| 1. |
- Schmidt, Viktor, et al.
(författare)
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Forecasting effects of "fast-tracks" for surgery in the Swedish national guidelines for distal radius fractures
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 17:2
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: National guidelines for treatment of distal radius fractures (DRFs) were presented in Sweden in 2021. In the guidelines, a fast-track is recommended for 4 subgroups of highly unstable DRFs. Regardless of the results of the closed reduction these are recommended for surgery within 1 week of injury. This study aims to evaluate the potential consequences of the newly presented national guidelines on incidence of surgical interventions.PATIENTS AND METHODS: In all, 1,609 patients (1,635 DRFs) with primary radiographs after a DRF between 2014 and 2017 at two Swedish hospitals were included in a retrospective cohort study. An estimation was made of the percentage of patients in the historical pre-guidelines cohort, that would have been recommended early primary surgery according to the new national guidelines compared to treatment implemented without the support of these guidelines.RESULTS: On a strict radiological basis, 32% (516 out of 1635) of DRFs were classified into one of the 4 defined subgroups. At 9-13 days follow-up, cast treatment was converted into delayed primary surgery in 201 cases. Out of these, 56% (112 out of 201) fulfilled the fast-track criteria and would with the new guidelines have been subject to early primary surgery.INTERPRETATION: The fast-track regimen in the new guidelines, has a high likelihood of identifying the unstable fractures benefitting from early primary surgery. If the proposed Swedish national guidelines for DRF treatment are implemented, a greater proportion of fractures would be treated with early primary surgery, and a delayed surgery avoided in the majority of cases. The potential benefits in relation to possible costs when using the fast-track criteria in every day practice are still unknown.
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| 2. |
- Engquist, Markus, et al.
(författare)
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A 5-to 8-year randomized study on the treatment of cervical radiculopathy : anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone
- 2017
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Ingår i: Journal of Neurosurgery. - : AMER ASSOC NEUROLOGICAL SURGEONS. - 1547-5654 .- 1547-5646. ; 26:1, s. 19-27
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.
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| 3. |
- Engquist, Markus, et al.
(författare)
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Factors Affecting the Outcome of Surgical Versus Nonsurgical Treatment of Cervical Radiculopathy
- 2015
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Ingår i: Spine. - : LIPPINCOTT WILLIAMS & WILKINS. - 0362-2436 .- 1528-1159. ; 40:20, s. 1553-1563
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Prospective randomized controlled trial. Objective. To analyze factors that may influence the outcome of anterior cervical decompression and fusion (ACDF) followed by physiotherapy versus physiotherapy alone for treatment of patients with cervical radiculopathy. Summary of Background Data. An understanding of patient-related factors affecting the outcome of ACDF is important for preoperative patient selection. No previous prospective, randomized study of treatment effect modifiers relating to outcome of ACDF compared with physiotherapy has been carried out. Methods. 60 patients with cervical radiculopathy were randomized to ACDF followed by physiotherapy or physiotherapy alone. Data for possible modifiers of treatment outcome at 1 year, such as sex, age, duration of pain, pain intensity, disability (Neck Disability Index, NDI), patient expectations of treatment, anxiety due to neck/arm pain, distress (Distress and Risk Assessment Method), self-efficacy (Self-Efficacy Scale) health status (EQ-5D), and magnetic resonance imaging findings were collected. A multivariate analysis was performed to find treatment effect modifiers affecting the outcome regarding arm/neck pain intensity and NDI. Results. Factors that significantly altered the treatment effect between treatment groups in favor of surgery were: duration of neck pain less than 12 months (P = 0.007), duration of arm pain less than 12 months (P = 0.01) and female sex (P = 0.007) (outcome: arm pain), low EQ-5D index (outcome: neck pain, P = 0.02), high levels of anxiety due to neck/arm pain (outcome: neck pain, P = 0.02 and NDI, P = 0.02), low Self-Efficacy Scale score (P = 0.05), and high Distress and Risk Assessment Method score (P = 0.04) (outcome: NDI). No factors were found to be associated with better outcome with physiotherapy alone. Conclusion. In this prospective, randomized study of patients with cervical radiculopathy, short duration of pain, female sex, low health quality, high levels of anxiety due to neck/arm pain, low self-efficacy, and a high level of distress before treatment were associated with better outcome from surgery. No factors were found to be associated with better outcome from physiotherapy alone.
