Improved patient reported outcomes with functional articulating spacers in two-stage revision of the infected hip

BACKGROUND Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties.Interval spacers can be functional articulating or prefabricated.Functional results of these spacers have scarcely been reported.AIM To compare retrospectively the patient reported outcome and infection eradication rate after two-stage revision arthroplasty of the hip with the use of a functional articulating or prefabricated spacer.METHODS All patients with two-stage revision of a hip prosthesis at our hospital between 2003 and 2016 were included in this retrospective cohort study.Patients were divided into two groups;patients treated with a functional articulating spacer or with a prefabricated spacer.Patients completed the Hip Osteoarthritis Outcome Score and the EQ-5D-3L(EQ-5D)and the EQ-5D quality of life thermometer(EQVAS)scores.Primary outcomes were patient reported outcome and infection eradication after two-stage revision.The results of both groups were compared to the patient acceptable symptom state for primary arthroplasty of the hip.Secondary outcomes were complications during spacer treatment and at final follow-up.Descriptive statistics,mean and range are used to represent the demographics of the patients.For numerical variables,students’t-tests were used to assess the level of significance for differences between the groups,with 95%confidence intervals;for binary outcome,we used Fisher’s exact test.RESULTS We consecutively treated 55 patients with a prefabricated spacer and 15 patients with a functional articulating spacer of the hip.The infection eradication rates for functional articulating and prefabricated spacers were 93%and 78%,respectively(P>0.05).With respect to the functional outcome,the Hip Osteoarthritis Outcome Score(HOOS)and its subscores(all P<0.01),the EQ-5D(P<0.01)and the EQVAS scores(P<0.05)were all significantly better for patients successfully treated with a functional articulating spacer.More patients in the functional articulating spacer group reached the patient acceptable symptom state for the HOOS pain,HOOS quality of life and EQ-VAS.The number of patients with a spacer dislocation was not significantly different for the functional articulating or prefabricated spacer group(P>0.05).However,the number of dislocations per patient experiencing a dislocation was significantly higher for patients with a prefabricated spacer(P<0.01).CONCLUSION Functional articulating spacers lead to improved patient reported functional outcome and less perioperative complications after two-stage revision arthroplasty of an infected total hip prosthesis,while maintaining a similar infection eradication rate compared to prefabricated spacers.

Technological developments enable measuring and using patientreported outcomes data in orthopaedic clinical practice

Patient-reported outcomes measures form the backbone of outcomes evaluation in orthopaedics,with most of the literature now relying on these scoring tools to measure change in patient health status.This patient-reported information is increasingly collected routinely by orthopaedic providers but use of the data is typically restricted to academic research.Developments in electronic data capture and the outcome tools themselves now allow use of this data as part of the clinical consultation.This review evaluates the role of patient reported outcomes data as a tool to enhance daily orthopaedic clinical practice,and documents how developments in electronic outcome measures,computer-adaptive questionnaire design and instant graphical display of questionnaire can facilitate enhanced patientclinician shared decision making.

Saving time and effort:Best practice for adapting existing patientreported outcome measures in hepatology

It is increasingly recognised that collecting patient reported outcome measures(PROMs)data is an important part of healthcare and should be considered alongside traditional clinical assessments.As part of a more holistic view of healthcare provision,there has been an increased drive to implement PROM collection as part of routine clinical care in hepatology.This drive has resulted in an increase in the number of PROMs currently developed to be used in various liver conditions.However,the development and validation of a new PROM is time-consuming and costly.Therefore,before deciding to develop a new PROM,researchers should consider identifying existing PROMs to assess their appropriateness and,if necessary,make adaptations to existing PROMs to ensure their rigour when used with the target population.Little is written in the literature on how to identify and adapt the existing PROMs in hepatology.This article aims to provide a summary of the current literature and guidance regarding identifying and adapting existing PROMs in clinical practice.

Patient reported outcome measures in anterior cruciate ligament rupture and reconstruction:The significance of outcome score prediction

BACKGROUND Numerous anterior cruciate ligament(ACL) clinical outcome measures exist.However,the result of one score does not equate to the findings of another even when evaluating the same patient group.AIM To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction.METHODS Fifty patients with ACL rupture were evaluated using nine clinical outcome measures.These included Tegner Activity Score,Lysholm Knee Score,Cincinnati Knee Score,International Knee Documentation Committee(IKDC) Objective Knee Score,Tapper and Hoover Meniscal Grading Score,IKDC Subjective Knee Score,Knee Outcome Survey-Activities of Daily Living Scale(KOS-ADLS),Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score.Thirtyfour patients underwent an ACL reconstruction and were reassessed post-operatively.RESULTS The mean total of each of the nine outcome scores appreciably differed from each other.Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively.The strongest correlation was found between Cincinnati and KOS-ADLS (r=0.91,P<0.001).The strongest regression formula was also found between Cincinnati and KOS-ADLS (R~2=0.84,P<0.001).CONCLUSION The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known.These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data.

