Background:
To evaluate the success of a breast augmentation, it is essential to measure outcomes from the patient perspective since a successful aesthetic result is especially determined by the ...patient. This study aimed to evaluate patient-reported satisfaction with their breasts, psychosocial, physical, and sexual well-being in patients undergoing breast augmentation using validated questionnaires.
Methods:
This is a multicenter cohort study based on ongoing routinely-collected data. Patient-reported satisfaction and health-related quality of life were assessed with the BREAST-Q Augmentation Module at intake and six months postoperatively.
Results:
A total of 1405 patients were included. Large changes in BREAST-Q scores (range, 0-100) between intake and six months postoperatively were seen: satisfaction with their breasts (mean, effect size: +57, 3.8), psychosocial well-being (+38, 2.1), physical well-being (-14, -1.2), and sexual well-being (+44, 2.4). Moreover, improvements in all four scales were not dependent on their intake scores and all postoperative scores reached similar levels. A decreased physical well-being of the chest was measured post-surgery. The satisfaction with the breasts scale correlated moderately to strongly with the psychosocial and sexual well-being scale 6 months post-surgery. Subgroup analysis based on patient characteristics found no differences in outcomes, except for BMI.
Conclusion:
Significant improvement in patient-reported satisfaction with their breasts, psychosocial, and sexual well-being can be seen six months after breast augmentation despite a declined physical well-being after treatment. Postoperative satisfaction levels do not depend on preoperative scores. These insights can contribute to improve preoperative communication between surgeon and patient regarding the expected outcomes.
Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented ...a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five "measurement tracks," including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.
Although nonsurgical treatment of thumb carpometacarpal (CMC-1) osteoarthritis (OA) provides short-term improvement, the durability of these effects beyond 1 year is unknown. In this study, we ...investigated patient-reported pain and limitations in activities of daily living (ADL) at >5 years following nonsurgical treatment (i.e., exercise therapy and use of an orthosis) for CMC-1 OA. We hypothesized that pain and limitations in ADL would not worsen after 12 months. Secondary outcomes were satisfaction with treatment results and health-related quality of life at >5 years of follow-up and the rate of conversion to surgery.
This was a multicenter, prospective cohort study using 2 overlapping samples. The change in the Michigan Hand Outcomes Questionnaire (MHQ) subscales of pain and ADL between 12 months and >5 years was the primary outcome as measured in the first sample (n = 170), which consisted of patients who did not undergo conversion to surgery. Additional measurement time points included baseline and 3 months. We evaluated conversion to surgery in a second sample, which included all patients who responded to the invitation for this follow-up study (n = 217).
At a median follow-up of 6.6 years (range, 5.1 to 8.7 years), the score on the MHQ pain subscale did not differ significantly from that at 12 months. The score on the MHQ ADL improved by 4.4 points (95% confidence interval CI,1.5 to 7.2) compared with 12 months, but this was not clinically relevant. At >5 years, 5% of the patients rated their satisfaction as "poor," 14% as "moderate," 26% as "fair," 39% as "good," and 16% as "excellent." The median EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score was 0.852 (range, 0.135 to 1). The rate of conversion to surgery was 22% (95% CI,16.4% to 27.7%) at a median follow-up of 7 years (range, 5.5 to 9.0 years).
We found positive outcomes at >5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable.
Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented ...a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five “measurement tracks,” including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.
(1) To identify predictive factors for outcome after splinting and hand therapy for carpometacarpal (CMC) osteoarthritis (OA) and to identify predictive factors for conversion to surgical treatment; ...and (2) to determine how many patients who have not improved in outcome within 6 weeks after start of treatment will eventually improve after 3 months.
Observational prospective multicenter cohort study.
Xpert Clinic in the Netherlands. This clinic comprises 15 locations in the Netherlands, with 16 European Board certified (FESSH) hand surgeons and over 50 hand therapists.
Between 2011 and 2014, patients with CMC OA (N=809) received splinting and weekly hand therapy for 3 months.
Not applicable.
Satisfaction and pain were measured with a visual analog scale and function with the Michigan Hand Questionnaire at baseline, 6 weeks, and 3 months posttreatment. Using regression analysis, patient demographics and pretreatment baseline scores were considered as predictors for the outcome of conservative treatment after 3 months and for conversion to surgery.
