Pub Date : 2024-12-19DOI: 10.1097/CORR.0000000000003349
Eduardo Silva Reis Barreto, César Romero Antunes Júnior, Israel Cardoso Silva, Vinicius Borges Alencar, Thiago Batista Faleiro, Durval Campos Kraychete
<p><strong>Background: </strong>Several meta-analyses have evaluated the use of platelet-rich plasma (PRP) in the treatment of Achilles tendinopathy. Although they generally did not find PRP to be effective, an updated meta-analysis containing all the available, high-quality randomized trial evidence that addresses the methodological shortcomings identified in earlier meta-analyses needs to be performed.</p><p><strong>Question/purposes: </strong>This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in improving (1) pain and function as assessed using the Victorian Institute of Sports Assessment-Achilles (VISA-A) score 3 months, 6 months, and 1 year after treatment and (2) VAS pain scores 3 months after treatment in patients with chronic Achilles tendinopathy.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Scopus, Embase, and Cochrane CENTRAL from their inception until June 2024, focusing on randomized clinical trials (RCTs) comparing PRP with placebo or other treatments for Achilles tendinopathy. Our search identified 1289 studies, of which 1262 were excluded after removing duplicates and screening titles and abstracts, leaving 27 studies for detailed review. Six RCTs met the inclusion criteria, encompassing 422 patients, with a predominance of participants who were men. Publication bias was suggested by funnel plot asymmetry, which suggested that, if anything, the results may have overstated the apparent benefit of PRP treatment. Risk of bias was evaluated using the Cochrane Risk of Bias tool for randomized trials, revealing an overall low or unclear risk of bias. The primary outcomes were pain relief and functional improvement, assessed using the VAS, scored 0 to 10, with higher scores representing more severe pain, and VISA-A score, scored 0 to 100, with higher scores representing better pain and function. Heterogeneity was assessed using the Cochran Q test and I2 statistics, and a random-effects model was applied due to substantial heterogeneity. Statistical analyses were performed using Review Manager 5.4 and RStudio, version 764.</p><p><strong>Results: </strong>We found no benefit in terms of VISA-A scores favoring PRP over placebo at 3 months (mean difference 1.7 [95% confidence interval (CI) -1.8 to 5.2]; p = 0.34), 6 months (mean difference 0.5 [95% CI [-8.5 to 9.3]; p = 0.92), or 1 year (mean difference -7.9 [95% CI -27.3 to 11.6]; p = 0.43). PRP did not improve VAS pain scores at 3 months (mean difference -0.22 [95% CI -0.56 to 0.12]; p = 0.21). Sensitivity analyses confirmed these findings. PRP showed no difference compared with stromal vascular fraction and was less effective in the short term compared with high-volume injection.</p><p><strong>Conclusion: </strong>Until future high-quality RCTs show a clear clinical benefit, PRP should not be used to treat Achilles tendinopathy. Our analysis found that PRP does not improve pain or function compared with placebo, and potential publ
背景：几项荟萃分析评估了富血小板血浆（PRP）在跟腱病治疗中的应用。虽然他们通常没有发现PRP是有效的，但需要进行一项包含所有可用的高质量随机试验证据的更新荟萃分析，以解决早期荟萃分析中发现的方法学缺陷。问题/目的：本系统综述和荟萃分析旨在评估PRP在改善慢性跟腱病患者治疗后3个月、6个月和1年维多利亚运动评估研究所跟腱（VISA-A）评分和治疗后3个月VAS疼痛评分方面的疗效(1)。方法：我们对PubMed、Scopus、Embase和Cochrane CENTRAL从成立到2024年6月进行了系统检索，重点是比较PRP与安慰剂或其他治疗跟腱病的随机临床试验（rct）。我们的检索确定了1289项研究，其中1262项在删除重复和筛选标题和摘要后被排除，留下27项研究供详细审查。6项随机对照试验符合纳入标准，共纳入422例患者，参与者以男性为主。漏斗图不对称表明发表偏倚，这表明，如果有的话，结果可能夸大了PRP治疗的明显益处。使用随机试验的Cochrane偏倚风险工具评估偏倚风险，显示总体偏倚风险较低或不明确。主要结局是疼痛缓解和功能改善，使用VAS评估，评分0至10分，得分越高表示疼痛越严重，VISA-A评分0至100分，得分越高表示疼痛和功能越好。异质性采用Cochran Q检验和I2统计量进行评估，由于异质性较大，采用随机效应模型。统计分析使用Review Manager 5.4和RStudio 764版本进行。结果：我们发现在3个月时，PRP优于安慰剂的VISA-A评分没有益处(平均差异为1.7[95%置信区间(CI) -1.8至5.2]；p = 0.34)， 6个月(平均差异0.5 [95% CI [-8.5 ~ 9.3]；p = 0.92)或1年(平均差异-7.9 [95% CI -27.3至11.6]；P = 0.43)。PRP在3个月时没有改善VAS疼痛评分(平均差异-0.22 [95% CI -0.56至0.12]；P = 0.21)。敏感性分析证实了这些发现。PRP与基质血管分数相比无差异，短期内与大容量注射相比效果较差。结论：在未来高质量的随机对照试验显示出明确的临床益处之前，PRP不应用于治疗跟腱病。我们的分析发现，与安慰剂相比，PRP并没有改善疼痛或功能，潜在的发表偏倚表明，PRP的明显益处可能被夸大了。外科医生在考虑这种情况下的PRP时应该谨慎，未来的研究应该集中在更大规模的试验和标准化的方案上，以提供更明确的指导。证据等级：II级，治疗性研究。
{"title":"Is Platelet-rich Plasma Effective in Treating Achilles Tendinopathy? A Meta-analysis of Randomized Clinical Trials.","authors":"Eduardo Silva Reis Barreto, César Romero Antunes Júnior, Israel Cardoso Silva, Vinicius Borges Alencar, Thiago Batista Faleiro, Durval Campos Kraychete","doi":"10.1097/CORR.0000000000003349","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003349","url":null,"abstract":"<p><strong>Background: </strong>Several meta-analyses have evaluated the use of platelet-rich plasma (PRP) in the treatment of Achilles tendinopathy. Although they generally did not find PRP to be effective, an updated meta-analysis containing all the available, high-quality randomized trial evidence that addresses the methodological shortcomings identified in earlier meta-analyses needs to be performed.</p><p><strong>Question/purposes: </strong>This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in improving (1) pain and function as assessed using the Victorian Institute of Sports Assessment-Achilles (VISA-A) score 3 months, 6 months, and 1 year after treatment and (2) VAS pain scores 3 months after treatment in patients with chronic Achilles tendinopathy.