title: The Artelon CMC spacer compared with tendon interposition arthroplasty Comparison between proximal row carpectomy and four‐corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients Early versus late mobilisation after simple excision of the trapezium. Reference bias: presentation of extreme health states prior to eq-vas improves health-related quality of life scores. a randomised cross-over trial Patients undergoing subacute rehabilitation have accurate expectations of their health-related quality of life at discharge Responsiveness of patient reported outcomes including fatigue, sleep quality, activity limitation, and quality of life following treatment with abatacept for rheumatoid arthritis A Comparison of Trapeziectomy Via Anterior and Posterior Approaches Intra-articular hyaluronic acid compared with corticoid injections for the treatment of rhizarthrosis. Using the SF-36 and Euroqol on an elderly population Continuous low-level heat wrap therapy is effective for treating wrist pain. A Comparison of Trapeziectomy with and without Ligament Reconstruction and Tendon Interposition Splinting the degenerative basal joint: custom-made or prefabricated neoprene? Reliability and Validity Testing of the SF-36 Questionnaire for the Evaluation of the Quality of Life of Chinese Urban Construction Workers
abstract: Background and purpose The Artelon CMC spacer is design ed for surgical treatment of osteoarthritis ( OA ) in the carpometacarpal joint of the thumb ( CMC-I ) . Good results using this degradable device were previously presented in a pilot study . We now present results from a larger r and omized , controlled , multicenter study . Patients and methods 109 patients ( 94 females ) with a mean age of 60 ( 42–83 ) years , suffering from painful CMC OA , were included in the study at 7 centers in Sweden . The patients were r and omized to Artelon CMC spacer ( test , n = 72 ) or tendon arthroplasty ( control , n = 37 ) at a ratio of 2:1 . Perceived pain was recorded on a visual analog scale ( VAS ) before treatment and after 3 , 6 , and 12 months , when measuring maximal tripod pinch strength ( primary outcome measure ) . In addition , range of motion , radiographic findings , and functional testing were recorded pre- and postoperatively . Results Swelling and pain were more common in the test group and 6 implants were removed because of such symptoms . 5 of these patients did not receive antibiotics preoperatively according to the study protocol . In a per- protocol analysis , i.e. patients without signs of concomitant OA in the scaphoid-trapezium-trapezoid ( STT ) joint and those in the test group who received antibiotics , the mean difference in tripod pinch strength increase , adjusted for baseline , was 1.4 kg in favor of the test group ( not statistically significant ) . Statistically significant pain relief was achieved in both groups , with perceived pain gradually decreasing during the follow-up period . In the intention-to-treat analysis but not in the per- protocol analysis , significantly better pain relief ( VAS ) was obtained in the control group . Patient-perceived disability evaluated by the DASH question naire improved in both groups . Interpretation The Artelon CMC spacer did not show superior results compared to tendon interposition arthroplasty . Proper use of preoperative antibiotics and a thorough patient selection appear to be important for the results OBJECTIVE : To compare the functional results of carpectomy and four‐corner fusion surgical procedures for treating osteoarthrosis following carpal trauma . METHODS : In this prospect i ve r and omized study , 20 patients underwent proximal row carpectomy or four‐corner fusion to treat wrist arthritis and their functional results were compared . The midcarpal joint was free of lesions in all patients . RESULTS : Both proximal row carpectomy and four‐corner fusion  reduced the pain . All patients had a decreased range of motion after surgery . The differences between groups were not statistically significant . CONCLUSIONS : Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non‐union advanced collapse ( SLAC/SNAC ) wrist without degenerative changes in the midcarpal joint This prospect i ve study compared the outcome --subjective , objective and radiographic -- of two surgical techniques for treating basal joint arthritis of the thumb : a " simple " trapeziectomy ( group I ) and a ligament reconstruction/tendon ( group II ) interposition technique . There were respectively 22 patients in group I and 34 in group II , all women with primary osteoarthritis . Both techniques gave favourable results and there were no significant differences for pain relief , patient satisfaction , mobility , DASH-score , key pinch force and gripping force . However in group II , the trapezial height was better preserved indicating that the proximal migration of the thumb was prevented or limited . There was also a significant correlation between the remaining trapezial