scholarly journals Six Sessions of Anterior-to-Posterior Ankle Joint Mobilizations Improve Patient-Reported Outcomes in Patients With Chronic Ankle Instability: A Critically Appraised Topic

2019 ◽  
Vol 28 (4) ◽  
pp. 381-384
Author(s):  
Erik A. Wikstrom ◽  
Sajad Bagherian ◽  
Nicole B. Cordero ◽  
Kyeongtak Song
Keyword(s):  
Ankle Joint ◽  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Patient Reported Outcome ◽  
Chronic Ankle Instability ◽  
Bottom Line ◽  
Joint Mobilization ◽  
Patient Reported ◽  
Improve Patient

Clinical Scenario: Chronic ankle instability (CAI) is a complex musculoskeletal condition that results in sensorimotor and mechanical alterations. Manual therapies, such as ankle joint mobilizations, are known to improve clinician-oriented outcomes like dorsiflexion range of motion, but their impact on patient-reported outcomes remains less clear. Focused Clinical Question: Do anterior-to-posterior ankle joint mobilizations improve patient-reported outcomes in patients with chronic ankle instability? Summary of Key Findings: Three studies (2 randomized controlled trials and 1 prospective cohort) quantified the effect of at least 2 weeks of anterior-to-posterior ankle joint mobilizations on improving patient-reported outcomes immediately after the intervention and at a follow-up assessment. All 3 studies demonstrated significant improvements in at least 1 patient-reported outcome immediately after the intervention and at the follow-up assessment. Clinical Bottom Line: At least 2 weeks of ankle joint mobilization improves patient-reported outcomes in patients with chronic ankle instability, and these benefits are retained for at least a week following the termination of the intervention. Strength of Recommendation: Strength of recommendation is grade A due to consistent good-quality patient-oriented evidence.

scholarly journals Exercise-Based Rehabilitation and Manual Therapy Compared With Exercise-Based Rehabilitation Alone in the Treatment of Chronic Ankle Instability: A Critically Appraised Topic

2020 ◽  
Vol 29 (5) ◽  
pp. 684-688 ◽  
Author(s):  
Bridget M. Walsh ◽  
Katherine A. Bain ◽  
Phillip A. Gribble ◽  
Matthew C. Hoch
Keyword(s):  
Manual Therapy ◽  
Ankle Instability ◽  
Patient Reported Outcome ◽  
Chronic Ankle Instability ◽  
Current Evidence ◽  
Bottom Line ◽  
Patient Reported ◽  
Outcome Scores ◽  
The Difference ◽  
Improve Patient

Clinical Scenario: Patients with chronic ankle instability (CAI) commonly display lower levels of self-reported function and health-related quality of life. Several rehabilitation interventions, including manual therapy, have been investigated to help CAI patients overcome these deficits. However, it is unclear if the addition of manual therapy to exercise-based rehabilitation is more effective than exercise-based rehabilitation alone. Clinical Question: Does incorporating manual therapy with exercise-based rehabilitation improve patient-reported outcomes when compared with exercise-based rehabilitation alone? Summary of Key Findings: The literature was searched for articles that examined the difference in outcomes for patients with CAI between manual therapy with exercise-based rehabilitation and exercise-based rehabilitation alone. A total of 3 peer-reviewed randomized controlled trials were identified. Two articles demonstrated improved patient-reported outcome scores following the incorporation of manual therapy with exercise-based rehabilitation, whereas one study found no statistically significant differences between interventions. Clinical Bottom Line: The current evidence suggests that incorporating manual therapy in addition to exercised-based rehabilitation may improve patient-reported outcome scores in patients with CAI. Strength of Recommendation: In accordance with the Strength of Recommendation Taxonomy, the grade of A is recommended due to consistent evidence from high-quality studies.

