Dutch Arthroplasty Registry. A deprivation indicator based on neighborhood income, unemployment rate, and education level was linked and categorized into quintiles. The primary outcome measures were the EQ-5D-3L index and Oxford Hip/Knee Score (OHS/OKS) preoperative, at 12-month follow-up, and the calculated change score between these measurements. We contrasted the most and least deprived quintiles using multivariable linear regression, adjusting for patient characteristics. Concurrently, we calculated concentration indices as a non-arbitrary tool to quantify inequalities. Results: Compared to the least deprived, the most deprived THA patients had poorer preoperative (EQ-5D −0.03 (95%CI −0.02, -0.04), OHS −1.26 (−0.99, −1.52)) and 12-month follow-up health (EQ-5D −0.02 (−0.01, −0.02), OHS −0.42 (−0.19, −0.65)), yet higher mean change (EQ-5D 0.02 (0.01, 0.03), OHS 0.84 (0.52, 1.16)). The most deprived TKA patients had similar results. The higher mean change among the deprived resulted from lower preoperative health in this group (confounding). After accounting for this, the most deprived patients had a lower mean change. The concentration indices showed similar inequality effects and provided information on the magnitude of inequalities over the entire socio-economic range. Conclusion: The most deprived THA and TKA patients have worse preoperative health, which persisted after surgery. The concentration indices allow comparison of inequalities across different outcomes (e.g., revision risk).</p

Do physical tests have a prognostic value in chronic midportion Achilles tendinopathy?

Objectives: To determine whether baseline physical tests have a prognostic value on patient-reported outcomes in Achilles tendinopathy. Design: Prospective cohort study, secondary analysis of data from a randomized trial. Methods: Patients with chronic midportion Achilles tendinopathy performed a progressive calf muscle exercise program. At baseline and after 2, 6, 12 and 24 weeks, patients completed the Victorian Institute of Sports Assessment—Achilles questionnaire and performed the following physical tests: ankle dorsiflexion range of motion with a bent knee or an extended knee, calf muscle strength, jumping height and pain on palpation (Visual Analogue Scale; 0–100) and after 10 hops (Visual Analogue Scale-10-hops). Associations between baseline test results and improvement (Victorian Institute of Sports Assessment—Achilles scores) were determined using a Mixed Linear Model. Results: 80 patients were included. The mean Victorian Institute of Sports Assessment—Achilles score improved 20 points (95 % confidence interval, 16–25, P &lt; .001) after 24 weeks. There were significant associations between the baseline ankle dorsiflexion range of motion with a bent knee (β 0.2, 95 % confidence interval 0.001 to 0.3, P = .049), the baseline pain provocation tests (Visual Analogue Scale palpation: β − 0.2; 95 % confidence interval: − 0.4 to − 0.1; P &lt; .001, Visual Analogue Scale-10-hops: β − 0.3; 95 % confidence interval: − 0.4 to − 0.2; P &lt; .001) and the change in the Victorian Institute of Sports Assessment—Achilles score. Conclusions: In patients with chronic midportion Achilles tendinopathy, easy-to-perform pain provocation tests have a clinically relevant prognostic value on patient-reported improvement. Patients with less pain during pain provocation tests at baseline have a better improvement in pain, function and activities after 24 weeks than patients with high baseline pain scores.</p

The CAST study protocol:A cluster randomized trial assessing the effect of circumferential casting versus plaster splinting on fracture redisplacement in reduced distal radius fractures in adults

Background There is no consensus concerning the optimal casting technique for displaced distal radius fractures (DRFs) following closed reduction. This study evaluates whether a splint or a circumferential cast is most optimal to prevent fracture redisplacement in adult patients with a reduced DRF. Additionally, the cost-effectiveness of both cast types will be calculated. Methods/design This multicenter cluster randomized controlled trial will compare initial immobilization with a circumferential below-elbow cast versus a below-elbow plaster splint in reduced DRFs. Randomization will take place on hospital-level (cluster, n = 10) with a cross-over point halfway the inclusion of the needed number of patients per hospital. Inclusion criteria comprise adult patients (≥ 18 years) with a primary displaced DRF which is treated conservatively after closed reduction. Multiple trauma patients (Injury Severity Score ≥ 16), concomitant ulnar fractures (except styloid process fractures) and patients with concomitant injury on the ipsilateral arm or inability to complete study forms will be excluded. Primary study outcome is fracture redisplacement of the initial reduced DRF. Secondary outcomes are patient-reported outcomes assessed with the Disability Arm Shoulder Hand score (DASH) and Patient-Rated Wrist Evaluation score (PRWE), comfort of the cast, quality of life assessed with the EQ-5D-5L questionnaire, analgesics use, cost-effectiveness and (serious) adverse events occurence. In total, 560 patients will be included and followed for 1 year. The estimated time required for inclusion will be 18 months. Discussion The CAST study will provide evidence whether the type of cast immobilization is of influence on fracture redisplacement in distal radius fractures. Extensive follow-up during one year concerning radiographic, functional and patient reported outcomes will give a broad view on DRF recovery. Trial registration Registered in the Dutch Trial Registry on January 14th 2020. Registration number: NL8311