Multivariable regression model explained 34%-42% of the variance in outcome (P<.001) with baseline satisfaction, pain, and function as significant predictors. Cox regression analysis showed that baseline pain and function were significant predictors for receiving surgery. Of patients with no clinically relevant improvement in pain and function after 6 weeks, 73%-83% also had no clinically relevant improvement after 3 months.
This study showed that patients with either high pain or low function may benefit most from conservative treatment. We therefore recommend to always start with conservative treatment, regardless of symptom severity of functional loss at start of treatment. Furthermore, it seems valuable to discuss the possibility of surgery with patients after 6 weeks of therapy, when levels of improvement are still mainly unsatisfactory.
Symptom improvement is an important goal when considering surgery for carpal tunnel syndrome. There is currently no prediction model available to predict symptom improvement for patients considering ...a carpal tunnel release (CTR).
To predict using a model the probability of clinically relevant symptom improvement at 6 mo after CTR.
We split a cohort of 2119 patients who underwent a mini-open CTR and completed the Boston Carpal Tunnel Questionnaire preoperatively and 6 mo postoperatively into training (75%) and validation (25%) data sets. Patients who improved more than the minimal clinically important difference of 0.8 at the Boston Carpal Tunnel Questionnaire-symptom severity scale were classified as "improved." Logistic regression, random forests, and gradient boosting machines were considered to train prediction models. The best model was selected based on discriminative ability (area under the curve) and calibration in the validation data set. This model was further assessed in a holdout data set (N = 397).
A gradient boosting machine with 5 predictors was chosen as optimal trade-off between discriminative ability and the number of predictors. In the holdout data set, this model had an area under the curve of 0.723, good calibration, sensitivity of 0.77, and specificity of 0.55. The positive predictive value was 0.50, and the negative predictive value was 0.81.
We developed a prediction model for clinically relevant symptom improvement 6 mo after a CTR, which required 5 patient-reported predictors (18 questions) and has reasonable discriminative ability and good calibration. The model is available online and might help shared decision making when patients are considering a CTR.
A patient's satisfaction with a treatment result is an important outcome domain as clinicians increasingly focus on patient-centered, value-based healthcare. However, to our knowledge, there are no ...validated satisfaction metrics focusing on treatment results for hand and wrist conditions.
Among patients who were treated for hand and wrist conditions, we asked: (1) What is the test-retest reliability of the Satisfaction with Treatment Result Questionnaire? (2) What is the construct validity of that outcomes tool?
This was a prospective study using two samples: a test-retest reliability sample and a construct validity sample. For the test-retest sample, data collection took place between February 2020 and May 2020, and we included 174 patients at the end of their treatment with complete baseline data that included both the primary test and the retest. Test-retest reliability was evaluated with a mean time difference of 7.2 ± 1.6 days. For the construct validity sample, data collection took place between January 2012 and May 2020. We included 3742 patients who completed the Satisfaction with Treatment Result Questionnaire, VAS, and the Net Promotor Score (NPS) at 3 months. Construct validity was evaluated using hypothesis testing in which we correlated the patients' level of satisfaction to the willingness to undergo the treatment again, VAS scores, and the NPS. We performed additional hypothesis testing on 2306 patients who also completed the Michigan Hand Outcomes Questionnaire (MHQ). Satisfaction with the treatment result was measured as the patients' level of satisfaction on a 5-point Likert scale and their willingness to undergo the treatment again under similar circumstances.
We found high reliability for level of satisfaction measured on Likert scale (intraclass correlation coefficient 0.86 95% CI 0.81 to 0.89) and almost-perfect agreement for both level of satisfaction measured on the Likert scale (weighted kappa 0.86 95% CI 0.80 to 0.91) and willingness to undergo the treatment again (kappa 0.81 95% CI 0.70 to 0.92) of the Satisfaction with Treatment Result Questionnaire. Construct validity was good to excellent as seven of the eight hypotheses were confirmed. In the confirmed hypotheses, there was a moderate-to-strong correlation with VAS pain, VAS function, NPS, MHQ pain, and MHQ general hand function (Spearman rho ranged from 0.43 to 0.67; all p < 0.001) and a strong to very strong correlation with VAS satisfaction and MHQ satisfaction (Spearman rho 0.73 and 0.71; both p < 0.001). The rejected hypothesis indicated only a moderate correlation between the level of satisfaction on a 5-point Likert scale and the willingness to undergo the treatment again under similar circumstances (Spearman rho 0.44; p < 0.001).
