20 research outputs found
Modelling treatment, age- and gender-specific recovery in acute injury studies
Get PDFBackground: Acute injury studies often measure physical ability repeatedly over
time through scores that have a finite range. This can result in a faster score change
at the beginning of the study than towards the end, motivating the investigation of
the rate of change. Additionally, the bounds of the score and their dependence on
covariates are often of interest.
Methods: We argue that transforming bounded data is not satisfactory in some
settings. Motivated by the Collaborative Ankle Support Trial (CAST), which investigated
different methods of immobilisation for severe ankle sprains, we developed a
model under the assumption that the recovery rate at a specific time is proportional to
the current score and the remaining score. This model enables a direct interpretation
of the covariate effects. We have re-analyzed the CAST data using these improved
methods, and explored novel relationships between age, gender and recovery rate.
Results: We confirm that using below knee cast is advantageous compared with a
tubular bandage in relation with the recovery rate. An age and gender effect on the
recovery rate and the maximum achievable score is demonstrated, with older female
patients recovering less fast (age-effect: -0.21, 95% confidence interval (CI) [-0.28,-
0.14]; gender effect: -0.06, CI [-0.12,-0.004]) and achieving a lower maximum score
(age-effect: -8.07, CI [-11.68,-4.01]; gender-effect: -5.34, CI [-8.18, -2.50]) than younger
male patients.
Conclusions: Our model is able to accurately model repeated measurements on the
original scale, while accounting for the bounded nature of a score. We demonstrate
that recovery in acute injury trials can differ substantially by age and gender. Older
female patients are less likely to recover well from a sprain
UK DRAFFT : a randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius
Get PDFBackground: Fractures of the distal radius are extremely common injuries in adults. However, the optimal
management remains controversial. In general, fractures of the distal radius are treated non-operatively if the bone
fragments can be held in anatomical alignment by a plaster cast or orthotic. However, if this is not possible, then
operative fixation is required. There are several operative options but the two most common in the UK, are
Kirschner-wire fixation (K-wires) and volar plate fixation using fixed-angle screws (locking-plates). The primary aim of
this trial is to determine if there is a difference in the Patient-Reported Wrist Evaluation one year following K-wire
fixation versus locking-plate fixation for adult patients with a dorsally-displaced fracture of the distal radius.
Methods/design: All adult patients with an acute, dorsally-displaced fracture of the distal radius, requiring
operative fixation are potentially eligible to take part in this study. A total of 390 consenting patients will be
randomly allocated to either K-wire fixation or locking-plate fixation. The surgery will be performed in trauma units
across the UK using the preferred technique of the treating surgeon. Data regarding wrist function, quality of life,
complications and costs will be collected at six weeks and three, six and twelve months following the injury. The
primary outcome measure will be wrist function with a parallel economic analysis.
Discussion: This pragmatic, multi-centre trial is due to deliver results in December 2013
Modelling the rate of change in a longitudinal study with missing data, adjusting for contact attempts
Get PDFThe Collaborative Ankle Support Trial (CAST) is a longitudinal trial in which interest lies in the rate of
improvement, the effectiveness of reminders and potentially informative missingness. A model is proposed for
continuous longitudinal data with non-ignorable or informative missingness, taking into account the nature of
attempts made to contact initial non-responders. The model combines a non-linear mixed model for the outcome\ud
model with a logistic regression model for the reminder process. A sensitivity analysis is used to contrast this
model with the traditional selection model, where we adjust for missingness by modelling the missingness process
Can researchers trust ICD-10 coding of medical comorbidities in orthopaedic trauma patients?
No full textAbstract. Objectives:. The 10th revision of the International Classification of Diseases (ICD-10) coding system may prove useful to orthopaedic trauma researchers to identify and document populations based on comorbidities. However, its use for research first necessitates determination of its reliability. The purpose of this study was to assess the reliability of electronic medical record (EMR) ICD-10 coding of nonorthopaedic diagnoses in orthopaedic trauma patients relative to the gold standard of prospective data collection.
Design:. Nonexperimental cross-sectional study.
Setting:. Level 1 Trauma Center.
Patients/Participants:. Two hundred sixty-three orthopaedic trauma patients from 2 prior prospective studies from September 2018 to April 2022.
Intervention:. Prospectively collected data were compared with EMR ICD-10 code abstraction for components of the Charlson Comorbidity Index (CCI), obesity, alcohol abuse, and tobacco use (retrospective data).
Main Outcome Measurements:. Percent agreement and Cohen's kappa reliability.
Results:. Percent agreement ranged from 86.7% to 96.9% for all CCI diagnoses and was as low as 72.6% for the diagnosis “overweight.” Only 2 diagnoses, diabetes without end-organ damage (kappa = 0.794) and AIDS (kappa = 0.798) demonstrated Cohen's kappa values to indicate substantial agreement.