space and key pinch force Background Assessment s of change in subjective patient reported outcomes such as health-related quality of life ( HRQoL ) are a key component of many clinical and research evaluations . However , conventional longitudinal evaluation of change may not agree with patient perceived change if patients ' underst and ing of the subjective construct under evaluation changes over time ( response shift ) or if patients ' have inaccurate re collection ( recall bias ) . This study examined whether older adults ' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay . It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced . Methods A prospect i ve longitudinal cohort design nested within a larger r and omised controlled trial was implemented . 103 hospitalised older adults participated in this investigation at a tertiary hospital facility . The  EQ-5D utility and Visual Analogue Scale ( VAS ) scores  were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable ( within three days of admission ) then again immediately prior to discharge . Three methods of change score calculation were used ( conventional change , patient perceived change and patient perceived change adjusted for recall bias ) . Agreement was primarily investigated using intraclass correlation coefficients ( ICC ) and limits of agreement . Results Overall 101 ( 98 % ) participants completed both admission and discharge assessment s. The mean ( SD ) age was 73.3 ( 11.2 ) . The median ( IQR ) length of stay was 38 ( 20 - 60 ) days . For agreement between conventional longitudinal change and patient perceived change : ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively . For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias : ICCs were 0.98 and 0.90 respectively . Discrepancy between conventional longitudinal change and patient perceived change was considered clinical ly meaningful for 84 ( 83.2 % ) of participants , after adjusting for recall bias this reduced to 8 ( 7.9 % ) . Conclusions Agreement between conventional change and patient perceived change was not strong . A large proportion of this disagreement could be attributed to recall bias . To overcome the invalidating effect of response shift ( on conventional change ) and recall bias ( on patient perceived change ) a method of adjusting patient perceived change for recall bias has been described We r and omly selected 39 patients undergoing excision of the trapezium for osteoarthritis of the first carpometacarpal joint into two groups , with mobilisation either at one or at four weeks after operation . The patients were review ed at a median of six months ( 6 to 8) . The clinical details , the severity of the disease and the preoperative clinical measurements of both groups were similar . Excision of the trapezium result ed in significant improvement in objective and subjective function . Comparison of the outcomes of the two groups showed no differences except that patients found early mobilisation significantly more convenient . Although there was no significant difference in the range of movement between the groups , there was a small loss of movement at the metacarpophalangeal joint in the late mobilisation group . Our findings show that simple excision of the trapezium is an effective procedure for patients with carpometacarpal osteoarthritis of the thumb and that prolonged splintage is neither necessary nor desirable Background Clinical practice and clinical research has made a concerted effort to move beyond the use of clinical indicators alone and embrace patient focused care through the use of patient reported outcomes such as health-related quality of life . However , unless patients give consistent consideration to the health states that give meaning to measurement scales used to evaluate these constructs , longitudinal comparison of these measures may be invalid . This study aim ed to investigate whether patients give consideration to a st and ard health state rating scale ( EQ-VAS )  and whether consideration of good and poor health state descriptors immediately changes their self-report . Methods A r and omised crossover trial was implemented amongst hospitalised older adults ( n = 151 ) . Patients were asked to consider descriptions of extremely good ( Description-A ) and poor ( Description-B ) health states . The EQ-VAS  was administered as a self-report at baseline , after the first descriptors ( A or B ) , then again after the remaining descriptors ( B or A respectively ) . At baseline patients were also asked if they had considered either EQ-VAS anchors . Results Overall 106/151 ( 70 % ) participants changed their self-evaluation by ≥5 points on the 100 point VAS , with a mean ( SD ) change of + 4.5 ( 12 ) points ( p < 0.001 ) . A total of 74/151 ( 49 % ) participants did not consider the best health VAS anchor , of the 77 who did 59 ( 77 % ) thought the good health descriptors were more extreme ( better ) then they had previously considered . Similarly 