Measuring outcomes following tibial fracture

Morris, Rhys; Pallister, Ian; Trickett, Ryan W

doi:10.1016/j.injury.2018.11.025

Cited by 18 publications

(19 citation statements)

References 191 publications

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“…A systematic review of outcomes following tibial shaft fractures in adults was recently published [99] . The aim of the study was to determine how clinical and patient-reported outcome measures are used to report results following tibial shaft fractures.…”

Section: Re-operation Rates In Tibial Fracturesmentioning

confidence: 99%

Epidemiology and incidence of tibia fractures in the Swedish Fracture Register

Wennergren

Bergdahl

Ekelund

et al. 2018

Injury

103

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Section: Re-operation Rates In Tibial Fracturesmentioning

confidence: 99%

Epidemiology and incidence of tibia fractures in the Swedish Fracture Register

Wennergren

Bergdahl

Ekelund

et al. 2018

Injury

103

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“…We hypothesised that improvements in objective outcome measures combining strength, agility and balance would mirror patients' own perceptions of their recovery after open lower limb fractures. There is a paucity of published data to establish reliable core clinical outcome measures in this group of patients (5,24). Open lower limb fractures can be life-changing injuries.…”

Section: Discussionmentioning

confidence: 99%

“…open lower limb fracture patients attending the Morriston Hospital Ortho-Plastic Trauma Research Clinic (OPRC) and these ndings were correlated with the passage of time from injury and the Disability Rating Index (DRI) (5,(11)(12)(13).…”

Section: An Observational Study Was Conducted Of the Objective Functimentioning

confidence: 99%

“…Indeed, disability rating index (DRI) scores at 12 months post injury are distinctly worse in open fracture patients compared to those with closed fractures (3,4). For these reasons the need for a de ned core outcome set for open lower limb fractures has been recognised (5). This would enable the meaningful comparison of surgical strategies within and between future studies.…”

Section: Introductionmentioning

confidence: 99%

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Objective Measures of Functional Outcome in Recovery from Open Lower Limb Fractures – A Report from an Ortho-Plastic Research Clinic

Pallister

Handley

Maggs

et al. 2020

Preprint

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BACKGROUNDOpen lower limb fractures are serious, potentially life-changing injuriesrequiring combined ortho-plastic surgery and have significantly worse outcomes than similar closed fractures. There is little objective published data to determine which functional outcome measures best reflect progress or completeness of physical recovery.Our hypothesis was that objective measures combining strength, agility and balance would better reflect recovery than isolated parameters (e.g. range of motion) and would compare well to patients’ perceived recovery.METHODSAdultopen lower limb fracture patients were followed-up at 6 and 12 weeks, 6, 9 and 12 months post-injury. The mechanism,injurypattern, age, gender and treatment were recorded. Isolated parameter objective functional outcome measures (OFOMs)(range of movement and MRC strength grade) were compared to combined OFOMs(timed up and go (TUAG), comfortable and fast gait speed (CGS and FGS), Edgren Side Step Test(ESST) and Single Leg balance. Patient reported outcomes were recorded (Global Perceived Effect (GPE) scoreand Disability Rating Index (DRI)). RESULTS68 patients (54 male) with a medianage of 45 years (range 20-75). Neither range of movement,strength nor Single Leg balance consistently improved with time. TUAG, ESST, CGS, FGS and GPE scoresshowed consistent improvement, with TUAG and FGS showing highest proportion of improving results at each time-point. Patients’ estimation of recovery paralleled these measures with all but 2 patients achieving the minimum clinical important difference in DRI by 12 months compared to baseline. However, the GPE score compared favourably withthe DRI having a higher proportion of improving responses at each time-point. DISCUSSIONFunctional recovery is a key determinant in patients returning to work, providing for themselves and their family or resuming independent living for older patients. This study has demonstrated time-related improvements in combined OFOMs measuringmobility, strength, agility and balance paralleling patients’ perception of recovery in the 12 months after open lower limb fractures. Over the same time-frame, the simple GPE score compared favourably with the DRI. Such parameters could become part of a defined core outcomes set. Focussing rehabilitation towards these combined OFOMs may help hasten recovery.Trial registrationSouth West Wales REC 06/WMW02/10)

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“…Indeed, Disability Rating Index (DRI) scores at 12 months post injury are distinctly worse in open fracture patients compared to those with closed fractures [ 3 , 4 ]. In our recent systematic review, we have shown that published outcome measures after either open and closed tibial fractures are inconsistently reported and seldom include direct measures of the patients’ locomotor ability [ 5 ]. For these reasons the need for a defined core outcome set for open lower limb fractures has been recognised [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Measuring recovery after open lower limb fractures: combined objective functional tests and global perceived recovery outperform narrower metrics and a standard generic patient reported outcome measure

Pallister

Handley

Maggs

et al. 2021

BMC Musculoskelet Disord

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Background Open lower limb fractures are serious injuries requiring combined ortho-plastic surgery and have significantly worse outcomes than similar closed fractures. There is little objective published data to determine which functional outcome measures best reflect progress or completeness of physical recovery. Our hypothesis was that objective measures combining strength, mobility and balance would better reflect recovery than isolated parameters (e.g. range of motion ROM) and would compare well to patients’ perceived recovery. Methods Adult open lower limb fracture patients were reviewed 6 and 12 weeks, 6, 9 and 12 months post-injury. The mechanism, injury pattern, age, gender and treatment were recorded. Isolated parameter objective functional outcome measures (OFOMs) (ROM and MRC strength grade) were compared to combined OFOMs (timed up and go, comfortable gait speed and fast gait speed, Edgren Side Step Test (TUAG, CGS, FGS, ESST) and Single Leg balance. Patient reported outcomes were recorded (Global Perceived Effect (GPE) score and Disability Rating Index (DRI)). Statistical analysis used non-parametric tests (e.g. Spearman correlation) compared each with time since injury. Results Sixty-eight patients (54 male) with a median age of 45(20–75) years. Of the 19 isolated OFOMs, only knee flexion and ankle plantar flexion ROM and strength improved with time (Spearman correlation p = 0.042, 0.008, 0.032, 0.036 respectively). TUAG, ESST, CGS, FGS and GPE scores showed significant improvement (Spearman correlation p < 0.001). Patients’ estimation of recovery paralleled these measures (Spearman correlation p < 0.001) with all but 2 patients achieving the minimum clinical important difference in DRI by 12 months compared to baseline. However, the GPE score had a higher proportion of improving responses than DRI at each time-point. Discussion Functional recovery is a key determinant in patients returning to work, providing for themselves and their family or resuming independent living for older patients. This study has demonstrated time-related improvements in combined OFOMs measuring mobility, strength, agility and balance paralleling patients’ perception of recovery in the 12 months after open lower limb fractures. Over the same time-frame, the simple GPE score compared favourably with the DRI. Such parameters could become part of a defined core outcomes set. Focussing rehabilitation towards these combined OFOMs may help hasten recovery. Trial registration South West Wales REC 06/WMW02/10).

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Measuring outcomes following tibial fracture

Cited by 18 publications

References 191 publications

Epidemiology and incidence of tibia fractures in the Swedish Fracture Register

Epidemiology and incidence of tibia fractures in the Swedish Fracture Register

Objective Measures of Functional Outcome in Recovery from Open Lower Limb Fractures – A Report from an Ortho-Plastic Research Clinic

Measuring recovery after open lower limb fractures: combined objective functional tests and global perceived recovery outperform narrower metrics and a standard generic patient reported outcome measure

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