Conclusion:. EMR diagnostic coding for medical comorbidities in orthopaedic trauma patients demonstrated variable reliability. Researchers may be able to rely on EMR coding to identify patients with diabetes without complications or AIDS. Chart review may still be necessary to confirm diagnoses. Low prevalence of most comorbidities led to high percentage agreement with low reliability.
Level of Evidence:. Level 1 diagnostic
Biomechanics Aware Collaborative Robot System for Delivery of Safe Physical Therapy in Shoulder Rehabilitation
No full textIn this work, we explore using computational musculoskeletal modeling to equip an industrial collaborative robot with awareness of the internal state of a patient to safely deliver physical therapy. A major concern of robot-mediated physical therapy is that robots may unwittingly injure patients. For patients with shoulder injuries this typically means the risk of tearing a rotator-cuff muscle tendon. Risk of reinjury hampers both human and robot therapists and it is the main reason for conservative physical therapy. Advances in human musculoskeletal modeling, however, can equip robots with additional perception of potential reinjury risks. While the ultimate goal is to improve the safety, range-of-motion and activity that patients receive through robot-mediated therapy, the aim of this letter is to develop and test a framework that enables the robot to understand the state of the patient and to execute physical therapy movements that demonstrate low injury risk and achieve a large range-of-motion in human subjects. We build on prior work in human-robot interaction via impedance control, but take robot awareness of the human to the next level by including and manipulating a musculoskeletal model in parallel to the patient. Taking the most common shoulder impairments (i.e., rotator-cuff tears) as an example, we demonstrate planned, model-based trajectories that minimize strain in these muscles and corresponding robot-mediated movements on healthy subjects. Our experiments suggest that musculoskeletal awareness is a promising approach to plan and deliver therapeutic movements that are safe and effective via an industrial robot.Accepted Author ManuscriptBiomechatronics & Human-Machine ControlHuman-Robot Interactio
International Orthopaedic Multicenter Study in Fracture Care: Coordinating a Large-Scale Multicenter Global Prospective Cohort Study
Get PDFUNLABELLED: Traditionally, the orthopaedic trauma literature has been dominated by small studies that were largely single-center initiatives. More recently, there has been a paradigm shift toward larger, multicenter studies because the orthopaedic community embraced the concepts of evidence-based medicine and the need for high-quality research to guide clinical practice. The International Orthopaedic Multicenter Study in Fracture Care is a large multicenter international cohort study in musculoskeletal trauma in Africa, Asia, and Latin America. This is the first study of this magnitude within the global orthopaedic trauma community. The International Orthopaedic Multicenter Study in Fracture Care study has provided an opportunity to form new international collaborative relationships and to develop new research capacity and global collaborative relationships that will provide the foundation for future studies in injury prevention and management. LEVELS OF EVIDENCE: IV
Conceptualizing the key components of rehabilitation following major musculoskeletal trauma: A mixed methods service evaluation
No full text\ua9 2019 John Wiley & Sons, Ltd.Rationale, Aims, and Objectives: The reorganization of acute major trauma pathways in England has increased survival following traumatic injury, resulting in an increased patient population with diverse and complex needs requiring specialist rehabilitation. However, national audit data indicate that only 5% of patients with traumatic injuries have access to specialist rehabilitation, and there are limited guidelines or standards to inform the delivery of rehabilitation interventions for individuals following major trauma. This group concept mapping project aimed to identify the clinical service needs of individuals accessing our major trauma rehabilitation service, prioritize these needs, determine whether each of these needs is currently being met, and plan targeted service enhancements. Methods: Participants contributed towards a statement generation exercise to identify the key components of rehabilitation following major trauma, and individually sorted these statements into themes. Each statement was rated based on importance and current success. Multi-dimensional scaling and hierarchical cluster analysis were applied to the sorted data to produce themed clusters of ideas within concept maps. Priority values were applied to these maps to identify key areas for targeted service enhancement. Results: Fifty-eight patients and health care professionals participated in the ideas generation activity, 34 in the sorting, and 49 in the rating activity. A 7-item cluster map was agreed upon, containing the following named clusters: Communication and Coordination; Emotional and psychological wellbeing; Rehabilitation environment; Early rehabilitation; Structured therapy input; Planning for home; and Long-term support. Areas for targeted service enhancement included access to timely and adequate information provision, collaborative goal setting, and specialist pain management across the rehabilitation pathway. Conclusion: The conceptual framework presented in this article illustrates the importance of a continuum of rehabilitation provision across the injury trajectory, and provides a platform to track future service changes and facilitate the codesign of new rehabilitation interventions for individuals following major trauma
Conceptualizing the key components of rehabilitation following major musculoskeletal trauma: A mixed methods service evaluation