85/151 ( 66 % ) participants did not consider the worst health anchor of the 66 who did 63 ( 95 % ) thought the poor health descriptors were more extreme ( worse ) then they had previously considered . Conclusions Health state self-reports may not be well considered . An immediate significant shift in response can be elicited by exposure to a mere description of an extreme health state despite no actual change in underlying health state occurring . Caution should be exercised in research and clinical setting s when interpreting subjective patient reported outcomes that are dependent on brief anchors for meaning . Trial Registration Australian and New Zeal and Clinical Trials Registry ( # ACTRN12607000606482 ) Background Expectations held by patients and health professionals may affect treatment choices and participation ( by both patients and health professionals ) in therapeutic interventions in contemporary patient-centered healthcare environments . If patients in rehabilitation setting s overestimate their discharge health-related quality of life , they may become despondent as their progress falls short of their expectations . On the other h and , underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit . There is a scarcity of empirical evidence evaluating whether patients ’ expectations of future health states are accurate . The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life . Methods A prospect i ve longitudinal cohort investigation of agreement between patients ’ anticipated discharge health-related quality of life ( as reported on the EQ-5D instrument at admission to a rehabilitation unit ) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken . The  mini-mental state examination  was used as an indicator of patients ’ cognitive ability . Results Overall , 232(85 % ) patients had all assessment data completed and were included in analysis . Kappa scores ranged from 0.42 - 0.68 across the five EQ-5D domains and two patient cognition groups . The percentage of exact correct matches within each domain ranged from 69 % to 85 % across domains and cognition groups . Overall 40 % of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses . Conclusions Patients admitted for subacute in-hospital rehabilitation were able to anticipate their discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy . This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury . Accurate patient expectations of the impact of treatment ( or disease progression ) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved Objective : To evaluate the responsiveness of patient reported outcomes ( PROs ) , including fatigue , sleep , activity limitation , and quality of life , in patients with rheumatoid arthritis ( RA ) . Methods : Data were considered from a r and omised controlled trial comparing  abatacept ( n = 258 )  with placebo ( n = 133 ) on a background of DMARD treatment in RA patients who were inadequate responders to anti-TNF therapy ( ATTAIN study ) . PROs assessed included SF-36 , activity limitation , fatigue , and sleep . For each outcome the treatment difference , relative per cent improvement , st and ardised response mean ( SRM ) , and relative efficiency for assessing an outcome ’s ability to detect a treatment effect relative to tender joint count ( TJC ) were calculated . A relative efficiency > 1 suggests a measure that is more efficient than TJC in detecting treatment effect . Results : Moderate to large SRMs ( ⩾0.6 ) were observed for the PRO measures . In particular , SRMs ( 95 % confidence interval ) were : physician global , 0.72 ( 0.51 to 0.94 ) ; HAQ , 0.63 ( 0.42 to 0.85 ) ; SF-36 physical component score , 0.62 ( 0.40 to 0.83 ) ; SF-36 bodily pain , 0.68 ( 0.46 to 0.90 ) ; and fatigue , 0.59 ( 0.38 to 0.81 ) . Relative efficiencies for physician global ( 1.6 ) , SF-36 bodily pain domain ( 1.4 ) , pain intensity ( 1.4 ) , HAQ ( 1.2 ) , SF-36 physical component score ( 1.2 ) , fatigue ( 1.1 ) , and patient global assessment ( 1.04 ) were all more responsive than TJC . The SF-36 mental component score ( 0.3 ) , swollen joint count ( 0.6 ) , activity limitation ( 0.8 ) , sleep ( 0.7 ) , and C reactive protein ( 0.9 ) were less responsive . Conclusions : Using PROs for evaluating treatments for RA can detect improvements and will identify changes that are important to patients . In general , physical assessment s are more responsive to an effective treatment than mental assessment Forty-three h and s in 41 adults with osteoarthrosis of the trapeziometacarpal joint were allocated r and omly to undergo  a trapeziectomy through either an anterior approach or the posterior ( dorsoradial ) approach .  