The Effect of Dry Needling on Patient-Reported Outcomes in Individuals With Chronic Ankle Instability: A Critically Appraised Topic

2019 ◽  
Vol 24 (5) ◽  
pp. 186-192
Author(s):  
Jennifer F. Mullins ◽  
Arthur J. Nitz ◽  
Matthew C. Hoch
Keyword(s):  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
The Other ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Dry Needling ◽  
Bottom Line ◽  
Patient Reported

Clinical Scenario: Chronic ankle instability (CAI) and its associated recurrent sprains, feelings of instability, and decreased function occur in approximately 40% of individuals that suffer an ankle sprain. Despite these continued deficits, more effective treatment has yet to be established. Decreased sensorimotor function has been associated with CAI and may be amenable to dry needling treatment, thereby improving patient-reported outcomes (PROs). Focused Clinical Question: Does dry needling improve PROs in individuals with CAI? Summary of Key Findings: Two studies were identified that examined dry needling in participants with CAI. One of the two studies reported improvements in PROs (PEDro score 7/10) while the other study did not identify any changes (PEDro score 9/10). The inconsistent results were likely related to different treatment durations and follow-up timelines across the included evidence. Clinical Bottom Line: Based on the included studies, there is inconsistent evidence that dry needling can improve PROs in individuals with CAI. Strength of Recommendation: Utilizing the Strength of Recommendation Taxonomy (SORT) guidelines, level B evidence exists to recommend dry needling treatment to improve PROs for individuals with CAI.

Joint Stabilization Surgery for Chronic Ankle Instability and Medial Ankle Osteoarthritis: A Critically Appraised Topic

2021 ◽  
pp. 1-5
Author(s):  
Kyle B. Kosik ◽  
Kyeongtak Song ◽  
Phillip A. Gribble ◽  
Matthew C. Hoch ◽  
Arjun Srinath
Keyword(s):  
Clinical Outcomes ◽  
Study Design ◽  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Bottom Line ◽  
Ankle Osteoarthritis ◽  
Joint Stabilization ◽  
Patient Reported

Clinical Scenario: Patients with chronic ankle instability (CAI) who require surgical intervention are often diagnosed with medial ankle osteoarthritis (OA). Lateral joint stabilization procedures are commonly performed among this patient population to restore bony alignment and improve cartilage loading patterns to increase patient-reported function and mitigate further degenerative changes. Focused Clinical Question: What is the available evidence to support joint stabilization procedures on patient-reported outcomes and progression of radiographic OA among patients with CAI who have medial ankle OA? Summary of Key Findings: An electronic search of relevant databases was performed to identify peer-reviewed articles examining preoperative and postoperative clinical outcomes and radiographic evidence of ankle OA. A total of 3 peer-reviewed articles were retrieved. All 3 articles employed a retrospective case series study design. All 3 articles demonstrated improved patient-reported outcomes at the final follow-up visit. Two articles demonstrated that between 11% and 27% of patients progressed in at least 1stage of radiographic ankle OA between the preoperative assessment and the final follow-up visit (40–56 mo). Clinical Bottom Line: Joint stabilization surgery for patients with CAI and medial ankle OA is associated with improved clinical outcomes and a low rate of worsening radiographic joint degeneration within the first 5 years. Strength of Recommendation: Consistent evidence exists across all 3 articles. However, this evidence is based on a low-quality study design. Therefore, there is a grade-C level of evidence to support joint stabilization for improving patient-reported and radiographic outcomes within the first 5 years after surgery for patients with CAI and medial ankle OA.

scholarly journals Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096518
Author(s):  
Karen Brage ◽  
Birgit Juul-Kristensen ◽  
John Hjarbaek ◽  
Eleanor Boyle ◽  
Per Kjaer ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Structural Changes ◽  
Supraspinatus Tendon ◽  
Patient Reported Outcome ◽  
Minimal Detectable Change ◽  
Detectable Change ◽  
Tendon Stiffness ◽  
Patient Reported ◽  
Tendon Thickness