Do inflammatory bowel disease patient preferences from treatment outcomes differ by ethnicity and gender?A cross-sectional observational study

BACKGROUND Inflammatory bowel disease(IBD)patients’expectations of treatment outcomes may differ by ethnicity.AIM To investigate treatment preferences of Jewish and Arabs patients.METHODS This prospective survey ranked outcomes treatment preferences among Arab IBD patients,based on the 10 IBD-disk items compared to historical data of Jews.An anonymous questionnaire in either Arabic or Hebrew was distributed among IBD patients.Patients were required to rank 10 statements describing different aspects of IBD according to their importance to the patients as treatment goals.Answers were compared to the answers of a historical group of Jewish patients.RESULTS IBD-disk items of 121 Arabs were compared to 240 Jewish patients.The Jewish patients included more females,[151(62.9%)vs 52(43.3%);P<0.001],higher education level(P=0.02),more urban residence[188(78.3%)vs 54(45.4%);P<0.001],less unemployment[52(21.7%)vs 41(33.9%);P=0.012],higher income level(P<0.001),and more in a partnership[162(67.8%)vs 55(45.4%);P<0.001].Expectations regarding disease symptoms:abdominal pain,energy,and regular defecation ranked highest for both groups.Arabs gave significantly lower rankings(range 4.29-6.69)than Jewish patients(range 6.25-9.03)regarding all items,except for body image.Compared to Arab women,Jewish women attached higher priority to abdominal pain,energy,education/work,sleep,and joint pain.Multivariable regression analysis revealed that higher patient preferences were associated with Jewish ethnicity(OR 4.77;95%CI 2.36-9.61,P<0.001)and disease activity.The more active the disease,the greater the odds ratio for higher ranking of the questionnaire items(1-2 attacks per year:OR 2.13;95%CI 1.02-4.45,P=0.043;and primarily active disease:OR 5.29;95%CI 2.30-12.18,P<0.001).Factors inversely associated with higher patient preference were male gender(OR 0.5;95%CI 0.271-0.935,P=0.030),UC(OR 0.444;95%CI 0.241-0.819,P=0.009),and above average income level(OR 0.267;95%CI:0.124-0.577,P=0.001).CONCLUSION The highest priority for treatment outcomes was symptom relief.,Patients preferences were impacted by ethnicity,gender,and socio-economic disparity.Understanding patients'priorities may improve communication and enable a personalized approach.

Evaluation of patient reported outcome measures post urethroplasty:Piloting a“Trifecta”approach

BACKGROUND Buccal mucosal graft urethroplasty is the gold standard treatment for urethral stricture disease.Toowoomba has obtained a fellowship trained urethroplasty surgeon who has been performing urethroplasties for the last two years.Patient reported outcome measure(PROM)questionnaires allow for a detailed and standardized analysis of success and morbidity post urethroplasty and can be used as a reference point against which urethral surgeons can benchmark their performance.AIM To assess whether patient compliance rates improved with the use of an abridged PROM questionnaire.METHODS Our database of urethroplasty patients was searched to identify patients who had completed the original PROM.This is routinely requested to be completed at the 3-,6-and 12-mo mark.All patients are asked to complete the questionnaire and to bring it back to their next appointment.Our original PROM consists of the international prostate symptom score,the sexual health index measure and the Global Response Assessment.An abridged version of the questionnaire was derived focusing on urinary flow,sexual function and overall quality of life and consisted of three questions.RESULTS Sixty-six patients were included in our study.Fifty-four patients had been invited to complete the original PROM with an overall compliance rate of 30%.Compliance rates improved to 91%with the introduction of the modified PROM.No correlation between non-compliance and patient factors were found.There was also no significant difference in patient reported quality of life when comparing urinary flow and sexual function.CONCLUSION We recommend the use of PROMs pre-and post-operatively to accurately determine the level of patient satisfaction.We acknowledge the aversion of patients in completing PROMs due to the length of these questionnaires.We propose a simplistic version aimed at the“Trifecta”of urethroplasty comprising of three questions focusing each on urinary flow,sexual function and quality of life.Our modified PROM demonstrated markedly improved compliance rates and can be used as a screening tool to identify patients who might have had a poor outcome and who require a more in-depth assessment.