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Scopus, Embase, and Cochrane CENTRAL from their inception until June 2024, focusing on randomized clinical trials (RCTs) comparing PRP with placebo or other treatments for Achilles tendinopathy. Our search identified 1289 studies, of which 1262 were excluded after removing duplicates and screening titles and abstracts, leaving 27 studies for detailed review. Six RCTs met the inclusion criteria, encompassing 422 patients, with a predominance of participants who were men. Publication bias was suggested by funnel plot asymmetry, which suggested that, if anything, the results may have overstated the apparent benefit of PRP treatment. Risk of bias was evaluated using the Cochrane Risk of Bias tool for randomized trials, revealing an overall low or unclear risk of bias. The primary outcomes were pain relief and functional improvement, assessed using the VAS, scored 0 to 10, with higher scores representing more severe pain, and VISA-A score, scored 0 to 100, with higher scores representing better pain and function. Heterogeneity was assessed using the Cochran Q test and I2 statistics, and a random-effects model was applied due to substantial heterogeneity. Statistical analyses were performed using Review Manager 5.4 and RStudio, version 764.</p><p><strong>Results: </strong>We found no benefit in terms of VISA-A scores favoring PRP over placebo at 3 months (mean difference 1.7 [95% confidence interval (CI) -1.8 to 5.2]; p = 0.34), 6 months (mean difference 0.5 [95% CI [-8.5 to 9.3]; p = 0.92), or 1 year (mean difference -7.9 [95% CI -27.3 to 11.6]; p = 0.43). PRP did not improve VAS pain scores at 3 months (mean difference -0.22 [95% CI -0.56 to 0.12]; p = 0.21). Sensitivity analyses confirmed these findings. PRP showed no difference compared with stromal vascular fraction and was less effective in the short term compared with high-volume injection.</p><p><strong>Conclusion: </strong>Until future high-quality RCTs show a clear clinical benefit, PRP should not be used to treat Achilles tendinopathy. Our analysis found that PRP does not improve pain or function compared with placebo, and potential publ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-18DOI: 10.1097/CORR.0000000000003343
Tom Joris Crijns
{"title":"CORR Insights®: Is It Possible to Develop a Patient-reported Experience Measure With Lower Ceiling Effect?","authors":"Tom Joris Crijns","doi":"10.1097/CORR.0000000000003343","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003343","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-17DOI: 10.1097/CORR.0000000000003348
Jessica Stambaugh, Patrick Morrissey, Andrew Hurvitz, Ethan Bernstein, Brian Barlow
<p><strong>Background: </strong>Femoroacetabular impingement (FAI) is a well-recognized cause of hip pain in adults. The hip-spine relationship between the femur, pelvis, and lumbosacral spine has garnered recent attention in hip arthroplasty. However, the hip-spine relationship has not been well described in patients with FAI.</p><p><strong>Questions/purposes: </strong>The goal of this study was to determine whether lumbopelvic mobility is altered after hip arthroscopy. Does lumbopelvic motion, defined as the difference between standing and sitting measurements for sacral slope (SS), pelvic tilt (PT), and pelvic-femoral angle (PFA), change after hip arthroscopy for FAI?</p><p><strong>Methods: </strong>Between June 2019 and March 2020, one surgeon performed 43 arthroscopic hip labral repair surgeries for FAI in active-duty military servicemembers. The diagnosis of FAI was made clinically and with standing AP pelvis, Dunn lateral, and false-profile radiographs. All patients underwent advanced imaging, including 3T MRI to identify labral tears and three-dimensional CT to characterize bony morphology. The musculoskeletal radiologist measured alpha angle, lateral center-edge angle, anterior center-edge angle, neck-shaft angle, femoral version, and acetabular version at 1200, 1300, 1400, and 1500 using CT. Patients also underwent a diagnostic fluoroscopic-guided injection with local anesthetic and corticosteroids; > 50% pain relief was considered a positive response to injection. During the study period, the operative surgeon did not perform any open procedures for FAI; all surgical treatment was performed arthroscopically. Preoperative sitting and standing radiographs were obtained from all patients. Ninety-five percent (41 of 43) of the cohort underwent adequate postoperative sitting and standing radiographs obtained 2 months after surgery, which were used for analysis in this retrospective study. The cohort was 71% male (29 of 41) and 29% female (12 of 41), with a mean age of 33 years. Within this military population undergoing primary hip arthroscopy, 30 were enlisted servicemembers and 11 were officers. SS, PT, and PFA were measured by four observers on sitting and standing lateral pelvic radiographs. Interclass correlation statistics indicated high reliability for SS, PT, and seated PFA (κ range 0.75 to 1.00) compared with lower reliability for standing PFA measurements (κ range 0.59 to 0.65). The delta between standing and sitting SS, PT, and PFA was compared perioperatively. Student t-test analysis was used for comparisons (p < 0.05).</p><p><strong>Results: </strong>Lumbosacral motion in the sitting position changed after hip arthroscopy. Measurements of the standing lumbopelvic mobility did not change with hip arthroscopy: ΔSS = 1.8° (p = 0.13), ΔPT = -0.56° (p = 0.50), ΔPFA = 0.54° (p = 0.50). However, measurements of sitting lumbopelvic mobility did change with hip arthroscopy. SS diminished (Δ = -4.3°; p = 0.008), PT increased (Δ = +3.9°;
