Bmc Musculoskel Dis
-
Bmc Musculoskel Dis · Apr 2015
Comparative StudyPrimary outcome measure use in back pain trials may need radical reassessment.
The answers to patient reported outcome measures and global transition questions for back pain can be discordant. For example, the most commonly used outcome measure in back pain trials, the Roland Morris Disability Questionnaire (RMDQ), can show improvement even though participants say that their back pain is worse. This gives cause for concern as transition questions are used as anchors to estimate minimally important change (MIC) thresholds on patient reported outcome measures such as the RMDQ. We aimed to explore and compare what people with back pain think when they respond to a transition question and when they complete the RMDQ. ⋯ Approaches to primary outcome assessment in back pain needs re-assessment. The RMDQ may be unsuitable for use as a primary outcome measure since patients may not attend to thinking about their back pain when completing it: patients' abilities to cope with tasks can be independent of the change in their back pain. Some participants who improve on the RMDQ consider themselves globally worse. As transition questions can be driven by pain and other physical factors, transition questions should not be used to anchor minimally important change thresholds on the RMDQ.
-
Bmc Musculoskel Dis · Apr 2015
Randomized Controlled Trial Multicenter StudyFunctional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis.
Physical forces have been widely used to stimulate bone growth in fracture repair. Addition of bone growth stimulation to the conservative treatment regime is more costly than standard health care. However, it might lead to cost-savings due to a reduction of the total amount of working days lost. This economic evaluation was performed to assess the cost-effectiveness of Pulsed Electromagnetic Fields (PEMF) compared to standard health care in the treatment of acute scaphoid fractures. ⋯ This study demonstrates that the desired effects in terms of cost-effectiveness are not met. When comparing the effects of PEMF to standard health care in terms of QALY's, PEMF cannot be considered a cost-effective treatment for acute fractures of the scaphoid bone.
-
Bmc Musculoskel Dis · Apr 2015
Comparative StudyBiomechanical evaluation of a new pedicle screw-based posterior dynamic stabilization device (Awesome Rod System)--a finite element analysis.
Pedicle-screw-based posterior dynamic stabilization devices are designed to alleviate the rate of accelerated degeneration of the vertebral level adjacent to the level of spinal fusion. A new pedicle-screw-based posterior dynamic stabilization device- the Awesome Dynamic Rod System was designed with curve cuts on the rods to provide flexibility. The current study was conducted to evaluate the biomechanical properties of this new device. ⋯ The results demonstrate that the Awesome Dynamic Rod System preserved more bridged segment motion than did the traditional rigid rod fixation system except in extension. However, the Awesome Dynamic Rod System bore a greater facet joint contact force in extension. The Awesome Dynamic Rod System did protect the adjacent level of fusion segments, but led to much greater ROM, disc stresses, and facet joint contact forces increasing at the adjacent level of instrumented segments.
-
Bmc Musculoskel Dis · Apr 2015
Comparative Study Observational StudyEarly postoperative mortality after simultaneous or staged bilateral primary total hip arthroplasty: an observational register study from the Swedish Hip Arthroplasty Register.
Approximately a fifth of all total hip arthroplasty (THA) patients suffers from bilateral osteoarthritis of the hip. It is unclear whether mortality risks differ between simultaneous bilateral THA and staged bilateral THA. We investigated mortality after simultaneous THA compared with staged bilateral THA in the largest cohort hitherto reported. ⋯ There were no clinically relevant differences in early postoperative mortality between simultaneous and staged bilateral surgery in healthy patients. Advanced age, RA, a high ASA class and male sex increased the risk of death within 90 days. There may be an issue with enhanced risk of implant revision in patients with simultaneous bilateral THA that needs to be explored further.