Background: The literature regarding the management of factitious disorder (FD) is diverse and generally of case reports or case series. To date there has been no systematic review of the effectiveness of management techniques. Methods: Systematic review of all evidence reporting the management and subsequent outcome in FD. Data were extracted and outcomes were assessed using an adaptation of the Global Improvement Scale. Results were analysed by parametric statistical tests; a meta-analysis was not possible. Results: Thirty-two case reports and 13 case series were eligible for inclusion. Analysis of the case reports found no significant difference in outcomes between confrontational and non-confrontational approaches [t(29) = 0.72, p = 0.48], between treatment with psychotherapy compared to no psychotherapy [t(30) = 0.69, p = 0.48], and when psychiatric medication had been prescribed compared with not [t(30) = 0.35, p = 0.73]. A trend was observed that a longer length of treatment lead to better outcomes, but this was not significant [F(5, 26) = 1.17, p = 0.35]. The consecutive case series demonstrated that many FD sufferers were not engaged in treatment and were lost to follow-up but did not provide any strong evidence regarding the effectiveness of different management approaches. Conclusions: There is an absence of sufficient robust research to determine the effectiveness of any management technique for FD. The establishment of a central reporting register to facilitate the development of evidence-based guidelines is recommended.
These results indicate that the process of peri-prosthetic osteolysis is complex and multifactorial; there may also be an influence of metallosis. Further research is needed to increase understanding of peri-prosthetic osteolysis and influence clinical practice.
There is no satisfactory method for clinically assessing shoulder function. This paper presents a method of assessment by way of a simple 100-point scoring system incorporating subjective measures of pain and activity and objective tests of range of movement and power. This provides an overall assessment of clinical function, which is reproducible and can be used irrespective of shoulder pathology as the affected side is easily compared with the unaffected side. The scoring system is reproducible and can also be used to monitor change in function across time or following intervention.
SummaryThis paper presents a scoring system for the functional assessment of the shoulder, which aimed to be a comprehensive but simple method for accurate evaluation of shoulder function. The authors devised and used this score over a 4-year period.The four components of the assessment are pain (15 marks), ability to perform activities of daily living (20 marks), range of motion (40 marks) and power (25 marks). This provides a total score out of 100, with a lower score indicating worse function (Tables 79.1 , 79.2 , 79.3 , 79.4 , 79.5 and 79.6 ). The authors recommend that assessments of both shoulders be made so comparisons can be made on an individual patient basis.Pain is rated by the patient as 15 for no pain, 10 for mild pain, 5 for moderate pain, and 0 for severe pain, scoring the worst pain they experience through activities of daily living.Activity level assessment is again subjectively completed by the patient in two components. The fi rst 10 marks are accounted for by their ability to perform full work, full recreation or sport and sleep unaffected by pain. The second 10 marks are where they feel they can
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