Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Feb 2019
The influence of mental health on Patient-Reported Outcomes Measurement Information System (PROMIS) and traditional outcome instruments in patients with symptomatic glenohumeral arthritis.
The Patient-Reported Outcomes Measurement Information System (PROMIS) assessment includes computerized adaptive tests (CATs) that assess function, pain, depression, and anxiety. The influence of mental health on patients' self-reported pain and function has not been explored using PROMIS in patients with symptomatic glenohumeral osteoarthritis. ⋯ In patients with glenohumeral osteoarthritis, PROMIS-reported anxiety and depression scores, particularly in those with moderate-to-severe scores, correlate with lower functional and higher pain scores. Further investigation is necessary to examine the influence that mental health has on outcomes after operative intervention in this population.
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J Shoulder Elbow Surg · Feb 2019
Psychometric evaluation of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function and Pain Interference Computer Adaptive Test for subacromial impingement syndrome.
The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computer Adaptive Test (CAT) was previously validated for rotator cuff disease and shoulder instability. This study evaluated the psychometric properties of the PROMIS Physical Function (PF) CAT, PROMIS Pain Interference (PI) CAT, and the American Shoulder and Elbow Surgeons (ASES) Shoulder Function Score for subacromial impingement syndrome. ⋯ The psychometric properties of PROMIS PF and PI CATs were favorable for subacromial impingement syndrome.
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J Shoulder Elbow Surg · Jan 2019
Multicenter StudyEpidemiology of the Frequency, Etiology, Direction, and Severity (FEDS) system for classifying glenohumeral instability.
The purpose of this multicenter epidemiologic study was to determine the distribution of patients within the Frequency, Etiology, Direction, and Severity (FEDS) classification system to determine which categories are of clinical importance. ⋯ There are 16 categories within the FEDS classification that are clinically significant. Solitary, traumatic, anterior dislocation and occasional, traumatic, anterior dislocation were the most frequently observed in our cohort.
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J Shoulder Elbow Surg · Jan 2019
Cost-effectiveness analysis of total elbow arthroplasty versus open reduction-internal fixation for distal humeral fractures.
Total elbow arthroplasty (TEA) and open reduction-internal fixation (ORIF) are 2 viable surgical treatment options for acute, intra-articular distal humeral fractures in elderly patients. Whereas recent systematic reviews and randomized trials have suggested that TEA and ORIF result in similar functional outcome scores, no previous study has assessed the comparative cost-effectiveness between TEA and distal humeral ORIF in this specific demographic. ⋯ These findings suggest TEA is a slightly more cost-effective procedure than ORIF for most elderly patients who sustain acute, intra-articular distal humeral fractures. Still, the unique limitations, complications, and revision rates for each strategy must be carefully weighed for each patient when making a decision.
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As reimbursement becomes increasingly tied to quality and patient experience, there is growing interest in alleviation of postoperative pain combined with optimal opioid stewardship. We characterized predictors of severe inpatient pain after elective total shoulder arthroplasty and evaluated its association with opioid use, operative time, hospital length of stay, discharge disposition, and cost. ⋯ Efforts to address psychological and social determinants of health might do as much or more than technical improvements to alleviate pain, limit opioid use, and contain costs after shoulder arthroplasty. These findings are important in the redesign of care pathways and bundling initiatives.