An Appreciation

Volume: XXI

Measuring Outcome after Wrist Injury: Translation and Validation of the Swedish Version of the Patient-Rated Wrist Evaluation (PRWE-Swe)

<p>Abstract</p> <p>Background</p> <p>There is a need for outcome measurement instruments for evaluation of disability after trauma. The Patient-Rated Wrist Evaluation (PRWE) is a self-administered region-specific outcome measuring instrument developed for use in evaluating disability and pain of the wrist. The aim of this study is to translate and to cross-culturally adapt the PRWE for use in a Swedish patient population. Moreover, we aim at investigating the PRWE in terms of validity, reliability and responsiveness.</p> <p>Methods</p> <p>We performed a translation and cross-cultural adaptation of the PRWE to Swedish (PRWE-Swe), utilising the process recommended by the American Association of Orthopedic Surgeons. A total of 124 patients with an injury to the wrist were included in the study. They filled in the PRWE and the DASH questionnaires at two separate occasions.</p> <p>Results</p> <p>Reliability of the PRWE in terms of internal consistency (Cronbach's alpha 0.97) and test-retest stability (intraclass correlation coefficient 0.93) were excellent. Face validity and content validity were judged as good. Criterion validity assessed as the correlation between the PRWE and the DASH was also good (Spearman's rho = 0.9). Responsiveness measured by the standardized response mean (SRM) was good with an SRM_PRWEof 1.29.</p> <p>Conclusion</p> <p>This Swedish version of the PRWE is a short and easily understood self-administered questionnaire with good validity, reliability, and responsiveness. Our results confirm that the PRWE is a valuable tool in evaluating the results after treatment of a wrist injury.</p

A numerical adaptation of SAW identities from the honeycomb to other 2D lattices

Recently, Duminil-Copin and Smirnov proved a long-standing conjecture by Nienhuis that the connective constant of self-avoiding walks on the honeycomb lattice is $\sqrt{2+\sqrt{2}}.$ A key identity used in that proof depends on the existence of a parafermionic observable for self-avoiding walks on the honeycomb lattice. Despite the absence of a corresponding observable for SAW on the square and triangular lattices, we show that in the limit of large lattices, some of the consequences observed on the honeycomb lattice persist on other lattices. This permits the accurate estimation, though not an exact evaluation, of certain critical amplitudes, as well as critical points, for these lattices. For the honeycomb lattice an exact amplitude for loops is proved.Comment: 21 pages, 7 figures. Changes in v2: Improved numerical analysis, giving greater precision. Explanation of why we observe what we do. Extra reference

Factor structure of the Shoulder Pain and Disability Index in patients with adhesive capsulitis

<p>Abstract</p> <p>Background</p> <p>The Shoulder Pain and Disability Index (SPADI) is a self-administered questionnaire that aims to measure pain and disability associated with shoulder disease. It consists of a pain section and a disability section with 13 items being responded to on visual analogue scales. Few researchers have investigated SPADI validity in specified diagnostic groups, although the selection of an evaluative instrument should be based on evidence of validity in the target patient group. The aim of the present study was to investigate factor structure of the SPADI in a study population of patients with adhesive capsulitis.</p> <p>Methods</p> <p>The questionnaire was administered to 191 patients with adhesive capsulitis. Descriptive statistics for items and a comparison of scores for the two subscales were produced. Internal consistency was analyzed by use of the Cronbach alpha and a principal components analysis with varimax rotation was conducted. Study design was cross-sectional.</p> <p>Results</p> <p>Two factors were extracted, but the factor structure failed to support the original division of items into separate pain and disability sections.</p> <p>Conclusion</p> <p>We found minimal evidence to justify the use of separate subscales for pain and disability. It is our impression that the SPADI should be viewed as essentially unidimensional in patients with adhesive capsulitis.</p

