Abstract
In this thesis we investigated the use of clinical information and Patient Reported Outcome Measures (PROMs) for patient evaluation in orthopaedic surgery and sports medicine.
In the first part, we showed that the Dutch version of the Simple Shoulder Test (SST) is a valid and reliable instrument for the
... read more
assessment of patients with shoulder complaints. Thus, the SST can be used for clinical trials and for comparisons of study results from different countries. We recommend the use of the Dutch translation of the SST for evaluating patients with shoulder complaints.
In the current healthcare environment, it is increasingly important to evaluate the outcome of treatment. Therefore it is important to find out, from the patient’s perspective, how many points a patient should improve on a PROM for the improvement to be considered a clinically relevant change. The Simple Shoulder Test (SST), the Disabilities of the Arm, Shoulder and Hand (DASH), the Shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and the Oxford Shoulder Score (OSS) are among the most commonly used PROMs for the shoulder. Our study results showed that a patient with shoulder complaints should improve an average of 12–20% on a PROM to experience a clinically relevant improvement in complaints.
In the second part, we showed that with a combination of patient information and a few clinical tests it is possible to increase the diagnostic value for traumatic anterior shoulder instability and rotator cuff tears. These two studies underscore the value of a rigorous patient history evaluation and clinical examination for diagnosing shoulder complaints.
In the final part, we conducted two studies: First, we evaluated the 8-10 year outcome after arthroscopic shoulder stabilisation. We found a failure rate (re-dislocation of the shoulder) of up to 35%. This was higher than we expected and highlights the importance of long-term follow-up. Failures are seen after 2 years of follow-up, which is the follow-up time used in most clinical studies.
Second, we evaluated the use of neurocognitive testing for diagnosing concussion. In the field of sports medicine, there is a need for more standardised measurements for diagnosing sports-related concussions in athletes. Historically, the focus has been on self-reported concussion symptoms. However, there is some doubt about whether athletes accurately report symptoms to their team’s medical personnel. Thus, there is a need for more objective data to determine better return-to-play recommendations. Neurocognitive testing has potential as a useful extra tool for diagnosing concussions. Our study results showed that relying purely on patient-reported symptoms leads to an under-diagnosis of 36% of the concussed patients. Using a combination of significant changes in patient symptoms and/or significant decreases of neurocognitive test scores leads to improved sensitivity of 93%.
In conclusion, this thesis highlights the importance of the using both clinician- and patient-based outcomes in patient evaluation.
show less
