Loss of Follow-up in Orthopaedic Trauma

Zelle, Boris A.; Buttacavoli, Frank; Shroff, Jeffrey B.; Stirton, Jacob

doi:10.1097/bot.0000000000000346

Cited by 86 publications

(82 citation statements)

References 10 publications

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“…The first main finding of this study was that travel distance, BMI and HIV status were the most important predictors of attendance for follow-up visits, with an increased travel distance, increased BMI and HIV-positive status making it more likely for patients not to return for follow-up. Alcohol use, smoking and male gender have been reported as major risk factors for loss to follow-up in the literature, [4,5,8] but this was not found in the present study. Zelle et al [4] reported travel distance not to be a predictor of loss to follow-up, [4] while the present study highlights this to be a risk factor.…”

Section: Discussioncontrasting

confidence: 73%

“…[11] The widespread poverty in the Northern Cape means that most patients who rely on government health services also depend on the government transport system that is tasked with transporting patients across the province to their required healthcare facilities. A recent study in the USA reported that travel distance was not related to loss to follow-up, [4] but in the developing world setting of the Northern Cape, vast distances ( Fig. 2) together with poverty can potentially make returning to a hospital very challenging for patients compared with those in the developed world.…”

Section: In Practicementioning

confidence: 99%

“…[3] Lack of follow-up can often lead to skewed results and influence study outcomes and validity. [3,4,9,10] This further creates the perception of poor study design, management and execution or poor performance of the researchers or clinicians, with the impression that patients were dissatisfied with their care and chose to visit alternative clinicians. [10] Although a genuine concern in private settings both locally and abroad, the possibility of a patient utilising the public healthcare system in SA failing to report for follow-up because of dissatisfaction with a primary healthcare provider is unlikely, because of the setup of the public healthcare system.…”

mentioning

confidence: 99%

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Lost to follow-up: Challenges to conducting orthopaedic research in South Africa

Westhuizen

Britz

et al. 2018

S Afr Med J

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Kimberley Provincial Hospital provides the sole public sector orthopaedic surgical service to the entire Northern Cape Province of South Africa (SA). Ankle fractures form part of the trauma burden and pose a challenge owing to high numbers and limited resources. The incidence of ankle fracture is reported to be 169.7/100 000/year. [1] Currently there are no statistics on the incidence in the Northern Cape. An alternative surgical method of treatment was explored in the form of a prospective cohort series, to increase turnaround time of patients needing surgery and thus improve service delivery. Data collection while conducting this prospective trial highlighted loss to follow-up in ankle fracture patients, which prompted this report. Numerous studies have highlighted the challenges in terms of loss to follow-up when conducting trials in musculoskeletal injuries. [2-5] The main factors contributing to this loss to follow-up are reported to be socioeconomic, and include level of education, poverty, male gender, smoking and alcohol abuse. [6] Young individuals as well as the very elderly are prone to be lost to follow-up. Potential reasons for this vary, but are hypothesised to include an increased frequency of substance abuse in younger populations and lack of mobility in older populations. [2,7] In addition, smokers are reported to have an 80% higher risk of loss to follow-up compared with non-smokers. The reason for this is not clear, but it has been postulated that individuals with substance use may lack motivation to change their behaviour for health-related purposes. [2] Several other studies also report smokers to be at risk of not attending for follow-up as expected. [4,5,8] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Section: Discussioncontrasting

confidence: 73%

Section: In Practicementioning

confidence: 99%

mentioning

confidence: 99%

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Lost to follow-up: Challenges to conducting orthopaedic research in South Africa

Westhuizen

Britz

et al. 2018

S Afr Med J

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“…The mean rate of loss to follow-up in orthopaedic trauma studies (10.5 %) was similar to that of all other subspecialty trials (10.4 %; p = 0.57). Suggested risk factors for loss to follow-up include racial and ethnic factors, age, gender, insurance status, and educational level [19][20][21][22][23]. The present investigation did not confirm age as a risk factor for loss to follow-up.…”

Section: Discussionmentioning

confidence: 94%

Loss to follow-up in orthopaedic clinical trials: a systematic review

Somerson

Bartush

Shroff

et al. 2016

International Orthopaedics (SICOT)

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“…Research in trauma and orthopaedic settings from other countries has explored various factors and demographics that are associated with a higher chance of dropout in treatment and research. Common risk factors included: male gender, current smokers, younger than 30 years, high alcohol and substance use, and lack of health insurance 35,36 . Increased efforts to maintain contact with patients identified as being at higher risk of not following up, may help to decrease the possible complications resulting from unmonitored recovery 37 .…”

Section: Retentionmentioning

confidence: 99%

Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country: A randomised feasibility study

Naude¹,

Klerk²

2019

S. Afr. j. occup. ther.

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Introduction: Flexor tendon injuries remain one of the most difficult hand injuries to manage post-operatively. Early active mobilisation protocols are considered 'best practice' internationally but have not been well researched in the developing country context. The feasibility of such research, and use of these protocols, need to be determined by considering the potential for improved functional outcomes for patients, together with various contextual and resource challenges. Purpose: To explore aspects of feasibility related to the recruitment, consent and retention rates in consideration of a future definitive Randomised Control Trail. In addition, preliminary results of an early active therapy protocol compared to an early passive therapy protocol were reported on, together with patient satisfaction and demographics. Methods: A parallel randomised pilot trial design was used. Thirty-one participants were recruited into one of two therapy groups (active or passive). Fourteen of these participants completed their therapy and eight-week assessments including: Total Active Motion, grip strength, the Michigan Hand Questionnaire and the Smith Hand Function Evaluation. 95% Confidence intervals examined feasibility data. Non-parametric data analysis was done primarily using medians and ranges. Results: Feasibility results of 37% recruitment rate, 97% consent rate and 45% retention rate, did not meet the criteria for success, deeming a trial in the present design, not feasible. Discussion: Due to the dearth of research from public health clinical settings in developing countries, this study contributes rich contextual data, but the challenges discussed need to be addressed before further research will achieve success.

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Loss of Follow-up in Orthopaedic Trauma

Cited by 86 publications

References 10 publications

Lost to follow-up: Challenges to conducting orthopaedic research in South Africa

Lost to follow-up: Challenges to conducting orthopaedic research in South Africa

Loss to follow-up in orthopaedic clinical trials: a systematic review

Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country: A randomised feasibility study

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