{"title":"Hip-Spine Relationship in Femoroacetabular Impingement: Does Hip Arthroscopy Affect Pelvic Mobility?","authors":"Jessica Stambaugh, Patrick Morrissey, Andrew Hurvitz, Ethan Bernstein, Brian Barlow","doi":"10.1097/CORR.0000000000003348","DOIUrl":"10.1097/CORR.0000000000003348","url":null,"abstract":"<p><strong>Background: </strong>Femoroacetabular impingement (FAI) is a well-recognized cause of hip pain in adults. The hip-spine relationship between the femur, pelvis, and lumbosacral spine has garnered recent attention in hip arthroplasty. However, the hip-spine relationship has not been well described in patients with FAI.</p><p><strong>Questions/purposes: </strong>The goal of this study was to determine whether lumbopelvic mobility is altered after hip arthroscopy. Does lumbopelvic motion, defined as the difference between standing and sitting measurements for sacral slope (SS), pelvic tilt (PT), and pelvic-femoral angle (PFA), change after hip arthroscopy for FAI?</p><p><strong>Methods: </strong>Between June 2019 and March 2020, one surgeon performed 43 arthroscopic hip labral repair surgeries for FAI in active-duty military servicemembers. The diagnosis of FAI was made clinically and with standing AP pelvis, Dunn lateral, and false-profile radiographs. All patients underwent advanced imaging, including 3T MRI to identify labral tears and three-dimensional CT to characterize bony morphology. The musculoskeletal radiologist measured alpha angle, lateral center-edge angle, anterior center-edge angle, neck-shaft angle, femoral version, and acetabular version at 1200, 1300, 1400, and 1500 using CT. Patients also underwent a diagnostic fluoroscopic-guided injection with local anesthetic and corticosteroids; > 50% pain relief was considered a positive response to injection. During the study period, the operative surgeon did not perform any open procedures for FAI; all surgical treatment was performed arthroscopically. Preoperative sitting and standing radiographs were obtained from all patients. Ninety-five percent (41 of 43) of the cohort underwent adequate postoperative sitting and standing radiographs obtained 2 months after surgery, which were used for analysis in this retrospective study. The cohort was 71% male (29 of 41) and 29% female (12 of 41), with a mean age of 33 years. Within this military population undergoing primary hip arthroscopy, 30 were enlisted servicemembers and 11 were officers. SS, PT, and PFA were measured by four observers on sitting and standing lateral pelvic radiographs. Interclass correlation statistics indicated high reliability for SS, PT, and seated PFA (κ range 0.75 to 1.00) compared with lower reliability for standing PFA measurements (κ range 0.59 to 0.65). The delta between standing and sitting SS, PT, and PFA was compared perioperatively. Student t-test analysis was used for comparisons (p < 0.05).</p><p><strong>Results: </strong>Lumbosacral motion in the sitting position changed after hip arthroscopy. Measurements of the standing lumbopelvic mobility did not change with hip arthroscopy: ΔSS = 1.8° (p = 0.13), ΔPT = -0.56° (p = 0.50), ΔPFA = 0.54° (p = 0.50). However, measurements of sitting lumbopelvic mobility did change with hip arthroscopy. SS diminished (Δ = -4.3°; p = 0.008), PT increased (Δ = +3.9°; ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-13DOI: 10.1097/CORR.0000000000003345
Kali Tileston
{"title":"CORR Insights®: No Association Between Growth Hormone Therapy and Upper Extremity Physeal Tension Injuries: A Matched Case-control Study.","authors":"Kali Tileston","doi":"10.1097/CORR.0000000000003345","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003345","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-12DOI: 10.1097/CORR.0000000000003342
Kathryn Canavan, Qais Zai, David Bruni, Jeremiah Alexander, Koen D Oude Nijhuis, David Ring
<p><strong>Background: </strong>Shoulder pain-mostly related to rotator cuff tendinopathy-is the most common reason adults seek upper limb specialty care. Tendinopathy of the long head of the biceps may be part of rotator cuff tendinopathy, which most of us develop as we age. Evidence that these processes are related and that both are part of human shoulder senescence could contribute to a reconceptualization of shoulder tendinopathy as a single set of age-related changes, which are often well-accommodated, sometimes misinterpreted as an injury, and associated with notable nonspecific treatment effects, thus meriting caution regarding the potential for overtreatment.</p><p><strong>Questions/purposes: </strong>This study reviewed a consecutive series of MRI scans ordered for the evaluation of shoulder pain and asked: (1) Is long head of the biceps tendinopathy associated with advancing age? (2) Is long head of the biceps tendinopathy associated with concomitant degeneration of the rotator cuff tendons?</p><p><strong>Methods: </strong>Five hundred consecutive radiologist interpretations of MRIs of the shoulder obtained between May 2016 and June 2017 for assessment of shoulder pain in adults at a radiology group that provides approximately 80% of the imaging in all practices in our region were reviewed. Patients with bilateral MRIs had one MRI included at random. Patients with fractures, dislocations, previous surgery, and soft tissue masses seen on MRI were excluded, leaving 406 shoulder MRI interpretations for review. The radiology reports were used to identify the presence and severity of rotator cuff and long head of the biceps tendinopathy. Forty-nine percent (197 of 406) were men with a mean ± SD age of 55 ± 14 years, and 54% (220 of 406) were right shoulders. Multivariable analyses accounting for age and gender evaluated the association of long head of the biceps tendinopathy with age and tendinopathy of the rotator cuff tendons.