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Exploring persistent postsurgical pain from the patient’s perspective 5 years after total knee arthroplasty: A mixed-methods study
Get PDFBackground: Osteoarthritis (OA) of the knee is a common ailment and is estimated to affect 240 million people globally, with 10% of men and 18% of women over 60 years having symptomatic knee OA. The main symptom of OA is pain, stiffness, and reduced function of the joint. Total knee arthroplasty (TKA) remains the treatment of choice in moderate to severe knee OA, when non-surgical treatments are no longer effective in alleviating symptoms. Unfortunately, approximately 20% of patients operated with primary TKA experience pain 12 months after surgery, with 15-19% reporting severe pain. With an anticipated increase in TKA procedures over the next decade, the number of patients living with persistent postsurgical pain (PPP) one year after surgery becomes substantial. Little is known about these patients’ outcomes and lives with PPP 5 or more years after TKA. Hence, this PhD project includes the patient’s perspective, exploring PPP over the first 5-7 years post-TKA.
Aim: The overall aim of this PhD thesis was to explore experiences of PPP in patients 5-7 years after TKA.
Methods: This thesis had a hybrid mixed-methods (MM) design, employing features from two independent parallel strands (one quantitative and one qualitative), as well as one explanatory sequential strand. The data was obtained from questionnaires and qualitative interviews with patients who underwent primary TKA for OA in a high-volume surgical clinic in Oslo. The MM design allowed for different perspectives and voices to explore the complex phenomenon of PPP within three sub-studies, and the findings were combined and presented in a joint display.
Study 1: Quantitative strand (n=136). A prospective longitudinal observational study design was employed to examine the associations between preoperative factors and moderate-tosevere pain and pain-related functional impairment 5 years after TKA. Socio Now Pop was employed to assess patients’ sociodemographic characteristics at baseline. Patient-reported outcome measures assessed at 5 years included the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression Scale. To assess associations between selected preoperative factors and moderate-to-severe pain or pain-related functional impairment at 5 years, statistically significant factors from univariate regressions were entered into a multiple logistic regression model.
Study 2: Qualitative strand (n=23). An explorative-descriptive qualitative design was employed to explore earlier experiences of pain and stress in patients with PPP at 12-months. Semi-structured interviews were conducted at 5-7 years, transcribed verbatim and analyzed through qualitative content analysis.
Study 3: Mixed-methods strand (qualitative=23, quantitative n=19). A sequential, explanatory design was employed to explore patients’ experiences of living with persistent pain 5-7 years after primary TKA. The BPI questionnaire was filled out at three timepoints. Semi-structured interviews were conducted at one timepoint. The quantitative analysis included descriptive and non-parametric statistics to compare the demographics of included and excluded patients. In addition, two multivariate mixed models for repeated measures were employed to estimate within‐patient and between‐patient differences, as well as to assess the effect of time on pain with walking, daily activity, and average pain. Interviews were analyzed through qualitative content analysis. The findings were integrated and presented in a joint display.
Results: Study 1 showed that severe preoperative pain, more preoperative painful sites, and more preoperative anxiety are associated with moderate-to-severe pain 5 years after surgery. More preoperative anxiety was also associated with pain-related functional impairment. Male sex was associated with less pain-related functional impairment; more severe OA was associated with less pain 5 years after TKA surgery. Study 2 identified two main themes: 1) Painful years – the burden of living with long lasting pain and 2) The burden of living with psychological distress. The participants told stories of severe long lasting knee pain and pain in other locations preoperatively. Moreover, the women had additional painful conditions that the men did not have. Participants’ stories included stressful experiences such as anxiety, grief, and loss, which impacted their lives over time. Study 3 identified three main themes: 1) persistent limitations after TKA, 2) regaining wellness over time, and 3) complexity in physical challenges. Limitations included PPP with certain movements and after physical activities. Other painful conditions and ailments may have hampered the knee rehabilitation process. Noteworthy, those with PPP at 12 months, experienced an overall decrease in pain 5-7 years after surgery, and no-one regretted their TKA at the time of the interview, 5-7 years after surgery.