The Satisfaction with Treatment Result Questionnaire has good-to-excellent construct validity and very high test-retest reliability in patients with hand and wrist conditions.
This questionnaire can be used to reliably and validly measure satisfaction with treatment result in striving for patient-centered care and value-based healthcare. Future research should investigate predictors of variation in satisfaction with treatment results.
Depression and pain catastrophizing are aspects of the patient's mindset that have been shown to be important in relation to the outcome of carpal tunnel release. However, other factors of the ...patient's mindset have been understudied, such as treatment expectations and illness perceptions. The aim of the present study was to investigate the influence of these mindset aspects on outcome of carpal tunnel release, in addition to psychological distress and pain catastrophizing.
A total of 307 patients with carpal tunnel syndrome who visited outpatient hand surgery clinics and who completed online questionnaires regarding demographic and psychosocial characteristics and carpal tunnel syndrome severity were included. The patient mindset was measured with the Patient Health Questionnaire-4, the Pain Catastrophizing Scale, the Credibility Expectancy Questionnaire, and the Brief Illness Perception Questionnaire. Hierarchical linear regression models were used to examine the relation between self-reported severity 6 months after carpal tunnel release, as measured with the Boston Carpal Tunnel Questionnaire, and psychosocial aspects of mindset, adjusting for preoperative Boston Carpal Tunnel Questionnaire score, patient characteristics, and comorbidities.
Independent associations with better self-reported outcome were found for higher treatment expectations (β = -0.202; p < 0.001) and illness comprehensibility (β = -0.223; p < 0.001). The additional explained variance in Boston Carpal Tunnel Questionnaire scores by the patient's mindset was 13.2 percent (psychological distress and pain catastrophizing together, 2.1 percent; treatment expectations and illness perceptions together, 11.1 percent).
Treatment outcome expectations and comprehensibility of illness are both independently associated with the outcome of carpal tunnel release, showing the importance of these aspects of the patient's mindset for the outcome of carpal tunnel release.
Risk, III.
Midcarpal instability (MCI) is a disabling condition and treatment options are limited.
Patients with MCI can benefit from an exercise program aiming to improve the strength and coordination of the ...wrist muscles.
Participants improved in hand/wrist function and 78% did not convert to surgery.
Non-invasive treatment should be the primary treatment choice for these patients.
Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI).
This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results.
PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36-30, p < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months (p < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery.
We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI.
The aim of this study was to investigate to what extent psychological factors are related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal ...joint.
We included patients (n = 255) at the start of non-invasive treatment for osteoarthritis of the first carpometacarpal joint who completed the Michigan Hand Outcome Questionnaire. Psychological distress, pain catastrophizing behavior and illness perception was measured. X-rays were scored on presence of scaphotrapeziotrapezoid osteoarthritis. We used hierarchical linear regression analysis to determine to what extent pain levels could be explained by patient characteristics, X-ray scores, and psychological factors.
Patient characteristics and X-ray scores accounted for only 6% of the variation in pre-treatment pain levels. After adding the psychological factors to our model, 47% of the variance could be explained.
Our results show that psychological factors are more strongly related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal joint than patient characteristics and X-ray scores, which implies the important role of these factors in the reporting of symptoms. More research is needed to determine whether psychological factors will also affect treatment outcomes for patients treated non-invasively for osteoarthritis of the first carpometacarpal joint.
IMPLICATIONS FOR REHABILITATION
Pain is the most important complaint for patients with osteoarthritis of the first carpometacarpal joint.
Psychological factors are strongly associated with pain levels prior to treatment.
Pain catastrophizing behavior appears to be a promising target for complementary treatment in patients with osteoarthritis of the first carpometacarpal joint.
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