Forty h and s were available for review at a median of 33 months postoperatively . The demographic characteristics , severity of disease and pre-operative measurements of the two groups were indistinguishable . Trapeziectomy result ed in significantly improved objective and subjective function in both groups , but the anterior approach group had better outcomes for power , scar tenderness and satisfaction . Scar-related complications were three times more common in the posterior group . Trapeziectomy is a good method of treating osteoarthritis of the thumb base , but outcomes for the anterior approach are equally good or better than with the posterior OBJECTIVE Prospect i ve assessment of the efficacy and tolerability of intra-articular sodium hyaluronate ( SH ; Ostenil mini ) and triamcinolone acetonide ( TA ; Volon A10 ) for treatment of osteoarthritis ( OA ) of the carpometacarpal ( CMC ) joint of the thumb in a 26-week , controlled , r and omized , on an intention to treat , masked-observer study . METHODS Patients were treated with three intra-articular injections of either SH ( n = 28 ) or TA ( n = 28 ) . Primary assessment s were pain according to a 100 mm visual analogue scale and extensive clinical and functional parameters such as swelling , grip power and range of motion . The population was analysed using one- and two-sided Mann-Whitney ( MW ) estimators . RESULTS Maximum pain relief occurred at 2 - 3 weeks for TA and at week 26 for SH after the first intra-articular injection . At weeks 2 - 3 TA was significantly better than SH ( MW : 0.3319 and 0.3063 ; P = 0.9827 and 0.9929 ) . At week 26 a slight superiority of SH could be observed ( MW : 0.53 ; P = 0.3624 ) and non-inferiority could be proven . After 26 weeks lateral pinch power was significantly better in the SH-group ( MW : 0.6331 ; P = 0.0226 ) . In all , 88.0 % of patients treated with SH and 79.1 % of the TA-group described pain improvement after 26 weeks . Both agents were well tolerated . No adverse events with causal connection to the investigational products occurred . CONCLUSION A single course of three SH injections is effective in relieving pain and improving joint function in patients with OA of the CMC joint of the thumb . Although in comparison with triamcinolone its effects are achieved more slowly , the results indicate a superior long-lasting effect of hyaluronan at 6 months after end of treatment period An important method ological issue in measuring health-related quality of life is whether instruments such as SF-36 and EQ can be used on an elderly population . This paper aims to test the completion , reliability and validity of the SF-36 and Euroqol on an elderly female population , and to compare them with the OPCS Disability Survey .  Three hundred and eighty women aged 75 and over participated in a r and omized controlled trial of the use of clodronate provided the sample . As part of the trial , patients were asked to complete the  UK SF-36 and Euroqol  , and the OPCS disability survey instrument  administered by interview in a hospital clinic at baseline . A r and om sub sample of respondents were retested six months later . The SF-36 achieved poorer levels of completion by dimension ( 68.1%–88.9 % ) than the OPCS ( 99.2 % ) and Euroqol ( 84%–93.5 % ) instruments . There were no major floor effects in the distribution of scores , except for the role dimensions of SF-36 . Correlation between test-retest were significant for all instruments , but lower for the role dimensions and social functioning of SF-36 , and these dimensions also had 95 % Cls for the mean differences in excess of 10 points . There was substantial agreement between the three instruments , and evidence for their construct validity against age and recent use of health services . The sensitivities of the instruments were tested through hypothetical changes in health status . There was some evidence of greater sensitivity to lower levels of morbidity in the SF-36 . Where brevity is required and the health changes are expected to be substantial , then EQ may be sufficient . For greater sensitivity SF-36 seems to have an advantage , however lower completion rates and problems with consistency suggest it requires adaptation . One solution would be to use interviewer administration . Another would be to change the SF-36 to make it more suitable for use in elderly people , although this may reduce its usefulness as a generic instrument OBJECTIVE To evaluate the efficacy of continuous low-level heat wrap therapy for the treatment of various sources of wrist pain including strain and sprain ( SS ) , tendinosis ( T ) , osteoarthritis ( OA ) , and carpal tunnel syndrome ( CTS ) . DESIGN Prospect i ve , r and omized , parallel , single-blind ( investigator ) , placebo-controlled , multicenter clinical trial . SETTING Two community-based research facilities . PARTICIPANTS Ninety-three patients ( age range , 18 - 65 y ) with wrist pain . INTERVENTION Subjects with moderate or greater wrist pain were r and omized and stratified to 1 of the following treatments : efficacy evaluation ( heat wrap , n=39 ; oral placebo , n=42 ) or blinding ( oral acetaminophen , n=6 ; unheated wrap , n=6 ) . Data were recorded over 3 days of treatment and 2 days of follow-up . MAIN OUTCOME MEASURES The primary