Background: Shoulder pain is common, with a lifetime prevalence of up to 67%. Evidence is conflicting in relation to imaging findings and pain in the shoulder. Sonoelastography can be used to estimate tissue stiffness and may be a clinically relevant technique for diagnosing and monitoring tendon healing. Purpose: To evaluate changes in supraspinatus tendon stiffness using strain elastography (SEL) and associations with changes in patient-reported outcomes, supraspinatus tendon thickness, and grade of tendinopathy after 12 weeks of unilateral shoulder exercises in patients with supraspinatus tendinopathy. Study Design: Controlled laboratory study. Methods: A total of 23 patients with unilateral clinical supraspinatus tendinopathy performed 12 weeks of “standard care” exercises. At baseline and follow-up, supraspinatus tendon stiffness was measured bilaterally using SEL and compared with tendinopathy grading on magnetic resonance imaging scans and tendon thickness measured using conventional ultrasound. Patient-reported outcome measures included physical function and symptoms from the Disabilities of the Arm, Shoulder and Hand questionnaire and pain rating (visual analog scale). Results: No significant changes in SEL within or between groups (asymptomatic vs symptomatic tendon) were seen. All patient-reported outcomes showed significant improvement from baseline to follow-up, but with no change in tendinopathy grading and tendon thickness. No significant differences in the proportion of patients changing above the minimal detectable change in SEL and PROM were seen, except for discomfort while sleeping. Conclusion: Despite no significant within-group or between-group changes in SEL, significant improvements were found in patient-reported outcomes. An acceptable agreement between patients changing above the minimal detectable change in SEL and patient-reported outcome measure was seen. Further studies should explore the use of SEL to detect changes after tendon repair and long-term training potentially in subgroups of different tendinopathy phases. Clinical Relevance: In the short term, structural changes in supraspinatus tendons could not be visualized using SEL, indicating that a longer time span should be expected in order to observe structural changes, which should be considered before return to sports. Subgrouping based on stage of tendinopathy may also be important in order to evaluate changes over time with SEL among patients with supraspinatus tendinopathy. Registration: NCT03425357 ( ClinicalTrials.gov identifier).

scholarly journals Acceptability of no-test medical abortion provided via telemedicine: analysis of patient-reported outcomes

2021 ◽  
pp. bmjsrh-2020-200954
Author(s):  
Chelsey Porter Erlank ◽  
Jonathan Lord ◽  
Kathryn Church
Keyword(s):  
Patient Reported Outcomes ◽  
Medical Abortion ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Post Procedure ◽  
High Satisfaction ◽  
First Choice ◽  
Patient Reported ◽  
At Home

IntroductionThe English government approved both stages of early medical abortion (EMA), using mifepristone and misoprostol under 10 weeks’ gestation, for at-home use on 30 March 2020. MSI Reproductive Choices UK (MSUK), one of the largest providers of abortion services in England, launched a no-test telemedicine EMA pathway on 6 April 2020. The objectives of this study were to report key patient-reported outcome measures and to assess whether our sample was representative of the whole population receiving no-test telemedicine EMA.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. A total of 1243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within 5 days post-procedure.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. The sample responding were broadly equivalent to the whole population receiving telemedicine. No patient reported that they were unable to consult privately. The majority (1035, 83%) of patients reported preferring the telemedicine pathway, with 824 (66%) indicating that they would choose telemedicine again if COVID-19 were no longer an issue.ConclusionsTelemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent.

scholarly journals Patient-reported outcomes in clinical practice

Hematology ◽  
2015 ◽  
Vol 2015 (1) ◽  
pp. 501-506 ◽  
Author(s):  
Sarah Dobrozsi ◽  
Julie Panepinto
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
Patient Reported Outcomes ◽  
Clinical Care ◽  
Patient Reported Outcome ◽  
Physician Communication ◽  
Valuable Data ◽  
Patient Reported ◽  
Improve Patient

Abstract Patient-reported outcome (PRO) measurement plays an increasingly important role in health care and understanding health outcomes. PROs are any report of a patient's health status that comes directly from the patient, and can measure patient symptoms, patient function, and quality-of-life. PROs have been used successfully to assess impairment in a clinical setting. Use of PROs to systematically quantify the patient experience provides valuable data to assist with clinical care; however, initiating use of PROs in clinical practice can be daunting. Here we provide suggestions for implementation of PROs and examples of opportunities to use PROs to tailor individual patient therapy to improve patient outcomes, patient–physician communication, and the quality of care for hematology/oncology patients.