</p><p><strong>Results: </strong>After controlling for tendinopathy of the other rotator cuff tendons, long head of the biceps tendinopathy was more common with advancing age (OR 1.04 [95% CI 1.02 to 1.06] per year; p < 0.001), meaning the prevalence increases by approximately 4% per year. Among people who were imaged for shoulder pain, everyone 85 years or older had both long head of the biceps and rotator cuff tendinopathy. Any rotator cuff pathophysiology was also notably associated with any long head of the biceps pathophysiology (OR 6.9 [95% CI 2.4 to 20]; p < 0.001). About half (49% [162 of 328]) of long head of the biceps tendons were normal in the presence of any supraspinatus tendinopathy, and 5% (9 of 175) of supraspinatus tendons were normal in the presence of any long head of the biceps tendinopathy.</p><p><strong>Conclusion: </strong>The finding that among people seeking care for shoulder pain, long head of the biceps tendinopathy and rotator cuff tendinopathy occur together and are more common with incre
{"title":"Long Head of Biceps Tendinopathy Is Associated With Age and Cuff Tendinopathy on MRI Obtained for Evaluation of Shoulder Pain.","authors":"Kathryn Canavan, Qais Zai, David Bruni, Jeremiah Alexander, Koen D Oude Nijhuis, David Ring","doi":"10.1097/CORR.0000000000003342","DOIUrl":"10.1097/CORR.0000000000003342","url":null,"abstract":"<p><strong>Background: </strong>Shoulder pain-mostly related to rotator cuff tendinopathy-is the most common reason adults seek upper limb specialty care. Tendinopathy of the long head of the biceps may be part of rotator cuff tendinopathy, which most of us develop as we age. Evidence that these processes are related and that both are part of human shoulder senescence could contribute to a reconceptualization of shoulder tendinopathy as a single set of age-related changes, which are often well-accommodated, sometimes misinterpreted as an injury, and associated with notable nonspecific treatment effects, thus meriting caution regarding the potential for overtreatment.</p><p><strong>Questions/purposes: </strong>This study reviewed a consecutive series of MRI scans ordered for the evaluation of shoulder pain and asked: (1) Is long head of the biceps tendinopathy associated with advancing age? (2) Is long head of the biceps tendinopathy associated with concomitant degeneration of the rotator cuff tendons?</p><p><strong>Methods: </strong>Five hundred consecutive radiologist interpretations of MRIs of the shoulder obtained between May 2016 and June 2017 for assessment of shoulder pain in adults at a radiology group that provides approximately 80% of the imaging in all practices in our region were reviewed. Patients with bilateral MRIs had one MRI included at random. Patients with fractures, dislocations, previous surgery, and soft tissue masses seen on MRI were excluded, leaving 406 shoulder MRI interpretations for review. The radiology reports were used to identify the presence and severity of rotator cuff and long head of the biceps tendinopathy. Forty-nine percent (197 of 406) were men with a mean ± SD age of 55 ± 14 years, and 54% (220 of 406) were right shoulders. Multivariable analyses accounting for age and gender evaluated the association of long head of the biceps tendinopathy with age and tendinopathy of the rotator cuff tendons.</p><p><strong>Results: </strong>After controlling for tendinopathy of the other rotator cuff tendons, long head of the biceps tendinopathy was more common with advancing age (OR 1.04 [95% CI 1.02 to 1.06] per year; p < 0.001), meaning the prevalence increases by approximately 4% per year. Among people who were imaged for shoulder pain, everyone 85 years or older had both long head of the biceps and rotator cuff tendinopathy. Any rotator cuff pathophysiology was also notably associated with any long head of the biceps pathophysiology (OR 6.9 [95% CI 2.4 to 20]; p < 0.001). About half (49% [162 of 328]) of long head of the biceps tendons were normal in the presence of any supraspinatus tendinopathy, and 5% (9 of 175) of supraspinatus tendons were normal in the presence of any long head of the biceps tendinopathy.</p><p><strong>Conclusion: </strong>The finding that among people seeking care for shoulder pain, long head of the biceps tendinopathy and rotator cuff tendinopathy occur together and are more common with incre","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-10DOI: 10.1097/CORR.0000000000003341
Cumhur Deniz Davulcu
{"title":"Letter to the Editor: Acquired Acromion Compromise, Including Thinning and Fragmentation, Is Not Associated With Poor Outcomes After Reverse Shoulder Arthroplasty.","authors":"Cumhur Deniz Davulcu","doi":"10.1097/CORR.0000000000003341","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003341","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1097/CORR.0000000000003339
Alvaro Ibaseta, Ignacio Pasqualini, Shujaa T Khan, Chao Zhang, Alison K Klika, Nicolas S Piuzzi