Comparison of clinical outcomes between total hip replacement and total knee replacement

BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.

Neuropathy experienced by colorectal cancer patients receiving oxaliplatin: A qualitative study to validate the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity scale

BACKGROUND Although oxaliplatin is widely established as a standard treatment in colorectal cancer(CRC),oxaliplatin-induced neuropathy has emerged as a prominent doselimiting side effect associated with quality of life decrements.Ongoing monitoring and management of neuropathy is important for CRC patient quality of life and adherence to treatment.Therefore,a validated self-reported measure of neuropathy would aid in the management and assessment of oxaliplatininduced neuropathy in clinical practice and research.We sought to evaluate the content validity of the 13-item Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale(FACT/GOGNtx)for CRC patients receiving oxaliplatin.AIM To understand the neuropathy experiences of CRC patients and assess content validity of the FACT/GOG-Ntx.METHODS Semi-structured concept elicitation and cognitive debriefing interviews were conducted with 31 CRC patients experiencing peripheral neuropathy from current or previous oxaliplatin treatment.Interview data were analyzed using a constant comparative approach,and data were mapped to the FACT/GOG-Ntx to assess content validity.RESULTS Mean age of the sample was 54(range 34-82).The sample was primarily Caucasian(84%)and consisted of nearly equal numbers of men and women.Participants described 28 unique neuropathy symptoms;hand tingling(experienced by 87%of respondents);feet tingling(81%);hand numbness(68%);and feet numbness(84%)were most frequently mentioned.Neuropathy symptoms occurring on the feet were most often identified as most bothersome by participants.Eleven of the 13 FACT/GOG-Ntx items exhibited moderate to strong evidence of content validity.Two items related to trouble hearing and ringing in the ears had weak support;however,these items represent severe neuropathy and could be useful for a patient reported outcome measure.CONCLUSION The FACT/GOG-Ntx represents the key neuropathy experiences of CRC patients treated with oxaliplatin.

High rate of clinically relevant improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis

BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital,Denmark.The patients were evaluated preoperatively and 3 months,6 months,12 months,and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index(WOOS),Oxford Shoulder Score(OSS)and Constant-Murley Score(CMS).The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID.Based on previous literature,MCID for WOOS,OSS,and CMS were defined as 12.3,4.3,and 12.8 respectively.RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis.Mean age at the time of surgery was 66 years(range 49.0-79.0,SD:8.3)and 65%were women.One patient was revised within the two years follow-up.The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points[95%confidence interval(95%CI):39.7-53.3,P<0.005]for WOOS,18.2 points(95%CI:15.5-21.0,P<0.005)for OSS and 37.8 points(95%CI:31.5-44.0,P<0.005)for CMS.Two years postoperatively,41 patients(87%)had an improvement in WOOS that exceeded the MCID,45 patients(94%)had an improvement in OSS that exceeded the MCID,and 42 patients(88%)had an improvement in CMS that exceeded the MCID.CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90%of patients has a clinically relevant improvement.This is a clear message when informing patients about their prognosis.

Health economics for intra-capsular hip fractures undertaking fixation

BACKGROUND Hip fracture is a common musculoskeletal injury in the elderly requiring surgery worldwide.The operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for fixation.AIM To determine the most beneficial method of fixation for patients with intracapsular hip fractures.METHODS A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation methods.Patient notes,electronic records and clinical codes for cost benefit were evaluated.A validated quality of life measure was collected at least 1 year after surgery.RESULTS A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective period.There were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age,gender,co-morbidities and fracture configuration.There was no significant difference in blood loss,tip apex distance,radiation exposure,length of stay,radiological union time,collapse,avascular necrosis or re-operation between fixation methods.Logistic regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of 7.25.There were 9(19%)and 4(11%)patients respectively,who required re-operation.There was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual CONCLUSION No significant advantage was identified with differing fixation type,but irrespective there were a high number of patients requiring re-operation.This was predicted by initial fracture displacement and patient age.Arthroplasty may need to be carefully considered for health economics and patient benefit.

What factors influence patient experience in orthopedic oncology office visits?

