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Development of a pelvic discomfort index to evaluate outcome following fixation for pelvic ring injury
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2015 (English)In: Journal of Orthopaedic Surgery, ISSN 1022-5536, E-ISSN 2309-4990, Vol. 23, no 2, p. 146-149Article in journal (Refereed) Published
Abstract [en]

Purpose. To develop a pelvic discomfort index (PDI) to evaluate outcome following fixation for pelvic ring injury. Methods. 29 female and 44 male consecutive patients (mean age, 36 years) underwent internal fixation for pelvic ring injury of type B1 (n=10), B2 (n=22), B3 (n=15), C1 (n=18), C2 (n=5), and C3 (n=3), based on the AO/OTA classification. At postoperative 6, 12, and 24 months, patients were asked to assess their discomfort in the pelvis using a 14-item questionnaire. Three questions were open-ended, and responses were categorised by a single assessor. The remaining 11 questions were closed-ended and had 6 ordinal options from 'no discomfort' (score=0) to' extremely severe discomfort' (score=5). The content validity and relevance of the 11 closed-ended questions was determined. The 14-item questionnaire was compared with the 36-item Short Form Health Survey (SF-36). Results. Respectively at postoperative 6, 12, and 24 months, 78%, 71%, and 71% of the patients completed the 14-item questionnaire. Based on the factor analysis and responses to the open-ended questions, the number of items was reduced to 6 including pain, walking, mobility of the hips, loss of sensation in the legs, sexual life, and operation scar. Four factors could explain 96% of the total variance. The first factor involved the first 3 items (pain, walking, and hip motion) and addressed 'pelvis', whereas 3 factors involved the remaining items and each addressed peripheral neurology, sexual life, and operation scar. A PDI was developed using these 6 items. The PDI had high internal reliability (alpha=0.89), adequate content and criterion validity, and moderate correlation with the SF-36 total score or scores of physical function, bodily pain, and general health (r=0.50-0.77). Conclusion. The PDI provides valid, specific, and relevant information to assess

Place, publisher, year, edition, pages
2015. Vol. 23, no 2, p. 146-149
Keywords [en]
fracture fixation, internal, patient outcome assessment, pelvis, quality of life
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-263545ISI: 000360670300005PubMedID: 26321538OAI: oai:DiVA.org:uu-263545DiVA, id: diva2:858565
Available from: 2015-10-02 Created: 2015-10-02 Last updated: 2020-02-24Bibliographically approved
In thesis
1. Surgical Treatment of Pelvic Ring Injuries and Acetabular Fractures: Aspects on Patient-reported Outcome
Open this publication in new window or tab >>Surgical Treatment of Pelvic Ring Injuries and Acetabular Fractures: Aspects on Patient-reported Outcome
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to study the patient perspective on outcome following surgical treatment of pelvic ring injuries and acetabular fractures. All studies were based on patients treated for such injuries at the Department of Orthopaedics, Uppsala University Hospital, Sweden.

In Study I, a patient-reported outcome measure to provide condition-specific information regarding outcome after surgical treatment of pelvic ring injuries was developed. Seventy-three patients were asked to complete a questionnaire at three time points during follow-up. Evaluation of data resulted in the Pelvic Discomfort Index (PDI). This instrument is comprised of six questions regarding residual problems from the pelvic region with respect to pain, walking, hip motion, leg numbness, sexual life and the operation scar.

The influence of the time-point post-surgery at which patients with surgically treated pelvic ring injuries or acetabular fractures estimate their pre-traumatic state was examined in study II. Seventy-three patients assessed their pre-traumatic status at three time-points post-surgery. It was found that pre-traumatic quality of life was high and comparable to a reference population. Pre-existing discomfort from the pelvic region was uncommon. A tendency for patients to estimate a better pre-traumatic status when assessments were delayed was observed.

The objective of Study III was to compare outcome after surgical treatment of complex acetabular fractures in the elderly using either the combined hip procedure, consisting of open reduction and internal fixation (ORIF) in conjunction with an acute total hip arthroplasty, or ORIF alone with respect to mortality, need for secondary surgery and patient-reported outcome. Thirteen patients treated with the CHP were compared to 14 patients with similar fracture patterns treated with ORIF alone. The CHP conferred a markedly reduced need for secondary surgical procedures while no differences in perioperative mortality or patient-reported outcome could be demonstrated.

Patient-reported outcome at five years following surgical treatment of pelvic ring injury was evaluated in study IV. The consequences of these injuries were found to be substantial and long-standing. Females reported a worse outcome than males, while influence of variables age, injury type and presence of associated injuries was limited.

In Study V, patient experiences of life following treatment for pelvic ring injury was explored. Semi-structured interviews were conducted with ten patients at a median of 11 years after injury and analyzed using inductive content analysis. Patients described a heterogenous outcome, with residual impairment ranging from virtually none to severe disability. A need for adequate patient information and individual assessments of patients was noted.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 53
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1643
Keywords
Pelvic ring injuries, acetabular fractures, patient.reported outcome, surgical treatment, PDI, SF-36
National Category
Orthopaedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-404264 (URN)978-91-513-0887-6 (ISBN)
Public defence
2020-04-23, H:son Holmdahlssalen, Akademiska sjukhuset, ing 100, 2 tr, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2020-03-18 Created: 2020-02-24 Last updated: 2020-05-19

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Borg, TomasHernefalk, BjörnCarlsson, MarianneLarsson, Sune

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