The Immediate Effects of Ankle Joint Mobilization on Ankle Musculotendinous Stiffness in Individuals With Chronic Ankle Instability

2020 ◽  
pp. 1-5
Author(s):  
M. Spencer Cain ◽  
Kyeongtak Song ◽  
J. Troy Blackburn ◽  
Kimmery Migel ◽  
Erik A. Wikstrom
Keyword(s):  
Ankle Joint ◽  
Ankle Instability ◽  
Change Score ◽  
Chronic Ankle Instability ◽  
Minimal Detectable Change ◽  
Plantar Flexor ◽  
Joint Mobilization ◽  
Before And After ◽  
Damped Oscillation ◽  
Musculotendinous Stiffness

Ankle joint mobilization has been shown to be effective at improving outcomes in those with chronic ankle instability (CAI), but the neuromuscular mechanisms are still unknown. We aimed to determine the immediate effect of a single Grade III anterior-to-posterior ankle joint mobilization bout on ankle musculotendinous stiffness (MTS) in those with CAI. Seventeen CAI participants had plantar flexor and fibularis MTS assessed before and after a 5-min joint mobilization treatment. MTS outcomes were estimated using the damped oscillation method. Fibularis (0.25 ± 0.41 N/m/kg, p = .028) but not plantar flexor MTS (−2.18 ± 14.35 N/m/kg, p = .539) changed following mobilization and exceeded the calculated minimal detectable change score (0.12 N/m/kg). Increased fibularis MTS may represent a neuromuscular mechanism by which ankle joint mobilizations improve postural control in those with CAI.

scholarly journals Systematic Evaluation of Patient-Reported Outcome Protocol Content and Reporting in Cancer Trials

2019 ◽  
Vol 111 (11) ◽  
pp. 1170-1178 ◽  
Author(s):  
Derek Kyte ◽  
Ameeta Retzer ◽  
Khaled Ahmed ◽  
Thomas Keeley ◽  
Jo Armes ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Reporting Quality ◽  
Patient Reported Outcome ◽  
Systematic Evaluation ◽  
Patient Reported ◽  
Informed Treatment ◽  
Cancer Trials ◽  
Consort Pro ◽  
Do So

Abstract Background Patient-reported outcomes (PROs) are captured within cancer trials to help future patients and their clinicians make more informed treatment decisions. However, variability in standards of PRO trial design and reporting threaten the validity of these endpoints for application in clinical practice. Methods We systematically investigated a cohort of randomized controlled cancer trials that included a primary or secondary PRO. For each trial, an evaluation of protocol and reporting quality was undertaken using standard checklists. General patterns of reporting where also explored. Results Protocols (101 sourced, 44.3%) included a mean (SD) of 10 (4) of 33 (range = 2–19) PRO protocol checklist items. Recommended items frequently omitted included the rationale and objectives underpinning PRO collection and approaches to minimize/address missing PRO data. Of 160 trials with published results, 61 (38.1%, 95% confidence interval = 30.6% to 45.7%) failed to include their PRO findings in any publication (mean 6.43-year follow-up); these trials included 49 568 participants. Although two-thirds of included trials published PRO findings, reporting standards were often inadequate according to international guidelines (mean [SD] inclusion of 3 [3] of 14 [range = 0–11]) CONSORT PRO Extension checklist items). More than one-half of trials publishing PRO results in a secondary publication (12 of 22, 54.5%) took 4 or more years to do so following trial closure, with eight (36.4%) taking 5–8 years and one trial publishing after 14 years. Conclusions PRO protocol content is frequently inadequate, and nonreporting of PRO findings is widespread, meaning patient-important information may not be available to benefit patients, clinicians, and regulators. Even where PRO data are published, there is often considerable delay and reporting quality is suboptimal. This study presents key recommendations to enhance the likelihood of successful delivery of PROs in the future.

scholarly journals Midterm Outcomes Following Hip Labral Augmentation

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0024
Author(s):  
Joseph Ruzbarsky ◽  
Justin Arner ◽  
Karen Briggs ◽  
Marc Philippon ◽  
Rui Soares
Keyword(s):  
Patient Satisfaction ◽  
Treatment Option ◽  
Patient Reported Outcomes ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Iliotibial Band ◽  
Patient Reported ◽  
Modified Harris Hip Score ◽  
Suction Seal