BACKGROUND Patient satisfaction and reported outcomes are becoming increasingly important in determining the efficacy of clinical care.To date no study has evaluated the patient experience in the orthopedic oncology outpatient setting to determine which factors of the encounter are priorities to the patient.AIM To evaluate what factors impact patient experience and report satisfaction in an outpatient orthopedic oncology clinic.METHODS Press Ganey®patient surveys from a single outpatient orthopedic oncology clinic at a tertiary care setting were prospectively collected per routine medical care.All orthopedic oncology patients who were seen in clinic and received electronic survey were included.All survey responses were submitted within one month of clinic appointment.IRB approval was obtained to retrospectively collect survey responses from 2015 to 2016.Basic demographic data along with survey category responses were collected and statistically analyzed.RESULTS One hundred sixty-two patient surveys were collected.Average patient age was 54.4 years(SD=16.2 years)and were comprised of 51.2% female and 48.4%male.64.2%of patients were from in-state.Out of state residents were more likely to recommend both the practice and attending physician.The likelihood to recommend attending physician was positively associated with MD friendliness/courtesy(OR=14.4,95%CI:2.5-84.3),MD confidence(OR=48.2,95%CI:6.2-376.5),MD instructions follow-up care(OR=2.5,95%CI:0.4-17.4),and sensitivity to needs(OR=16.1,95%CI:1-262.5).Clinic operations performed well in the categories of courtesy of staff(76%)and cleanliness(75%)and less well in ease of getting on the phone(49%),information about delays(36%),and wait time(37%).CONCLUSION Orthopedic specialties can utilize information from this study to improve care from the patient perspective.Future studies may be directed at how to improve these areas of care which are most valued by the patient.

Comparison of effects of six main gastrectomy procedures on patients’ quality of life assessed by Postgastrectomy Syndrome Assessment Scale-45

BACKGROUND The effects of various gastrectomy procedures on the patient’s quality of life(QOL)are not well understood.Thus,this nationwide multi-institutional crosssectional study using the Postgastrectomy Syndrome Assessment Scale-45(PGSAS-45),a well-established questionnaire designed to clarify the severity and characteristics of the postgastrectomy syndrome,was conducted.AIM To compare the effects of six main gastrectomy procedures on the postoperative QOL.METHODS Eligible questionnaires retrieved from 2368 patients who underwent either of six gastrectomy procedures[total gastrectomy with Roux-en-Y reconstruction(TGRY;n=393),proximal gastrectomy(PG;n=193),distal gastrectomy with Roux-en-Y reconstruction(DGRY;n=475),distal gastrectomy with Billroth-I reconstruction(DGBI;n=909),pylorus-preserving gastrectomy(PPG;n=313),and local resection of the stomach(LR;n=85)]were analyzed.Among the 19 main outcome measures of PGSAS-45,the severity and characteristics of postgastrectomy syndrome were compared for the aforementioned six gastrectomy procedures using analysis of means.RESULTS TGRY and PG significantly impaired the QOL of postoperative patients.Postoperative QOL was excellent in LR(cardia and pylorus were preserved with minimal resection).In procedures removing the distal stomach,diarrhea subscale(SS)and dumping SS were less frequent in PPG than in DGBI and DGRY.However,there was no difference in the postoperative QOL between DGBI and DGRY.The most noticeable adverse effects caused by gastrectomy were mealrelated distress SS,dissatisfaction at the meal,and weight loss,with significant differences among the surgical procedures.CONCLUSION Postoperative QOL greatly differed among six gastrectomy procedures.The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures,overcome surgical shortcomings,and enhance postoperative care.

Patient-centric periodontal research:A pioneering application of patient-reported outcome measures

Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.

Predictors of clinical outcomes after non-operative management of symptomatic full-thickness rotator cuff tears