Conclusion: The study provides insight into non-improving TKA patients as individuals and suggests ways of identifying patients who are at risk for developing PPP after TKA. These are patients who may benefit from personalized care and perioperative pain management. Health personnel who interact with patients preoperatively may use the findings from the current study to inform and guide patients on strategies for coping with pain, comorbidity, and function in the time leading up to surgery. Furthermore, health personnel may support and guide those with delayed improvements in pain toward more realistic expectations for recovery and rehabilitation.
Bakgrunn: Artrose i kneet anslås å ramme 240 millioner mennesker globalt. Man regner med at totalt 9,6 % av menn og 18 % av kvinner over 60 år i verden, har symptomatisk kne-artrose. Symptomene på artrose er smerte, stivhet og nedsatt leddfunksjon. Når annen ikke-kirurgisk behandling er forsøkt uten symptomlindring, er total kneprotese (TKP) den foretrukne behandlingen ved moderat til alvorlig artrose. Dessverre opplever omtrent 20 % av pasientene vedvarende postoperative smerter 12 måneder etter primær TKP, 15-19 % av disse rapporterer om sterke smerter. Med en forventet vekst i TKP-kirurgi i løpet av det neste årene, blir antallet pasienter med vedvarende postoperative smerter ett år etter TKP betydelig. Det er lite kunnskap om disse pasientenes erfaringer med smerter 5 år etter TKP. Derfor inkluderer dette PhD prosjektet, pasienters erfaringer når vedvarende postoperative smerter utforskes i ett 5 års perspektiv.
Hensikt: Denne studiens overordnede hensikt var å bidra til økt kunnskap om vedvarende postoperative smerter hos pasienter 5-7 år etter primær TKP for artrose.
Metode: Avhandlingen har et hybrid mixed-methods (MM) design hvor to parallelle grener (en kvantitativ og en kvalitativ) og en MM gren kombineres. Dataene stammer fra spørreskjemaer og kvalitative intervjuer. De inkluderte pasientene gjennomgikk primær TKP for artrose i en høy-volums kirurgisk klinikk i Oslo. MM-designet tillater å belyse ulike perspektiver for kompleksiteten ved vedvarende postoperative smerter. Funnene integreres og presenteres i en felles sammenfatning: et «joint display».
Studie 1: kvantitativ gren (n=136). Et prospektivt longitudinelt observasjonsdesign ble anvendt for å undersøke assosiasjonene mellom preoperative faktorer, og smerte og smerterelatert funksjonsnedsettelse 5 år etter TKA. Socio Now Pop ble anvendt preoperativt for å samle demografiske data og data om komorbiditet. Pasientrapporterte utfallsmål inkludert i denne studien; The Brief Pain Inventory, og Hospital Anxiety and Depression Scale. For å teste og identifisere sammenhengen mellom utvalgte preoperative faktorer og smerte eller smerterelatert funksjonsnedsettelse 5 år etter TKP, ble statistisk signifikante faktorer fra univariate regresjoner inkludert i en multippel logistisk regresjonsmodell.
Studie 2: kvalitativ gren (n=23). Et eksplorativt-beskrivende kvalitativt design ble anvendt for å utforske tidligere erfaringer med smerte og psykisk stress hos pasienter med vedvarende postoperative smerter etter TKP. Individuelle semistrukturerte intervjuer ble gjennomført. Intervjuene ble analysert med kvalitativ innholdsanalyse.