Objectives: Arthroscopic hip labral preservation techniques have evolved over the last decade. Arthroscopic hip labral augmentation with iliotibial band (ITB) autograft placed into a labral defect with viable circumferential fibers is a novel treatment option to restore the hip suction seal and improve functionality. The purpose of this study is to determine midterm (3-5 year follow up) outcomes of arthroscopic hip labral augmentation procedure. Methods: Patients who underwent arthroscopic hip labral augmentation from August 2011 to March 2017 were prospectively evaluated. Pre- and post-operative patient reported outcome scores were compared and included SF12 PCS, SF12 MCS, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) (Activities of Daily Living (ADL) and Sport). Post-operative Tegner Activity Scale and patient satisfaction (1 – 10) were also evaluated. Results: One hundred and six patients underwent arthroscopic hip labral augmentation with minimum 3-year follow-up. Mean follow-up was 5-year follow-up (range, 3 to 9.2 years). All patient reported outcomes improved after labral augmentation (SF12 PCS 39±8 vs. 50±10, p>0.01; mHHS 59±15 vs. 79±21, p<0.01; WOMAC 31±16 vs. 16±17, p<0.01; HOS ADL 64±17 vs. 84±21, p<0.01; HOS Sport 41±22 vs. 71±29, p<0.01). Median post-operative Tegner score was 4. Median post-operative patient satisfaction was 9 out of 10 (range, 1-10). In terms of survivorship, 12 patients (11%) required revision surgery and 6 (5.7%) converted to total hip arthroplasty (THA). Conclusions: Arthroscopic hip labral augmentation is a successful treatment option for patients that have viable circumferential fibers present at the time of arthroscopy. This technique continues to show improved patient reported outcomes and is another hip labral preservation technique that may help reestablish the intra-articular fluid suction seal.

scholarly journals Effects of midfoot joint mobilization on perceived ankle-foot function in chronic ankle instability. A crossover clinical trial

2021 ◽  
Author(s):  
Abbis Jaffri ◽  
John J. Fraser ◽  
Rachel M. Koldenhoven ◽  
Jay Hertel
Keyword(s):  
Ankle Instability ◽  
Dynamic Balance ◽  
Chronic Ankle Instability ◽  
Post Treatment ◽  
Home Exercise ◽  
Pain Patient ◽  
Joint Mobility ◽  
Joint Mobilization ◽  
Patient Reported ◽  
To Receive

AbstractBackgroundChronic ankle instability (CAI) is a complex clinical entity that commonly includes ankle-foot impairment.ObjectiveTo investigate the effects of midfoot joint mobilizations and a one-week home exercise program (HEP) compared to a sham intervention and HEP on pain, patient-reported outcomes (PROs), ankle-foot joint mobility, and neuromotor function in young adults with CAI.MethodsTwenty participants with CAI were instructed in a stretching, strengthening, and balance HEP and were randomized a priori to receive midfoot joint mobilizations (forefoot supination, cuboid glide and plantar 1st tarsometatarsal) or a sham laying-of-hands. Changes in foot morphology, joint mobility, strength, dynamic balance, and PROs assessing pain, physical, and psychological function were assessed pre-to-post treatment and one-week following. Participants crossed-over to receive the alternate treatment and were assessed pre-to-post treatment and one-week following. Linear modelling was used to assess changes in outcomes.ResultsParticipants who received midfoot mobilization demonstrated significantly greater perceived improvement immediately posttreatment in the single assessment numeric evaluation (Sham: 5.0±10.2%; Mobilization: 43.9±26.2%; β: 6.8 p<0.001, Adj R2:0.17) and Global Rating of Change (Sham: −0.1±1.1; Mobilization: 1.1±3.0; β: 1.8 p=0.01, Adj R2:0.12). Following the mobilization intervention, participants demonstrated greater improved rearfoot inversion mobility (Sham: 4.4±8.4°; Mobilization: −1.6±6.1°; β: −6.37, p=0.01, Adj R2:0.19), plantarflexion mobility (Sham: 2.7°±6.4; Mobilization: −1.7°±4.3; β: −4.36, p=0.02, Adj R2:0.07), and posteromedial dynamic balance (Sham: 2.4±5.9%; Mobilization: 6.0±5.4%; β: 3.88, p=0.04, Adj R2:0.10) compared to controls at 1-week post-treatment.ConclusionParticipants with CAI who received midfoot joint mobilization had greater perceived improvement and physical signs that may benefit this clinical population.

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