comparison was between the heat wrap and the oral placebo group among SS/T/OA subjects for pain relief . Outcome measures included pain relief ( 0 - 5 scale ) , joint stiffness ( 101-point numeric rating scale ) , grip strength measured by dynamometry , and perceived pain and disability ( Patient Rated Wrist Evaluation [ PRWE ] ) ; subjects with CTS also completed the Symptom Severity Scale and Functional Status Scale . RESULTS Heat wrap therapy showed significant benefits in day 1 to 3 mean pain relief ( P=.045 ) and increased day 3 grip strength ( P=.02 ) versus oral placebo for the SS/T/OA group . However , joint stiffness and PRWE results were comparable between the 2 treatments . For the CTS group , heat wraps provided greater day 1 to 3/hour 0 to 8 mean pain relief ( P=.001 ) , day 1 to 3 mean joint stiffness reduction ( P=.004 ) , increased day 3 grip strength ( P=.003 ) , reduced PRWE scores ( P=.0015 ) , reduced symptom severity ( P=.001 ) , and improved functional status ( P=.04 ) . In addition , the heat wrap showed significant extended benefits through follow-up ( day 5 ) in the CTS group . CONCLUSIONS Continuous low-level heat wrap therapy was efficacious for the treatment of common conditions causing wrist pain and impairment Forty-three patients were r and omly allocated to undergo either  trapeziectomy alone ( control ) or with a ligament reconstruction and tendon interposition ( LRTI ) using an abductor pollicis longus tendon slip .  The patients were review ed at a median 13 ( range , 7–29 ) months after surgery . The demographic characteristics , severity of disease and pre-operative clinical measurements of the two study groups were indistinguishable but LRTI lengthened the operation by approximately 15 minutes . Both groups expressed equal satisfaction with the operation and there were no significant differences between the two treatment groups . Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb and the addition of a ligament reconstruction was not shown to confer any additional benefit The purpose of this study was to compare the objective , subjective , and radiographic responses of patients with carpometacarpal joint osteoarthritis ( CMCJ-OA ) wearing a prefabricated neoprene splint ( PFN ) , which crosses the CMCJ and metacarpophalangeal joint , with those of patients wearing a custom-made thermoplastic short opponens splint ( CMT )  , which crosses only the CMCJ . Patients ( N = 25 ) with first CMCJ stage I and II osteoarthritis were assigned r and omly to wear either the PFN splint or the CMT splint for one week . After one week , the subjects rated their function in the splint and their satisfaction and pain levels on visual analogue scales . Pinch measurements were performed and x-rays were taken to assess carpometacarpal subluxation . The second splint was then applied for one week and all measures were repeated . The subjects rated the  PFN splint  significantly higher , and most reported that they would choose the PFN splint over the CMT splint for daily and long-term use . Both pain and function were improved with splinting , but the effect was amplified with the PFN splint compared with the CMT splint . Both splints reduced subluxation at the first carpometacarpal joint , but the  CMT effect was greater . This study further supports current evidence that subjects with stage I and II first CMCJ-OA will have pain relief with thumb splinting . In addition , the PFN splint will provide greater relief when compared with the CMT splint . Furthermore , this study reveals that patients prefer the PFN splint to the CMT splint The quality of life ( QOL ) of the Chinese ‘ floating ’ migrant population is of growing concern . Urban construction workers are the main migrant population in China , but there is little published research on their QOL . The reliability and validity of the 36-Item Short Form Health Survey ( SF-36 ) question naire were assessed by conducting a population -based study of migrant construction workers in Shenyang , China . Two construction sites were r and omly selected from each of the five districts of Shenyang City and 1200 copies of the question naire were distributed to rurally-registered , non-Shenyang workers aged ≥ 16 years at these sites . A total of 1125 question naires were evaluated . The overall Cronbach 's a coefficient of the SF-36 question naire was 0.821 while the respective Cronbach 's α coefficient for each dimension was > 0.70 . Results showed that the SF-36 question naire demonstrated good reliability and validity , and that it can be used to measure QOL among Chinese migrant urban construction workers
target: The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness .
  A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness .
  The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness .
  The PEM and PRWE also had favourable empirical evidence reported for these elements .
background: This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change .