<p><strong>Background: </strong>Patients who undergo a second THA at least 1 year after the first one may experience different recovery courses after each THA. It is unknown what the clinically relevant improvements and healthcare utilization are after each THA in patients undergoing contralateral THA > 1 year apart.</p><p><strong>Questions/purposes: </strong>(1) Do patient-reported outcome measures (PROMs) differ at baseline and 1 year after THA for the first and second hip arthroplasty? (2) Does the likelihood of achieving minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds differ for the first and second hip arthroplasty? (3) Does utilization of healthcare within 90 days of THA, using discharge disposition, length of stay (LOS), and 90-day readmission risk as proxies, differ between the first and second hip arthroplasty?</p><p><strong>Methods: </strong>Between January 2016 and December 2021, a total of 14,023 primary THAs for hip osteoarthritis were performed at a large tertiary academic center, and data from each were longitudinally maintained in an institutional database. In this retrospective study, we excluded nonelective (n = 265), simultaneous bilateral (n = 89), staged bilateral < 1 year apart (n = 1856), unilateral THAs (n = 7541), and those who were lost prior to the minimum study follow-up of 1 year or had incomplete data sets (n =3618), leaving 654 contralateral THAs > 1 year apart (327 patients) for analysis here. The median (range) patient age was 64 years (26 to 88) at the time of the first THA and 66 years (27 to 88) at the second THA. The mean (IQR) time from first THA to second THA was 696 days (488 to 1008). In all, 62% (204 of 327) of patients were women, and 89% (286 of 321) were White. The median (range) BMI was 29 kg/m2 (first THA 16 to 60, second THA 18 to 56) at both THAs. PROMs were obtained preoperatively and at 1 year after each of the THAs and included Hip Disability and Osteoarthritis Outcome Score pain (HOOS-pain), physical function (HOOS-PS), and joint replacement (HOOS-JR) scores, as well as the Veterans Rand 12-Item Health Survey mental component summary score. Each was scored from 0 to 100, with higher scores representing better patient perceived outcomes. A distribution-based method was used to calculate the MCID thresholds (HOOS-pain 8.35, HOOS-PS 9.47, and HOOS-JR 7.76), while an anchor-based method was utilized for the PASS thresholds (HOOS-pain 80.6, HOOS-PS 83.6, and HOOS-JR 83.6). Healthcare utilization outcomes included discharge disposition, LOS, and 90-day readmission rates.</p><p><strong>Results: </strong>Patients had slightly lower baseline PROM scores in all HOOS subdomains before the first THA compared with the second THA (median HOOS-pain 38 versus 42, p < 0.001; HOOS-PS 54 versus 58, p < 0.001; HOOS-JR 43 versus 47, p < 0.001). The difference between baseline and 1-year postoperative scores was slightly larger in all HOOS subdomains after the fi
{"title":"Contralateral THA More Than 1 Year Apart: Do PROMs and Healthcare Utilization Differ After Each Surgery?","authors":"Alvaro Ibaseta, Ignacio Pasqualini, Shujaa T Khan, Chao Zhang, Alison K Klika, Nicolas S Piuzzi","doi":"10.1097/CORR.0000000000003339","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003339","url":null,"abstract":"<p><strong>Background: </strong>Patients who undergo a second THA at least 1 year after the first one may experience different recovery courses after each THA. It is unknown what the clinically relevant improvements and healthcare utilization are after each THA in patients undergoing contralateral THA > 1 year apart.</p><p><strong>Questions/purposes: </strong>(1) Do patient-reported outcome measures (PROMs) differ at baseline and 1 year after THA for the first and second hip arthroplasty? (2) Does the likelihood of achieving minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds differ for the first and second hip arthroplasty? (3) Does utilization of healthcare within 90 days of THA, using discharge disposition, length of stay (LOS), and 90-day readmission risk as proxies, differ between the first and second hip arthroplasty?</p><p><strong>Methods: </strong>Between January 2016 and December 2021, a total of 14,023 primary THAs for hip osteoarthritis were performed at a large tertiary academic center, and data from each were longitudinally maintained in an institutional database. In this retrospective study, we excluded nonelective (n = 265), simultaneous bilateral (n = 89), staged bilateral < 1 year apart (n = 1856), unilateral THAs (n = 7541), and those who were lost prior to the minimum study follow-up of 1 year or had incomplete data sets (n =3618), leaving 654 contralateral THAs > 1 year apart (327 patients) for analysis here. The median (range) patient age was 64 years (26 to 88) at the time of the first THA and 66 years (27 to 88) at the second THA. The mean (IQR) time from first THA to second THA was 696 days (488 to 1008). In all, 62% (204 of 327) of patients were women, and 89% (286 of 321) were White. The median (range) BMI was 29 kg/m2 (first THA 16 to 60, second THA 18 to 56) at both THAs. PROMs were obtained preoperatively and at 1 year after each of the THAs and included Hip Disability and Osteoarthritis Outcome Score pain (HOOS-pain), physical function (HOOS-PS), and joint replacement (HOOS-JR) scores, as well as the Veterans Rand 12-Item Health Survey mental component summary score. Each was scored from 0 to 100, with higher scores representing better patient perceived outcomes. A distribution-based method was used to calculate the MCID thresholds (HOOS-pain 8.35, HOOS-PS 9.47, and HOOS-JR 7.76), while an anchor-based method was utilized for the PASS thresholds (HOOS-pain 80.6, HOOS-PS 83.6, and HOOS-JR 83.6). Healthcare utilization outcomes included discharge disposition, LOS, and 90-day readmission rates.</p><p><strong>Results: </strong>Patients had slightly lower baseline PROM scores in all HOOS subdomains before the first THA compared with the second THA (median HOOS-pain 38 versus 42, p < 0.001; HOOS-PS 54 versus 58, p < 0.001; HOOS-JR 43 versus 47, p < 0.001). The difference between baseline and 1-year postoperative scores was slightly larger in all HOOS subdomains after the fi","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-05DOI: 10.1097/CORR.0000000000003314