The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery

BACKGROUND: The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability) to 100. The main purpose of this study was to assess the longitudinal construct validity of the DASH among patients undergoing surgery. The second purpose was to quantify self-rated treatment effectiveness after surgery. METHODS: The longitudinal construct validity of the DASH was evaluated in 109 patients having surgical treatment for a variety of upper-extremity conditions, by assessing preoperative-to-postoperative (6–21 months) change in DASH score and calculating the effect size and standardized response mean. The magnitude of score change was also analyzed in relation to patients' responses to an item regarding self-perceived change in the status of the arm after surgery. Performance of the DASH as a measure of treatment effectiveness was assessed after surgery for subacromial impingement and carpal tunnel syndrome by calculating the effect size and standardized response mean. RESULTS: Among the 109 patients, the mean (SD) DASH score preoperatively was 35 (22) and postoperatively 24 (23) and the mean score change was 15 (13). The effect size was 0.7 and the standardized response mean 1.2. The mean change (95% confidence interval) in DASH score for the patients reporting the status of the arm as "much better" or "much worse" after surgery was 19 (15–23) and for those reporting it as "somewhat better" or "somewhat worse" was 10 (7–14) (p = 0.01). In measuring effectiveness of arthroscopic acromioplasty the effect size was 0.9 and standardized response mean 0.5; for carpal tunnel surgery the effect size was 0.7 and standardized response mean 1.0. CONCLUSION: The DASH can detect and differentiate small and large changes of disability over time after surgery in patients with upper-extremity musculoskeletal disorders. A 10-point difference in mean DASH score may be considered as a minimal important change. The DASH can show treatment effectiveness after surgery for subacromial impingement and carpal tunnel syndrome. The effect size and standardized response mean may yield substantially differing results

The critical fugacity for surface adsorption of self-avoiding walks on the honeycomb lattice is 1+21+\sqrt{2}

In 2010, Duminil-Copin and Smirnov proved a long-standing conjecture of Nienhuis, made in 1982, that the growth constant of self-avoiding walks on the hexagonal (a.k.a. honeycomb) lattice is $\mu=\sqrt{2+\sqrt{2}}.$ A key identity used in that proof was later generalised by Smirnov so as to apply to a general O(n) loop model with $n\in [-2,2]$ (the case $n=0$ corresponding to SAWs). We modify this model by restricting to a half-plane and introducing a surface fugacity $y$ associated with boundary sites (also called surface sites), and obtain a generalisation of Smirnov's identity. The critical value of the surface fugacity was conjectured by Batchelor and Yung in 1995 to be $y_{\rm c}=1+2/\sqrt{2-n}.$ This value plays a crucial role in our generalized identity, just as the value of growth constant did in Smirnov's identity. For the case $n=0$, corresponding to \saws\ interacting with a surface, we prove the conjectured value of the critical surface fugacity. A crucial part of the proof involves demonstrating that the generating function of self-avoiding bridges of height $T$, taken at its critical point $1/\mu$, tends to 0 as $T$ increases, as predicted from SLE theory.Comment: Major revision, references updated, 25 pages, 13 figure

Recovery: What does this mean to patients with low back pain?

Copyright © 2009, American College of Rheumatology. This article is freely available through the publisher’s link below.Objective - To explore patients' perceptions of recovery from low back pain, about which little is known. Methods - A qualitative study was conducted in which 36 participants, either recovered or unrecovered from low back pain, participated in focus groups. Interviews were audiorecorded and transcribed verbatim. Framework analysis was used to identify emergent themes and domains of recovery. Results - Patients' views of recovery encompassed a range of factors that can be broadly classified into the domains of symptom attenuation, improved capacity to perform a broad scope of self-defined functional activities, and achievement of an acceptable quality of life. An interactive model is proposed to describe the relationships between these domains, cognitive appraisal of the pain experience, and self-rated recovery. Pain attenuation alone was not a reliable indicator of recovery. Conclusion - The construct of recovery for typical back pain patients seeking primary care is more complex than previously recognized and is a highly individual construct, determined by appraisal of the impact of symptoms on daily functional activities as well as quality of life factors. These findings will be valuable for reassessing how to optimize measures of recovery from low back pain by addressing the spectrum of factors patients consider meaningful

Unravelling the mystery of the M31 bar

The inclination of M31 is too close to edge-on for a bar component to be easily recognised and is not sufficiently edge-on for a boxy/peanut bulge to protrude clearly out of the equatorial plane. Nevertheless, a sufficient number of clues allow us to argue that this galaxy is barred. We use fully self-consistent N-body simulations of barred galaxies and compare them with both photometric and kinematic observational data for M31. In particular, we rely on the near infrared photometry presented in a companion paper. We compare isodensity contours to isophotal contours and the light profile along cuts parallel to the galaxy major axis and offset towards the North, or the South, to mass profiles along similar cuts on the model. All these comparisons, as well as position velocity diagrams for the gaseous component, give us strong arguments that M31 is barred. We compare four fiducial N-body models to the data and thus set constraints on the parameters of the M31 bar, as its strength, length and orientation. Our `best' models, although not meant to be exact models of M31, reproduce in a very satisfactory way the main relevant observations. We present arguments that M31 has both a classical and a boxy/peanut bulge. Its pseudo-ring-like structure at roughly 50' is near the outer Lindblad resonance of the bar and could thus be an outer ring, as often observed in barred galaxies. The shape of the isophotes also argues that the vertically thin part of the M31 bar extends considerably further out than its boxy bulge, i.e. that the boxy bulge is only part of the bar, thus confirming predictions from orbital structure studies and from previous N-body simulations.Comment: 14 pages, 12 figures, minor corrections, accepted by MNRAS. Version with high resolution figures at http://www.oamp.fr/dynamique/pap/M31_th.pd

Approaches for estimating minimal clinically important differences in systemic lupus erythematosus.