Get PDFRationale, aims and objectives: The reorganisation of acute major trauma pathways in England has increased survival following traumatic injury, resulting in an increased patient population with diverse and complex needs requiring specialist rehabilitation. However, national audit data indicates that only 5% of patients with traumatic injuries have access to specialist rehabilitation, and there are limited guidelines or standards to inform the delivery of rehabilitation interventions for individuals following major trauma. This group concept mapping project aimed to identify the clinical service needs of individuals accessing our major trauma rehabilitation service, prioritise these needs, determine whether each of these needs is currently being met, and plan targeted service enhancements. Methods: Participants contributed towards a statement generation exercise to identify the key components of rehabilitation following major trauma, and individually sorted these statements into themes. Each statement was rated based on importance and current success. Multidimensional scaling and hierarchical cluster analysis were applied to the sorted data to produce themed clusters of ideas within concept maps. Priority values were applied to these maps to identify key areas for targeted service enhancement. Results: Fifty-eight patients and healthcare professionals participated in the ideas generation activity, 34 in the sorting and 49 in the rating activity. A 7-item cluster map was agreed upon, containing the following named clusters: Communication and coordination; Emotional and psychological wellbeing; Rehabilitation environment; Early rehabilitation; Structured therapy input; Planning for home; and Long-term support. Areas for targeted service enhancement included access to timely and adequate information provision, collaborative goal setting and specialist pain management across the rehabilitation pathway. Conclusion: The conceptual framework presented in this paper illustrates the importance of a continuum of rehabilitation provision across the injury trajectory, and provides a platform to track future service changes and facilitate the co-design of new rehabilitation interventions for individuals following major trauma
Severe intimate partner violence affecting both young and elderly patients of both sexes
Get PDFBackground Intimate partner violence (IPV) affects 25-35 % of women and men in Western countries. Despite the high prevalence of IPV among trauma patients, very little is known about the associated injuries. Most previous studies excluded male victims and IPV is often limited to violence against women. Few reports on IPV among elderly patients exist. Methods We examined self-reports of IPV among patients at two major trauma centers of the Helsinki Central Hospital in Finland. Based on previous studies, we hypothesized that we would find the most severe injuries among young and middle-aged women. Results We identified 29 patients with a total of 105 injuries; patients typically presented with multiple injuries. Half of all patients required hospitalization or surgery. Contrary to previous studies, 17 % of our cohort were male, while 17 % of patients were 65 years or older. We found that 40 % of male victims presented with a New Injury Severity Score (NISS) over 15, indicating severe trauma. Two elderly patients presented with an NISS of 27, the highest in our study. Conclusions IPV leads to severe injury across all age groups among both male and female patients. The injury mechanism should be clearly defined for all trauma patients, keeping IPV in mind as a potential cause despite patient age or gender.Peer reviewe
The Impact of Differential Cost Sharing of Non-Steroidal Anti-Inflammatory Agents on the Use and Costs of Analgesic Drugs
Get PDFOBJECTIVE: To estimate the effect of differential cost sharing (DCS) schemes for non-steroidal anti-inflammatory drugs (NSAIDs) on drug subsidy program and beneficiary expenditures. DATA SOURCES/STUDY SETTING: Monthly aggregate claims data from Pharmacare, the public drug subsidy program for seniors in British Columbia, Canada over the period 1989-11 to 2001-06. STUDY DESIGN: DCS limits insurance reimbursement of a group of therapeutically similar drugs to the cost of the lowest priced drugs, with beneficiaries responsible for costs above the reimbursement limit. Pharmacare introduced two different forms of DCS, generic substitution (GS) and reference pricing (RP), in April 1994 and November 1995, respectively, to the NSAIDs. Under GS, generic and brand versions of the same NSAID are considered interchangeable, whereas under RP different NSAIDs are. We extrapolated average reimbursement per day of NSAID therapy over the months before GS and RP to estimate what expenditures would have been without the policies. These counterfactual predictions were compared to actual values to estimate the impact of the policies; the estimated impacts on reimbursement rates were multiplied by the post-policy volume of NSAIDS dispensed, which appeared unaffected by the policies, to estimate expenditure changes. DATA COLLECTION: The cleaned NSAID claims data, obtained from Pharmacare’s databases, were aggregated by month and by their reimbursement status under the GS and RP policies. PRINCIPAL FINDINGS: After RP, program expenditures declined by 4 million annually, cutting expenditure by half. Most savings accrued from the substitution of low cost NSAIDs for more costly alternatives. About 20% of savings represented expenditures by seniors who elected to pay for partially-reimbursed drugs. GS produced one quarter the savings of RP. CONCLUSIONS: RP of NSAIDs achieved its goal of reducing drug expenditures and was more effective than GS. The effects of RP on patient health and associated health care costs remain to be investigated.Reference pricing; generic substitution; prescription drugs; drug cost containment; NSAIDs.