Studie 3: MM-gren (n=23 kvalitative/19 kvantitative). Et mixed-methods-design ble anvendt, for å utforske pasientenes erfaringer med å leve med vedvarende smerte 5-7 år etter primær TKP. Deltakerne fylte ut Brief Pain Inventory spørreskjemaet på tre tidspunkter; preoperativt, 12 måneder- og 5 år etter operasjonen. Individuelle semistrukturerte intervjuer ble gjennomført én gang. Deskriptive statistiske analyser og ikke-parametriske analyser ble gjennomført for å sammenligne inkluderte pasienter med de ikke-inkluderte. I tillegg ble det utført to multivariate «mixed-models» for gjentatte målinger, for å estimere innenfor- og mellom-pasient variasjoner i tillegg til å vurdere effekten av tid på smerte-utfallet. De kvalitative dataene ble analysert med kvalitativ innholdsanalyse. Funnene ble integrert og presentert i en «joint display».
Resultater: Studie 1 viste at sterke preoperative smerter, flere smertefulle steder og engstelse var assosiert med moderate til sterke smerter 5 år etter operasjonen, Engstelse var i tillegg assosiert med smerterelatert funksjonsnedsettelse. Å være mann var assosiert med mindre smerterelatert funksjonsnedsettelse. Mer alvorlig artrose var forbundet med mindre smerter 5 år etter TKA-operasjon. Studie 2 identifiserte to hovedtemaer: 1) Smertefulle år – byrden av å leve med langvarig smerter og 2) Byrden av å leve med psykiske plager over tid. Deltakerne fortalte om alvorlige og langvarige knesmerter i tillegg til langvarige preoperative smerter andre steder i kroppen. De kvinnelige deltakerne hadde i tillegg smertefulle tilstander som mennene ikke hadde. Deltakerne fremhevet historier med engstelse, sorg og tap i nære relasjoner som viktige i sine erfaringer før kneoperasjonen. Mange opplevde en dobbel belastning av smerte og psykisk stress som preget livet i lang tid før kneoperasjonen. Studie 3 identifiserte tre hovedtemaer: 1) Vedvarende smerter ved daglige aktiviteter 2) En gjenvunnet følelse av velvære med forbedret livskvalitet og mindre smerte og 3) Kompleksitet i fysiske utfordringer. Noen deltakere erfarte fortsatt kortvarige smerter ved spesifikke bevegelser. Alle ga uttrykk for mindre smertepåvirkning i hverdagen på intervjutidspunktet. Andre smertefulle tilstander og plager opplevdes som hemmende i rehabiliteringsprosessen etter TKP. Ingen angret på TKP-operasjonen 5-7 år etter.
Konklusjon: Denne studien gir et innblikk i opplevelser knyttet til vedvarende postoperative smerter 5-7 år etter kneprotesekirurgi. Funnene identifiserer faktorer som kan avdekke sårbare pasienter for vedvarende smerter før operasjonen. Helsepersonell som samhandler med pasienter før operasjonen, kan bruke funnene fra denne studien til å informere og veilede pasienter om strategier for håndtering av smerte, aktivitet og andre ikke-kne-relaterte smertefulle symptomer i tiden før operasjonen. Videre kan det virke som pasienter som opplever forsinket rehabilitering kan dra nytte av personlig tilpasset støtte og veiledning lengre tid etter operasjonen for håndtering av smerter og fysisk aktivitet og for å justere forventninger til bedring og rehabilitering.publishedVersio
Eldre pasienters siste levedager i sykehus
Get PDFUbehagelige symptomer forekommer hyppig
hos eldre pasienter innlagt i sykehus de siste levedager. For at
eldre pasienter skal få en verdig død, er det en forutsetning at
sykepleiere lindrer symptomer av fysisk, psykologisk, åndelig
og eksistensiell karakter. Det kan være utfordrende for sykepleiere
å åpne opp for samtaler med eldre pasienter om det å ha kort forventet levetid og døden. Behandling og tiltak som
kun fører til at dødsprosessen forlenges bør avsluttes. Det kan
være følelsesmessig vanskelig for både pasientens pårørende
og sykepleiere at døende pasienter ikke får kunstig ernæring og
væske. En verdig død er forbundet med at døende pasienter
har noen hos seg i dødsøyeblikket
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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