Patient expectations and satisfaction concerning total knee arthroplasty Background

Approximately 5-10% of patients is dissatisfied after a total knee arthroplasty. Several studies suggest that unrealistic expectations contribute to this; however, a systematic overview of the literature is missing. We searched for literature on the relationship between preoperative expectations and patient satisfaction after primary total knee arthroplasty. Our hypothesis was that high or unfulfilled expectations lead to more dissatisfaction. Design: Systematic literature review Method: Using a systematic search strategy, prospective and retrospective studies with a follow-up of a minimum of six months, were obtained from PubMed publisher, MEDLINE, Embase, Cochrane, PsycINFO, CINAHL, and Web-of-Science. The search terms included 'total knee arthroplasty', 'preoperative expectations' and 'patient satisfaction'. Two reviewers independently selected the studies. Two reviewers independently conducted the quality assessment. Finally, a best evidence synthesis was performed. Results: The search yielded 6802 studies, of which eight met the inclusion criteria. Limited evidence was found that there is no significant relation between expectations and satisfaction regarding limitations in recreation, walking distance, use of a walking aid and expected time to full recovery. Conflicting evidence was found that high expectations regarding general improvement, pain reduction and limitations in activities of daily living are associated with more dissatisfaction. Moderate evidence was found that patients with unfulfilled expectations were more often dissatisfied. Conclusion: Limited prospective research has been published on the relationship between expectations and patient satisfaction concerning total knee arthroplasty. The outcomes are very heterogenous and conclusions from these outcomes should be treated carefully. Future research needs to be more standardised and should utilise validated questionnaires.</p

Patient expectations and satisfaction concerning total knee arthroplasty Background

Approximately 5-10% of patients is dissatisfied after a total knee arthroplasty. Several studies suggest that unrealistic expectations contribute to this; however, a systematic overview of the literature is missing. We searched for literature on the relationship between preoperative expectations and patient satisfaction after primary total knee arthroplasty. Our hypothesis was that high or unfulfilled expectations lead to more dissatisfaction. Design: Systematic literature review Method: Using a systematic search strategy, prospective and retrospective studies with a follow-up of a minimum of six months, were obtained from PubMed publisher, MEDLINE, Embase, Cochrane, PsycINFO, CINAHL, and Web-of-Science. The search terms included 'total knee arthroplasty', 'preoperative expectations' and 'patient satisfaction'. Two reviewers independently selected the studies. Two reviewers independently conducted the quality assessment. Finally, a best evidence synthesis was performed. Results: The search yielded 6802 studies, of which eight met the inclusion criteria. Limited evidence was found that there is no significant relation between expectations and satisfaction regarding limitations in recreation, walking distance, use of a walking aid and expected time to full recovery. Conflicting evidence was found that high expectations regarding general improvement, pain reduction and limitations in activities of daily living are associated with more dissatisfaction. Moderate evidence was found that patients with unfulfilled expectations were more often dissatisfied. Conclusion: Limited prospective research has been published on the relationship between expectations and patient satisfaction concerning total knee arthroplasty. The outcomes are very heterogenous and conclusions from these outcomes should be treated carefully. Future research needs to be more standardised and should utilise validated questionnaires.</p

Effects of eccentric exercises on improving ankle dorsiflexion in soccer players

Purpose: The purpose of this study was to determine the effect of targeted eccentric calf muscle exercises compared to regular training on ankle dorsiflexion in healthy adolescent soccer players with a decreased ankle dorsiflexion. Methods: Male adolescent players (aged 14–21 years) from two professional soccer clubs were evaluated with the Weight Bearing Dorsiflexion Lunge Test (WBDLT) at baseline and after 12 weeks of this prospective controlled study. One club served as the control group and the other as the intervention group. Players with decreased ankle dorsiflexion (WBDLT) ≤ 10 cm) performed stretching and eccentric calf muscle exercises three times per week next to regular training in the intervention group, and performed only regular training in the control group. Primary outcome was the between-group difference in change in WBDLT between baseline and 12 weeks. Results: Of 107 eligible players, 47(44 %) had a decreased ankle dorsiflexion. The WBDLT (± standard deviation) increased in the intervention group from 7.1 (± 1.8) to 7.4 (± 2.4) cm (95 % Confidence Interval (CI)[-0.493 to 1.108], p = 0.381) and in the control group from 6.1 (± 2.4) to 8.2 (± 2.9) cm (95 % CI [1.313 to 2.659], p < 0.001). The difference in change of WBDLT between both groups was statistically significant (95 % CI [-2.742 to -0.510], p = 0.005). Conclusions: Targeted eccentric calf muscle exercises do not increase ankle dorsiflexion in healthy adolescent soccer players. Compared to regular training, eccentric exercises even resulted in a decreased calf muscle flexibility. Trial registration: This trial was registered retrospectively on the 7th of September 2016 in The Netherlands Trial Register (ID number: 6044)