Omar K Mahmoud, Francesco Petri, Said El Zein, Madiha Fida, Felix E Diehn, Jared T Verdoorn, Audrey N Schuetz, M Hassan Murad, Ahmad Nassr, Elie F Berbari
<p><strong>Background: </strong>Identifying a microorganism in patients with native vertebral osteomyelitis presents diagnostic challenges. Microorganism identification through culture-based methods is constrained by prolonged processing times and sensitivity limitations. Despite the availability of molecular diagnostic techniques for identifying microorganisms in native vertebral osteomyelitis, there is considerable variability in reported sensitivity and specificity across studies, leading to uncertainty in their clinical utility.</p><p><strong>Questions/purposes: </strong>What are the sensitivity, specificity, and diagnostic odds ratios for 16S broad-range PCR followed by Sanger sequencing (16S) and metagenomic next-generation sequencing (NGS) for detecting bacteria in native vertebral osteomyelitis?</p><p><strong>Methods: </strong>On June 29, 2023, we searched Cochrane, Embase, Medline, and Scopus for results from January 1970 to June 2023. Included studies involved adult patients with suspected native vertebral osteomyelitis undergoing molecular diagnostics-16S bacterial broad-range PCR followed by Sanger sequencing and shotgun or targeted metagenomic NGS-for bacteria detection. Studies involving nonnative vertebral osteomyelitis and cases of brucellar, tubercular, or fungal etiology were excluded. The reference standard for the diagnosis of native vertebral osteomyelitis was a composite clinical- and investigator-defined native vertebral osteomyelitis diagnosis. Diagnostic performance was assessed using a bivariate random-effects model. Risk of bias and diagnostic applicability were evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. After a manual screening of 3403 studies, 10 studies (5 on 16S, 5 on NGS) were included in the present analysis, from which 391 patients were included from a total of 958 patients overall. Quality assessment via QUADAS-2 criteria showed moderate risk of bias and good applicability.</p><p><strong>Results: </strong>16S showed 78% (95% confidence interval [CI] 95% CI 31% to 96%) sensitivity and 94% (95% CI 73% to 99%) specificity, whereas NGS demonstrated 82% (95% CI 63% to 93%) sensitivity and 71% (95% CI 37% to 91%) specificity. In addition, the diagnostic ORs were 59 (95% CI 9 to 388) and 11 (95% CI 4 to 35) for 16S and NGS, respectively. Summary receiver operating characteristic curves showed high test performance for 16S (area under the curve for 16S 95% [95% CI 93% to 97%] and for NGS 89% [95% CI 86% to 92%]). Certainty in estimates was moderate because of sample size limitations.</p><p><strong>Conclusion: </strong>This meta-analysis found moderate-to-high diagnostic performance of molecular methods on direct patient specimens for the diagnosis of native vertebral osteomyelitis. When used as a complementary test to microbiological analyses, a positive 16S result rules in the diagnosis of native vertebral osteomyelitis, while further studies are needed to understand
背景：在原发性椎体骨髓炎患者中识别一种微生物提出了诊断挑战。通过基于培养的方法进行微生物鉴定受到处理时间长和灵敏度限制的限制。尽管分子诊断技术可用于鉴定原生椎体骨髓炎中的微生物，但不同研究报告的敏感性和特异性存在相当大的差异，导致其临床应用的不确定性。问题/目的：16S广谱PCR、Sanger测序（16S）和宏基因组新一代测序（NGS）检测原生椎体骨髓炎细菌的敏感性、特异性和诊断优势比是什么？方法：我们于2023年6月29日检索Cochrane、Embase、Medline和Scopus，检索1970年1月至2023年6月的结果。纳入的研究包括疑似先天性椎体骨髓炎的成年患者，他们接受了分子诊断——16s细菌广谱PCR，然后采用Sanger测序和霰弹枪或靶向宏基因组ngs进行细菌检测。涉及非原生椎体骨髓炎和布鲁氏菌、结核或真菌病因的研究被排除在外。诊断先天性椎体骨髓炎的参考标准是临床和研究者定义的先天性椎体骨髓炎的综合诊断。采用双变量随机效应模型评估诊断效果。使用修订后的诊断准确性研究质量评估（QUADAS-2）工具评估偏倚风险和诊断适用性。在对3403项研究进行人工筛选后，本分析纳入了10项研究（5项关于16S， 5项关于NGS），其中391名患者来自总共958名患者。通过QUADAS-2标准进行的质量评估显示偏倚风险中等，适用性良好。结果：16S显示78%（95%置信区间[CI] 95% CI 31%至96%）的敏感性和94% （95% CI 73%至99%）的特异性，而NGS显示82% （95% CI 63%至93%）的敏感性和71% （95% CI 37%至91%）的特异性。此外，16S和NGS的诊断or分别为59 （95% CI 9 ~ 388）和11 （95% CI 4 ~ 35）。总的受试者工作特征曲线显示，16S的测试性能很高（16S曲线下面积为95% [95% CI 93%至97%]，NGS为89% [95% CI 86%至92%]）。由于样本量的限制，估计的确定性是中等的。结论：本荟萃分析发现，分子方法对直接患者标本诊断原发性椎体骨髓炎具有中高的诊断效能。当作为微生物分析的补充检测时，16S阳性结果在诊断先天性椎体骨髓炎方面具有优势，但NGS在诊断先天性椎体骨髓炎中的作用有待进一步研究。在常规微生物学之外，特别是在标准微生物试验结果普遍阴性的复杂病例中，如有这些检测，应用于检测挑剔细菌，或在其分离和致病性尚不清楚的情况下确认致病细菌。在未来的研究中，需要大量的样本来了解这些技术作为独立诊断测试的使用。证据等级：III级，诊断性研究。
{"title":"What Is the Accuracy of 16S PCR Followed by Sanger Sequencing or Next-generation Sequencing in Native Vertebral Osteomyelitis? A Systematic Review and Meta-analysis.","authors":"Omar K Mahmoud, Francesco Petri, Said El Zein, Madiha Fida, Felix E Diehn, Jared T Verdoorn, Audrey N Schuetz, M Hassan Murad, Ahmad Nassr, Elie F Berbari","doi":"10.1097/CORR.0000000000003314","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003314","url":null,"abstract":"<p><strong>Background: </strong>Identifying a microorganism in patients with native vertebral osteomyelitis presents diagnostic challenges. Microorganism identification through culture-based methods is constrained by prolonged processing times and sensitivity limitations. Despite the availability of molecular diagnostic techniques for identifying microorganisms in native vertebral osteomyelitis, there is considerable variability in reported sensitivity and specificity across studies, leading to uncertainty in their clinical utility.</p><p><strong>Questions/purposes: </strong>What are the sensitivity, specificity, and diagnostic odds ratios for 16S broad-range PCR followed by Sanger sequencing (16S) and metagenomic next-generation sequencing (NGS) for detecting bacteria in native vertebral osteomyelitis?