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| 4. |
- Engquist, Markus
(författare)
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Surgery versus nonsurgical treatment of cervical radiculopathy. Randomized studies of anterior cervical decompression and fusion followed by physiotherapy versus structured physiotherapy alone
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: Cervical radiculopathy (CR) is a symptom complex comprising neck pain and radiating arm pain due to compression of one or more cervical nerve roots, caused by spondylotic narrowing of the intervertebral foramina, intervertebral disc herniation or both. Anterior cervical decompression and fusion (ACDF) is a common surgical procedure to treat CR, but the evidence supporting use of this method versus nonsurgical treatment is scarce. The main aims of this thesis were to evaluate the additive value of ACDF when combined with physiotherapy (PT) in regard to disability, pain, patient satisfaction, health outcome and recovery of function, and to find patient-related factors that may predict the outcome of surgery and PT. Patients and methods: Sixty-three patients were included in the study. They were all evaluated prior to treatment and two years after treatment start, while 59 were also evaluated 5-8 years after treatment. Patients were randomized into two groups: ACDF followed by a structured PT program or the same PT program alone. Outcome measures at 2 years were disability using the Neck Disability Index, (NDI), pain intensity, patient global assessment and objective function. At 5-8 years, health outcome (EQ-5D) was also analyzed, but function was not. Based on the outcomes of the NDI and pain intensity at one year, possible patient-related modifiers of treatment outcome such as age, gender, smoking and psychological factors were analyzed. Results: During the first two years, the only significant differences between treatment groups were that the operated patients had less neck pain throughout the entire period, while at one year, the patient global assessment of the treatment effect was superior in the surgery group. After 5-8 years, the surgical patients fared significantly better concerning NDI, neck pain and global assessment. No significant differences were seen regarding arm pain, health outcome or function. Factors that significantly altered the treatment effect between the two treatment groups in favor of surgery regarding one or more of the outcome measures were: duration of neck and arm pain < 12 months, female sex, low EQ-5D index, high levels of anxiety due to neck/arm pain, low SES score and high DRAM score. No factors were found to be associated with better outcome from PT alone. Discussion: The studies in this thesis represent the first scientific evidence to support use of ACDF for treatment of cervical radiculopathy, based on a randomized study of surgical versus nonsurgical treatment. From the results of the studies, it is reasonable to recommend a trial of structured physiotherapy in the early phase of CR, before deciding upon surgery. However, for patients with substantial residual symptoms, ACDF is a good option for achieving greater and more rapid improvement, which can also be expected to last at least throughout a 5-8 year time span. Patients should not be disqualified from surgical treatment due to gender, poor health or a high level of distress and/ or anxiety. When surgery is deemed necessary, better treatment outcomes can be expected when the procedure is performed within one year of onset of CR symptoms.
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| 5. |
- Peolsson, Anneli, et al.
(författare)
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Physical Function Outcome in Cervical Radiculopathy Patients After Physiotherapy Alone Compared With Anterior Surgery Followed by Physiotherapy A Prospective Randomized Study With a 2-Year Follow-up
- 2013
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 38:4, s. 300-307
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. Prospective randomized study. Objective. To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program. Summary of Background Data. No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging–verified nerve compression due to cervical disc disease. Methods. Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging–verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups. Results. There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17–0.91). Both groups showed improvements over time in neck muscle endurance (P <= 0.01), manual dexterity (P <= 0.03), and right-handgrip strength (P = 0.01). Conclusion. Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery.
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