BACKGROUND Previous studies have shown that non-surgical management can be an effective treatment strategy for many patients with rotator cuff tears.Despite the prevalence of rotator cuff disease,few studies have examined the patient and tear related factors that predict outcomes of nonsurgical management in this cohort of patients.AIM To identify factors that are associated with changes in patient reported outcomes over time in individuals with full-thickness rotator cuff tears treated without surgery.METHODS A cohort of 59 patients who underwent non-surgical management of full thickness rotator cuff tears with a minimum of 1-year follow-up were identified from our institutional registry.Patient demographics,comorbidities and tear characteristics were collected at initial presentation.Outcome measures were collected at baseline and at each clinical follow-up,which included Western Ontario Rotator Cuff(WORC)index,American Shoulder and Elbow Surgeons score,Visual Analog Scale for pain and Single Assessment Numerical Evaluation.Multi-and univariate regression analyses were used to determine the impact of each patient and tear related variable on final WORC scores and change in WORC scores throughout the study.RESULTS In this non-surgical cohort,all patient-reported outcome measures significantly improved compared to baseline at 1 and 2-year follow-up.There was no significant difference in outcomes between 1 and 2 years.The average improvement surpassed the published minimal clinically important differences values for WORC,American Shoulder and Elbow Surgeons,Visual Analog Scale pain and Single Assessment Numerical Evaluation scores.Regression analysis identified female gender(β=-19.88,P=0.003),smoking(β=-29.98,P=0.014)and significant subscapularis fatty infiltration(β=-15.35,P=0.024)as predictors of less favorable WORC scores at 1 year,and female gender(β=-19.09,P=0.015)alone as a predictor of lower WORC scores at 2 years.Patients with symptom duration greater than 1 year at presentation reported less improvement in WORC scores at 1-year follow-up(β=-14.63,P=0.052)and patients with traumatic tears reported greater improvements in WORC scores at 2-year follow-up(β=17.37,P=0.031).CONCLUSION Patients with full thickness rotator cuff tears can achieve and maintain clinically meaningful benefit from non-surgical management through 2-year follow-up.Female patients,smokers,and those with significant subscapularis fatty infiltration tend to have lower overall WORC scores at 1-year follow-up,and females also have lower WORC scores at 2-year follow-up.Patients presenting with symptoms greater than 1 year had less clinical improvement at 1-year follow-up,and those with traumatic tears had greater clinical improvement at 2-year follow-up.

Arabic Version of the Modified Constant Murley Score

Objectives: “Patient-reported outcome measures” has been used extensively, and it has shown the diseases’ impact on patient quality of life and has enabled the clinician to evaluate the clinical care efficacy. In the literature, there are more than 34 shoulder function assessment scoring instruments;the Modified Constant Murley Score (M-CMS) is one of the most popular scores. Although, the M-CMS had been translated and culturally adapted to Danish, Brazilian and Turkish versions, there is no Arabic version found in the literature. We aim to translate and culturally adapt M-CMS into the Arabic language. Method: The M-CMS was translated using previously published guidelines. The translation and cultural adaptation were done in five stages, initial translation by two bilingual translators then a synthesis of the translations after that, back translation by two native English speakers. Then an expert committee meeting approved the pre-final Arabic version. Finally, a pilot test was conducted on 41 patients to ensure its validity. Results: The M-CMS was successfully translated from the original English version to the Arabic version;no difficulties in the translation process were faced. Conclusion: A validated Arabic version of the M-CMS was produced and ready to be used for functional assessment of different shoulder pathologies in Arabic-speaking countries. Future study is needed for translation and cultural adaptation of the English standardized test protocol to assure the reproducibility of the Arabic version of the M-CMS.

Investigating the Effect of COVID-19 Infection on Professional Athletes’ Post-Infection with a Focus on Fatigue and Chronic Fatigue Syndrome

Introduction and Objectives: COVID-19 has been reported to cause long-term sequela including persistent fatigue and Chronic Fatigue Syndrome (CFS) in the general population. However, it remains to be seen if similar effects are observed in an athlete population. The aetiology and pathophysiology are poorly understood but is thought to be multi-factorial. Patient reported outcome measures are commonly used to improve patient-centred outcomes (PROMs). They are essential to assess patient quality of life post-COVID infection. This paper aims to assess the effect of COVID-19 on athletes’ long-term fatigue and CFS and identify the PROMs used to characterise this. Methodology: Articles were selected for extraction based on the eligibility criteria and PRISMA guidelines. The inclusion criteria required papers to assess competitive athletes over eighteen years of age who were clinically diagnosed with COVID-19. Articles were extracted to assess different variables including type of sport, type of athlete and ethnicity. Key terms were obtained using MeSH trees and utilised with Web of Science and NCBI Pubmed. Papers were graded by quality using the Hawker quality assessment tool. Results and Discussion: Forty articles (N = 40) were identified for full-text screening (N = 8). Eight were selected for extraction based on the eligibility criteria. Data was obtained on athlete characteristics, sport characteristics, properties of PROM measurement techniques and fatigue presentation. Male athletes were found to be 10% - 50% more likely than female athletes to suffer from persistent fatigue symptoms (N = 2). Persistent fatigue was present in 9% - 10% Athletes from mixed backgrounds and genders (N = 2). Initial fatigue was documented to be between 47% - 56% (N = 2). A heterogenous range of PROMs were utilised to assess symptoms including fatigue and excluded emotional or mental fatigue. Conclusion: COVID-19 is associated with signs of persisting fatigue and potentially CFS in athlete populations. More work needs to be done to develop standardised and validated PROMs specific to CFS.