</p><p><strong>Methods: </strong>On June 29, 2023, we searched Cochrane, Embase, Medline, and Scopus for results from January 1970 to June 2023. Included studies involved adult patients with suspected native vertebral osteomyelitis undergoing molecular diagnostics-16S bacterial broad-range PCR followed by Sanger sequencing and shotgun or targeted metagenomic NGS-for bacteria detection. Studies involving nonnative vertebral osteomyelitis and cases of brucellar, tubercular, or fungal etiology were excluded. The reference standard for the diagnosis of native vertebral osteomyelitis was a composite clinical- and investigator-defined native vertebral osteomyelitis diagnosis. Diagnostic performance was assessed using a bivariate random-effects model. Risk of bias and diagnostic applicability were evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. After a manual screening of 3403 studies, 10 studies (5 on 16S, 5 on NGS) were included in the present analysis, from which 391 patients were included from a total of 958 patients overall. Quality assessment via QUADAS-2 criteria showed moderate risk of bias and good applicability.</p><p><strong>Results: </strong>16S showed 78% (95% confidence interval [CI] 95% CI 31% to 96%) sensitivity and 94% (95% CI 73% to 99%) specificity, whereas NGS demonstrated 82% (95% CI 63% to 93%) sensitivity and 71% (95% CI 37% to 91%) specificity. In addition, the diagnostic ORs were 59 (95% CI 9 to 388) and 11 (95% CI 4 to 35) for 16S and NGS, respectively. Summary receiver operating characteristic curves showed high test performance for 16S (area under the curve for 16S 95% [95% CI 93% to 97%] and for NGS 89% [95% CI 86% to 92%]). Certainty in estimates was moderate because of sample size limitations.</p><p><strong>Conclusion: </strong>This meta-analysis found moderate-to-high diagnostic performance of molecular methods on direct patient specimens for the diagnosis of native vertebral osteomyelitis. When used as a complementary test to microbiological analyses, a positive 16S result rules in the diagnosis of native vertebral osteomyelitis, while further studies are needed to understand ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Knee osteoarthritis (OA) is a common and disabling condition that often carries severe psychosocial implications. Chronic illness-related shame has emerged as a substantial psychosocial factor affecting individuals with knee OA, but it is unclear how chronic illness-related shame is associated with the long-term clinical and psychosocial outcomes in individuals with knee OA.</p><p><strong>Questions/purposes: </strong>(1) Does a higher level of shame correlate with worse clinical and psychosocial outcomes at baseline among individuals with knee OA? (2) Is a higher level of shame at baseline associated with worse clinical and psychosocial outcomes at 4-month and 12-month follow-up among individuals with knee OA? (3) Are sociodemographic characteristics correlated with levels of shame among individuals with knee OA?</p><p><strong>Methods: </strong>Between June 2021 and February 2022, we screened 977 patients based on the inclusion criteria of (1) age 45 years or older, (2) independent in community mobility with or without walking aids, (3) proficient in English or Chinese language, and (4) met the clinical criteria for OA diagnosis outlined by the National Institute for Health and Care Excellence. Of these patients, 47% (460) were eligible and enrolled. A further 53% (517) were excluded for prespecified reasons. Of the 460 enrolled patients, 7% (30) dropped out before data collection began, and 46% (210) of patients did not complete the psychological questionnaires, leaving 48% (220) of patients for analysis. From this final sample, 25% (56) were lost to follow-up at 4 months, and an additional 7% (16) were lost by the 12-month follow-up, leaving 67% (148) of the original eligible group for analysis. All patients were recruited from the outpatient clinics of the orthopaedic and physiotherapy departments across two Singapore hospitals within the National Healthcare Group. The study population had a mean ± SD age of 64 ± 8 years, with 69% (152 of 220) women, and the mean ± SD duration of knee OA symptoms was 6 ± 6 years. Outcome measures used were the Chronic Illness-Related Shame Scale (CISS), the 12-item Knee Injury and Osteoarthritis Outcome Score (KOOS-12), Patient Health Questionnaire 4 (PHQ-4), the 8-item Arthritis Self-Efficacy Scale (ASES-8), and the Brief Fear of Movement Scale (BFOM). The CISS is a validated tool specifically designed to measure feelings of shame (internal and external shame) in individuals living with chronic illness. The scale has been validated for use among patients with knee OA in Singapore. The functional outcome measure used was the Modified Barthel Index. Data on demographic characteristics were collected. Data were collected at baseline, 4-month follow-up, and 12-month follow-up. Statistical analyses included the Spearman correlation, linear regression, and cluster analysis.</p><p><strong>Results: </strong>At baseline, there was a weak to moderate negative correlation between CISS sco
