Purpose Patient-rated instruments are increasingly used to measure orthopaedic outcomes. However, the clinical relevance of modest score changes on such instruments is often unclear. This study was designed to define the minimal clinically important differences (MCID) of the Disabilities of the Arm, Shoulder, and Hand (DASH), QuickDASH, and Patient Rated Wrist Evaluation (PRWE) for atraumatic conditions of the hand, wrist, and forearm. Methods One hundred two patients undergoing nonoperative treatment for isolated tendonitis, arthritis, or nerve compression syndromes from the forearm to the hand were analyzed prospectively. Patients completed the DASH, Quick DASH (subset of DASH), and PRWE at enrollment, 2 weeks (n=78 used in analysis), and 4 weeks (n=24 used in analysis) after initiating treatment by telephone. Patients reporting clinical improvement each contributed a single data point categorized as no change (n=41), minimal improvement (n=30), or marked improvement (n=31) via a validated anchor-based approach. The minimal clinically important difference was calculated as the mean change score for each outcome measure in the minimal improvement group. Results The MCID (95%CI) for the DASH was 10 (5-15). The MCID for the Quick DASH was 14 (9-20). The MCID was 14 (8-20) for the PRWE. MCID values were significantly different from changes in these outcome measures at times of either no change or marked improvement. MCID values positively correlated with baseline outcome measure scores to a greater degree than final outcome measure scores. Discussion Longitudinal changes on the DASH of 10 points, the Quick DASH of 14 points, and the PRWE of 14 points represent minimal clinically important changes. We recommend application of these MCID values for group-level analysis when conducting research and interpreting data examining groups of patients as opposed to assessing individual patients. These MCID values may provide a basis for sample size calculations for future investigation using these common patient-rated outcome measures. Level of Evidence: Diagnostic III
Purpose To use the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist to critically evaluate the change in quality of observational trial reporting in the Journal of Hand Surgery American between 2005 and 2011. Methods A cross-sectional analysis of observational studies published in Journal of Hand Surgery American was designed to sample 2 6-month periods of publication (March 2005 - August 2005 and June 2011 - November 2011). Fifty-one items were extracted from the STROBE statement for evaluation. Overall STROBE compliance rates for articles and specific checklist items were determined. Final compliance percentages from each period were compared by Student t-testing. Changes in item compliance over time were quantified. Results Overall compliance with the STROBE statement was 38% (range, 10-54%) in 2005 and 58% (range, 39%-85%) for 2011 manuscripts representing a significant improvement. Seventy-five percent or greater of articles (2005/2011) provided the explicit reporting of background (100%/97%), follow-up time (85%/94%), overall interpretation of data (100%/94%), and results of similar studies (95%/89%). Twenty-five percent or less of articles provided the study design in the abstract (10%/20%), a clear description of the study's setting (10%/23%), the handling of missing data (0%/6%), the potential directions of bias (5%/11%) and use of a power analysis (0%/17%). Eighty-six percent (44/51) of items were more frequently satisfied in 2011 articles compared to 2005 publications. Absolute increases in compliance rates of ≥40% were noted in 10 items (20%) with no worsening in compliance for an individual item over 6%. Discussion The overall quality of the reporting of observational trials in Journal of Hand Surgery American improved from 2005 to 2011. Current observational trials in hand surgery could still benefit from increased reporting of methodologic details including the use of power analyses, the handling of missing data, and consideration of potential bias.
Background The thumb trapeziometacarpal joint is one of the most common sites of arthritic degeneration prompting specialty care. Surgical treatment algorithms are based on radiographic arthritic progression. However, the pain and disability attributable to trapeziometacarpal arthritis do not correlate with arthritic stage, and depression has independently predicted poorer self-rated hand function both at baseline and after treatment in patients' atraumatic hand conditions. Questions/purposes (1) Does thumb trapeziometacarpal osteoarthritis impact both self-perceived general health and hand function? (2) Do depression and other comorbid conditions differentially impact patient-rated hand function based on the presence or absence of symptomatic trapeziometacarpal arthritis? (3) How do disease-specific, patient demographics and comorbid conditions impact selfreported hand function in patients with trapeziometacarpal osteoarthritis? Methods This cross-sectional study compared patients with symptomatic trapeziometacarpal osteoarthritis (n = 47) with matched control subjects without a symptomatic hand condition (n = 47). All participants self-reported medical (including depression) and musculoskeletal comorbidities and completed the SF-36 and the Michigan Hand Questionnaire (MHQ). Bivariate statistical analyses contrasted the patients with trapeziometacarpal osteoarthritis to control subjects. Linear regression modeling determined the impact of subject demographic data, comorbidity burden, and examination findings on total MHQ scores in patients with trapeziometacarpal arthritis. Results Patients with scored trapeziometacarpal osteoarthritis indicated poorer perceived general health on the SF-36 categories of limitations resulting from physical health (52 ± 29 versus 71 ± 31, mean difference 19 [95% confidence interval {CI}, 7-31], p = 0.003) and limitations resulting from emotional problems (50 ± 27 versus 67 ± 50, mean difference 17 [95% CI, 3-33], p = 0.022) compared with control subjects. Self-reported depression was associated with worse hand function (total MHQ score) in patients with trapeziometacarpal arthritis (69 ± 20 versus 49 ± 22: mean difference À20 [95% CI, À5 toÀ36], p = 0.012) but not in control patients (90 ± 13 versus 84 ± 20: mean difference À5 [95% CI, À8 to 19], p = 0.404). In multivariate modeling, depression (b À20, [95% CI, À5 to À34], p = 0.009) and upper extremity comorbidities (b À25, [95% CI, À10 to À40], p = 0.002) were both associated with reduced total MHQ scores in patients with trapeziometacarpal osteoarthritis, and those factors accounted for 34% of the variance in the MHQ score.
Difficulty opening medication packaging can have serious consequences that can lead to patient harm via medication mismanagement or poor adherence. However, the quality of literature pertaining to these issues has yet to be collated and critiqued. This systematic review examined cross-sectional studies that objectively examined the ability of participants to open different medication packaging. Of the 8,692 studies identified, 12 met the inclusion criteria, all of which were direct observational studies given that prior research has identified a mismatch between self-report and actual ability. Scoring via the Appraisal Tool for Cross Sectional Studies revealed that the methodological quality of included studies was typically low. Study samples mostly consisted of older adults. All studies reported a non-negligible proportion of participants unable to open packaging, with the most difficulty associated with child-resistant containers. Several studies examined associations; however, no factor was consistently found to be significantly associated with the ability to open packaging. Despite these studies spanning >40 years, the packaging types examined remained largely the same. This suggests that, despite decades of research demonstrating that packaging is problematic, there has been a stagnation in medication packaging development. Whether this is attributed to a paucity of high-quality research, and therefore a lack of strong evidence that change is needed, is unclear. Future research should strive for better methodological quality, with generalisable cohorts assessed via observation in their home. If the problems identified in prior research persist, this may provide the impetus for change that is overdue in the medication packaging industry.
BackgroundMethamphetamine use is increasing in prevalence. There is a theoretical increased risk of complication postoperative due to catecholamine depletion. When presented with an urgent surgical problem, there are little data to help counsel the patient on the risks of undergoing surgery in the setting of a positive methamphetamine test result.
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