Objective To develop an instrument to evaluate the credibility of anchor based minimal important differences (MIDs) for outcome measures reported by patients, and to assess the reliability of the instrument. Design Instrument development and reliability study. Data sources Initial criteria were developed for evaluating the credibility of anchor based MIDs based on a literature review (Medline, Embase, CINAHL, and PsycInfo databases) and the experience of the authors in the methodology for estimation of MIDs. Iterative discussions by the team and pilot testing with experts and potential users facilitated the development of the final instrument. Participants With the newly developed instrument, pairs of masters, doctoral, or postdoctoral students with a background in health research methodology independently evaluated the credibility of a sample of MID estimates. Main outcome measures Core credibility criteria applicable to all anchor types, additional criteria for transition rating anchors, and inter-rater reliability coefficients were determined. Results The credibility instrument has five core criteria: the anchor is rated by the patient; the anchor is interpretable and relevant to the patient; the MID estimate is precise; the correlation between the anchor and the outcome measure reported by the patient is satisfactory; and the authors select a threshold on the anchor that reflects a small but important difference. The additional criteria for transition rating anchors are: the time elapsed between baseline and follow-up measurement for estimation of the MID is optimal; and the correlations of the transition rating with the baseline, follow-up, and change score in the patient reported outcome measures are satisfactory. Inter-rater reliability coefficients (ĸ) for the core criteria and for one item from the additional criteria ranged from 0.70 to 0.94. Reporting issues prevented the evaluation of the reliability of the three other additional criteria for the transition rating anchors. Conclusions Researchers, clinicians, and healthcare policy decision makers can consider using this instrument to evaluate the design, conduct, and analysis of studies estimating anchor based minimal important differences.

A prospective clinical study used joint scintigraphy to investigate conservative treatment of juvenile osteochondritis dissecans (JOCD) of the femoral condyle. The predictive value of scintigraphic evaluation and various parameters (age at onset, sex, location and size of lesion) were analyzed. Over a 10 year period, the senior author followed 92 knees in 76 patients, 60 of whom were male and 16 female (11 and 5 bilaterals, respectively). All patients were participants in athletics or exercise programs. All patients had orthopaedic assessment, roentgenographic studies (AP, lateral, and tunnel views), 99m-Technetium phosphate compound joint scintigraphy, and instruction in a symptom-free existence (with all athletic activity proscribed). Patients were reevaluated and scanned every 8 weeks. No casts or braces were used, although crutches were sometimes necessary to maintain symptom-free levels. Based on specific indications for failure of conservative treatment, 50% of these patients failed and underwent surgery. Of the 92 knees, 52 were successfully treated conservatively, while 40 failed. Average followup was 4.2 years. Average age at onset was 12.5 years; the success group averaged 12.1 years and the failure group 13.0 years. The average lesion size was 363.2 mm2, with 309.5 mm2 in the success group and 436.0 mm2 in the failure group. Parameters of location, sex, and scan classification were not statistically significant as predictive factors. This study found no predictors for the success or failure of treatment beyond a moderate correlation of larger lesion size with failed conservative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

BackgroundMost TKA prostheses are designed based on the anatomy of white patients. Individual studies have identified key anthropometric differences between the knees of the white population and other major ethnic groups, yet there is limited understanding of what these findings may indicate if analyzed collectively.Question/purposeWhat are the differences in morphologic features of the distal femur and proximal tibia among and within various ethnicities?MethodsA systematic review of the PubMed database and a hand-search of article bibliographies identified 235 potentially eligible English-language studies. Studies were excluded if they did not include morphology results or had insufficient data for analysis, were unrelated to the distal femur or proximal tibia, were conducted in pediatric patients or those undergoing unicondylar knee arthroplasty, or bone surface measurements were obtained for trauma products. This left 30 eligible studies (9050 knees). Study quality was assessed and reported as good, fair, or poor according to the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Morphometric data for the distal femur and proximal tibia were available for four ethnic groups: East Asian (23 studies; 5543 knees), white (11 studies; 3111 knees), Indian (three studies; 283 knees), and black (three studies; 113 knees). Although relatively underrepresented, the knees from the Indian and black studies were maintained for hypothesis-generating purposes and to highlight crucial gaps in the data. The two key dimensions for selecting a suitable implant based on a patient’s unique anatomy—AP length and mediolateral (ML) width—were assessed for the femur and tibia, in addition to aspect ratio, calculated by dividing the ML width by the AP length. Study measurement techniques were compared visually when possible to ensure that each pooled study conducted a similar measurement process. Any significant measurement outliers were reviewed for eligibility to determine if the measurement techniques and landmarks used were comparable to the other studies included.ResultsWhite patients had larger femoral AP measurements than East Asians (62 mm, [95% CI, 57–66 mm] vs 59 mm, [95% CI, 54–63 mm]; mean difference, 3 mm; p < 0.001), a smaller femoral aspect ratio than East Asians (1.20, [95% CI, 1.11–1.29] vs 1.25, [95% CI, 1.16–1.34]; mean difference, 0.05; p = 0.001), and a larger tibial aspect ratio than black patients (1.55, [95% CI, 1.40–1.71] vs 1.49, [95% CI, 1.33–1.64]; mean difference, 0.06; p = 0.005).ConclusionsThis analysis uncovered differences of size (AP height and ML width of the femur and tibia) and shape (tibial and femoral aspect ratios) among knees from white, East Asian, and black populations. Future research is needed to understand the clinical implications of these discrepancies and to provide additional data with underrepresented groups.

This experiment examined whether a photoarray administrator's knowledge of a suspect's identity increased false identification rates. Fifty participant-administrators (PAs) presented 50 participant-witnesses (PWs) two perpetrator-absent photoarrays following a live staged crime involving two perpetrators. For one photoarray per trial, the experimenter revealed the suspect's identity to the PA. Each PA presented the photoarrays sequentially or simultaneously in the presence or absence of an observer. When the observer was present, PA knowledge of the suspect's identity had a biasing effect in sequential photoarrays only. This pattern did not emerge when the observer was absent. The experimental manipulations did not affect PAs' and PWs' ratings of photoarray fairness or PWs' ratings of pressure to make an identification. These data suggest that only administrators who are blind to the suspect's identity should present sequential photoarrays.The vagaries of eyewitness identification are well-known... . A major factor contributing to the high incidence of miscarriage of justice from mistaken identification has been the degree of suggestion inherent in the manner in which the prosecution presents the suspect to witnesses for pretrial identification. . . . Suggestion can be created intentionally or unintentionally in many subtle ways.-Supreme Court Justice William Brennan, writing for the majority in United States v. Wade (1967) 940This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.