背景：膝骨关节炎（OA）是一种常见的致残疾病，通常会带来严重的社会心理影响。慢性疾病相关羞耻感已成为影响膝关节OA患者的重要社会心理因素，但目前尚不清楚慢性疾病相关羞耻感如何与膝关节OA患者的长期临床和社会心理结果相关。问题/目的：(1)在膝关节炎患者中，较高的羞耻感水平是否与基线时较差的临床和社会心理结果相关？(2)在膝关节OA患者中，基线时较高的羞耻感水平是否与4个月和12个月随访时较差的临床和社会心理结果相关？(3)社会人口学特征是否与膝关节OA患者的羞耻感水平相关？方法：在2021年6月至2022年2月期间，我们根据以下纳入标准筛选了977名患者：(1)年龄在45岁或以上，(2)有或没有助行器在社区独立活动，(3)精通英语或中文，(4)符合国家健康与护理卓越研究所概述的OA诊断临床标准。在这些患者中，47%（460）人符合条件并入组。另有53%（517人）因预先指定的原因被排除在外。在460名入组患者中，7%（30名）的患者在数据收集开始前退出，46%（210名）的患者没有完成心理问卷调查，剩下48%（220名）的患者进行分析。在最后的样本中，25%（56例）在4个月时失去了随访，另外7%（16例）在12个月的随访中失去了随访，剩下67%（148例）的原始合格组进行分析。所有患者均来自国家医疗集团旗下两家新加坡医院骨科和理疗部门的门诊诊所。研究人群的平均±SD年龄为64±8岁，其中69%（220人中有152人）为女性，膝关节OA症状的平均±SD持续时间为6±6年。结果测量采用慢性疾病相关羞耻感量表（CISS）、12项膝关节损伤和骨关节炎结局评分（KOOS-12）、患者健康问卷4 （PHQ-4）、8项关节炎自我效能量表（ASES-8）和短暂运动恐惧量表（bom）。CISS是一种经过验证的工具，专门用于测量慢性疾病患者的羞耻感（内部和外部羞耻感）。该量表已在新加坡的膝关节OA患者中得到验证。功能性结果测量采用改良Barthel指数。收集了人口统计学特征数据。在基线、4个月随访和12个月随访时收集数据。统计分析包括Spearman相关、线性回归和聚类分析。结果：基线时，CISS评分与KOOS-12和ASES-8评分呈弱至中度负相关(Spearman相关系数范围为-0.46 ~ -0.36；所有p值均< 0.001)，表明较高水平的羞耻感与轻度至中度的膝关节功能恶化和较低的自我效能感相关。CISS评分与PHQ-4和BFOM评分呈中度正相关(Spearman相关系数为0.43 ~ 0.46；所有p值都< 0.001)，表明更高水平的羞耻感与更多的心理困扰和更大的运动恐惧有关。在4个月的随访中，基线时较高的CISS评分与KOOS-12的降低相关(校正系数-0.86[95%可信区间(CI) -1.33至-0.40]；p < 0.001)和asas -8(校正系数-0.12 [95% CI -0.19至-0.06]；P < 0.001)评分，表明随着时间的推移，膝关节功能恶化，自我效能降低。基线时较高的CISS评分也与PHQ-4升高相关(校正系数0.23 [95% CI 0.14至0.31]；p < 0.001)和BFOM(校正系数0.22 [95% CI 0.08 ~ 0.36]；P = 0.002)，在4个月的随访中，反映出更大的心理困扰和更大的运动恐惧。在12个月的随访中，基线时较高的CISS评分与KOOS-12的降低相关(校正系数-0.72 [95% CI -1.25至-0.19]；p = 0.008)和asas -8(校正系数-0.12 [95% CI -0.20至-0.04]；P = 0.002)得分，表明那些最初羞耻感水平较高的人继续经历较差的膝盖功能和较低的自我效能感。基线时较高的CISS评分也与PHQ-4升高相关(校正系数0.13 [95% CI 0.04至0.21]；p = 0.004)和bbfm(校正系数0.20 [95% CI 0.06 ~ 0.34]；P = 0.007)在12个月的随访中得分，表明持续的心理困扰和运动恐惧。 聚类分析发现，CISS评分和BMI较低、单侧关节炎和OA持续时间较短的失业老年患者在4个月时的膝关节功能较好(平均差值为7 [95% CI 1 ~ 12]；p = 0.02)和12个月(平均差异7 [95% CI 1 ~ 13]；P = 0.02)。在控制了年龄、性别、种族和就业状况后，回归分析发现BMI越高，CISS评分越高(校正系数0.21 [95% CI 0.07 ~ 0.34]；P = 0.003)。结论：慢性疾病相关羞耻感与膝关节OA患者的临床和社会心理结果有小到中等程度的关联。卫生保健专业人员应定期纳入社会心理评估，以及早发现和管理羞耻感，从而潜在地改善临床和社会心理结果。认识到较高的身体质量指数与羞耻感的增加有关，可以专门指导有针对性的情感和社会心理支持。此外，将接受和承诺治疗以及同伴支持等干预措施与传统治疗相结合，可以提高依从性和患者的总体结果，使综合护理更加有效。证据等级：II级，预后研究。
{"title":"How Does Shame Relate to Clinical and Psychosocial Outcomes in Knee Osteoarthritis?","authors":"Jia Ying Yeo, Chien Joo Lim, Su-Yin Yang, Bryan Yijia Tan","doi":"10.1097/CORR.0000000000003329","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003329","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis (OA) is a common and disabling condition that often carries severe psychosocial implications. Chronic illness-related shame has emerged as a substantial psychosocial factor affecting individuals with knee OA, but it is unclear how chronic illness-related shame is associated with the long-term clinical and psychosocial outcomes in individuals with knee OA.</p><p><strong>Questions/purposes: </strong>(1) Does a higher level of shame correlate with worse clinical and psychosocial outcomes at baseline among individuals with knee OA? (2) Is a higher level of shame at baseline associated with worse clinical and psychosocial outcomes at 4-month and 12-month follow-up among individuals with knee OA? (3) Are sociodemographic characteristics correlated with levels of shame among individuals with knee OA?</p><p><strong>Methods: </strong>Between June 2021 and February 2022, we screened 977 patients based on the inclusion criteria of (1) age 45 years or older, (2) independent in community mobility with or without walking aids, (3) proficient in English or Chinese language, and (4) met the clinical criteria for OA diagnosis outlined by the National Institute for Health and Care Excellence. Of these patients, 47% (460) were eligible and enrolled. A further 53% (517) were excluded for prespecified reasons. Of the 460 enrolled patients, 7% (30) dropped out before data collection began, and 46% (210) of patients did not complete the psychological questionnaires, leaving 48% (220) of patients for analysis. From this final sample, 25% (56) were lost to follow-up at 4 months, and an additional 7% (16) were lost by the 12-month follow-up, leaving 67% (148) of the original eligible group for analysis. All patients were recruited from the outpatient clinics of the orthopaedic and physiotherapy departments across two Singapore hospitals within the National Healthcare Group. The study population had a mean ± SD age of 64 ± 8 years, with 69% (152 of 220) women, and the mean ± SD duration of knee OA symptoms was 6 ± 6 years. Outcome measures used were the Chronic Illness-Related Shame Scale (CISS), the 12-item Knee Injury and Osteoarthritis Outcome Score (KOOS-12), Patient Health Questionnaire 4 (PHQ-4), the 8-item Arthritis Self-Efficacy Scale (ASES-8), and the Brief Fear of Movement Scale (BFOM). The CISS is a validated tool specifically designed to measure feelings of shame (internal and external shame) in individuals living with chronic illness. The scale has been validated for use among patients with knee OA in Singapore. The functional outcome measure used was the Modified Barthel Index. Data on demographic characteristics were collected. Data were collected at baseline, 4-month follow-up, and 12-month follow-up. Statistical analyses included the Spearman correlation, linear regression, and cluster analysis.</p><p><strong>Results: </strong>At baseline, there was a weak to moderate negative correlation between CISS sco","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-03DOI: 10.1097/CORR.0000000000003304
Amnuay Kleebayoon, Viroj Wiwanitkit
{"title":"Letter to the Editor: Is Information About Musculoskeletal Malignancies From Large Language Models or Web Resources at a Suitable Reading Level for Patients?","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.1097/CORR.0000000000003304","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003304","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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