A minimal clinically important difference (MCID) is an important concept used to determine whether a medical intervention improves perceived outcomes in patients. Prior to the introduction of the concept in 1989, studies focused primarily on statistical significance. As most recent clinical trials in systemic lupus erythematosus (SLE) have failed to show significant effects, determining a clinically relevant threshold for outcome scores (that is, the MCID) of existing instruments may be critical for conducting and interpreting meaningful clinical trials as well as for facilitating the establishment of treatment recommendations for patients. To that effect, methods to determine the MCID can be divided into two well-defined categories: distribution-based and anchor-based approaches. Distribution-based approaches are based on statistical characteristics of the obtained samples. There are various methods within the distribution-based approach, including the standard error of measurement, the standard deviation, the effect size, the minimal detectable change, the reliable change index, and the standardized response mean. Anchor-based approaches compare the change in a patient-reported outcome to a second, external measure of change (that is, one that is more clearly understood, such as a global assessment), which serves as the anchor. Finally, the Delphi technique can be applied as an adjunct to defining a clinically important difference. Despite an abundance of methods reported in the literature, little work in MCID estimation has been done in the context of SLE. As the MCID can help determine the effect of a given therapy on a patient and add meaning to statistical inferences made in clinical research, we believe there ought to be renewed focus on this area. Here, we provide an update on the use of MCIDs in clinical research, review some of the work done in this area in SLE, and propose an agenda for future research

Exploring the Effect of the COVID-19 Pandemic on the Dental Team:Preparedness, Psychological Impacts and Emotional Reactions

The work was supported by NHS Education Scotland and University of St Andrews provided the open access publication fee.Background: The COVID-19 pandemic has placed increased demands on clinical staff in primary dental care due to a variety of uncertainties. Current reports on staff responses have tended to be brief enquiries without some theoretical explanation supported by developed measurement systems. Aim: To investigate features of health and well-being as an outcome of the uncertainties surrounding COVID-19 for dentists and dental health professionals in primary dental care and for those in training. In addition, the study examined the well-being indices with reference to normative values. Finally a theoretical model was explored to explain depressive symptoms and investigate its generalisability across dentists and dental health professionals in primary dental care and those in postgraduate training. Methods: A cross-sectional survey of dental trainees and primary dental care staff in Scotland was conducted in June to October 2020. Assessment was through “Portal,” an online tool used for course bookings/management administered by NHS Education for Scotland. A non-probability convenience sample was employed to recruit participants. The questionnaire consisted of four multi-item scales including: preparedness (14 items of the DPPPS), burnout (the 9 item emotional exhaustion subscale and 5 items of the depersonalisation subscale of the MBI), the 22 item Impact of Event Scale-Revised, and depressive symptomatology using the Patient Health Questionnaire-2. Analysis was performed to compare the levels of these assessments between trainees and primary dental care staff and a theoretically based path model to explain depressive symptomology, utilising structural equation modelling. Results: Approximately, 27% of all 329 respondents reported significant depressive symptomology and 55% of primary care staff rated themselves as emotionally exhausted. Primary care staff (n = 218) felt less prepared for managing their health, coping with uncertainty and financial insecurity compared with their trainee (n = 111) counterparts (all p's < 0.05). Depressive symptomology was rated higher than reported community samples (p < 0.05) The overall fit of the raw data applied to the theoretical model confirmed that preparedness (negative association) and trauma associated with COVID-19 (positive association) were significant factors predicting lowered mood (chi-square = 46.7, df = 21, p = 0.001; CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). Burnout was indirectly implicated and a major path from trauma to burnout was found to be significant in primary care staff but absent in trainees (p < 0.002). Conclusion: These initial findings demonstrate the possible benefit of resourcing staff support and interventions to assist dental staff to prepare during periods of high uncertainty resulting from the recent COVID-19 pandemic.Publisher PDFPeer reviewe