External validation of the Moroccan Arabic version of the European Organization for Research and Treatment of Cancer colorectal(CR29)module:Monocentric study

BACKGROUND Quality of life(QoL)outcomes are a focal endpoint of cancer treatment strategies.AIM To externally validate the Moroccan Arabic version of the European Organization for Research and Treatment of Cancer(EORTC)QoL Questionnaire(QLQ)for colorectal cancer(CRC)patients(CR29).METHODS Both Moroccan Arabic modules of QLQ-CR29 and QLQ-C30 were administered to Moroccan CRC.Psychometric properties were retested by measuring Cronbach’s alpha coefficient for reliability and Intraclass correlation coefficient(ICC)to examine test-retest reproducibility.The multitrait-scaling analysis was performed to demonstrate the validity of the instrument and known-groups comparison was used to test the score’s ability to discriminate between different groups of patients.RESULTS In total,221 patients were included in our study and 34 patients completed the questionnaire twice.The Urinary Frequency scale and Stool Frequency scale had good internal consistency with alpha Cronbach coefficients of 0.79 and 0.83 respectively,while the same coefficients were moderately lower for the Blood and Mucus in Stool scale(0.61)and the Body Image scale(0.67).The ICCs ranged from 0.88 to 1 indicating good to excellent reproducibility.In multitrait scaling analyses,the criterion for item convergent and divergent validity was satisfactory.The known-group comparison showed statistically significant differences between patients according to age,gender,stoma status,tumor location,and radiotherapy.CONCLUSION The Moroccan Arabic version of the EORTC QLQ-CR29 is a valid and reliable tool that can be used safely for research and clinical purposes in Moroccan CRC patients.

Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:A comparison of clinical and radiological outcomes

BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.

Hamstring autograft utilization in reconstructing anterior cruciate ligament:Review of harvesting techniques,graft preparation,and different fixation methods

Rupture of the anterior cruciate ligament(ACL)is a common orthopedic injury.Various graft options are available for the reconstruction of ruptured ACL.Using the hamstring muscle as an autograft was first described in 1934,and it remains a commonly harvested graft for ACL reconstruction.Hamstring autografts can be harvested using the traditional anteromedial approach or the newer posteromedial technique.An isolated semitendinosus tendon can be used or combined with the gracilis tendon.There are numerous methods for graft fixation,such as intra-tunnel or extra-tunnel fixation.This comprehensive review discusses the different hamstring muscle harvesting techniques and graft preparation options and fixation methods.It provides a comprehensive overview for choosing the optimal surgical technique when treating patients.

Development of a Functional Assessment of Chronic Illness Therapy item library and primary symptom list for the assessment of patient-reported adverse events associated with immune checkpoint modulators

Aim:To develop a comprehensive item library of patient-reported,immunotherapy-related adverse events(irAEs)that draws from and expands on the Functional Assessment of Chronic Illness Therapy(FACIT)Measurement System.Methods:Literature review and iterative expert input.Based on a literature review of irAEs,we developed a framework of immunotherapy classes and their associated symptoms.Clinical experts then reviewed iterations of symptom summaries and item maps linked to the immunotherapy framework.Experts provided content review and feedback was shared across experts until consensus was reached.The iterative process facilitated creation of a Primary Symptom List associated with immune checkpoint modulators(ICMs),drawn from the larger set of symptoms.Existing FACIT items were mapped to the symptom list,and new items were written as needed to create the item library.Results:The full item library of irAEs is comprised of 239 items,covering 142 unique symptoms across 75 inflammatory reactions/immune conditions.A subset of 66 items comprises a Primary Symptom List considered most common/relevant to ICM treatment.This includes gastrointestinal,skin,pulmonary,neurologic,musculoskeletal,and multiple miscellaneous and constitutional symptoms.Conclusion:The FACIT Immunotherapy Item Library is a compilation of 239 self-report items that capture the wide range of AEs experienced by people receiving immune treatments.A subset of 66 items comprises a Primary Symptom List meant for ICM therapy.Use of items selected from this library is encouraged in clinical research and clinical practice evaluation.