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Ellen J. Mackenzie - One of the best experts on this subject based on the ideXlab platform.
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ability of lower extremity injury severity scores to predict functional outcome after limb salvage
Journal of Bone and Joint Surgery American Volume, 2008Co-Authors: Thuan V Ly, Michael J. Bosse, Renan C Castillo, Thomas G Travison, Ellen J. MackenzieAbstract:Background: Lower-extremity injury severity scoring systems were developed to assist surgeons in decision-making regarding whether to amputate or perform limb salvage after high-energy trauma to the lower extremity. These scoring systems have been shown to not be good predictors of limb amputation or salvage. This study was performed to evaluate the clinical utility of the five commonly used lower-extremity injury severity scoring systems as predictors of final functional outcome. Methods: We analyzed data from a cohort of patients who participated in a multicenter prospective study of clinical and functional outcomes after high-energy lower-extremity trauma. Injury severity was assessed with use of the Mangled Extremity Severity Score; the Limb Salvage Index; the Predictive Salvage Index; the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score; and the Hannover Fracture Scale-98. Functional outcomes were measured with use of the physical and psychosocial domains of the Sickness Impact Profile at both six months and two years following hospital discharge. Four hundred and seven subjects for whom the reconstruction regimen was considered successful at six months were included in the analysis. We used partial correlation statistics and multiple linear regression models to quantify the association between injury severity scores and Sickness Impact Profile outcomes with the subjects' ages held constant. Results: The mean age of the patients was thirty-six years (interquartile range, twenty-six to forty-four years); 75.2% were male and 24.8% were female. The median Sickness Impact Profile scores were 15.2 and 6.0 points at six and twenty-four months, respectively. The analysis showed that none of the scoring systems were predictive of the Sickness Impact Profile outcomes at six or twenty-four months to any reasonable degree. Likewise, none were predictive of patient recovery between six and twenty-four months postoperatively as measured by a change in the scores in either the physical or the psychosocial domain of the Sickness Impact Profile. Conclusions: Currently available injury severity scores are not predictive of the functional recovery of patients who undergo successful limb reconstruction. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.
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functional outcomes following trauma related lower extremity amputation
Journal of Bone and Joint Surgery American Volume, 2004Co-Authors: Ellen J. Mackenzie, Marc F Swiontkowski, Michael J. Bosse, Renan C Castillo, James F Kellam, Andrew R Burgess, Lawrence X Webb, Roy Sanders, Douglas G Smith, Alan L JonesAbstract:Background: The principal aims of this study were to examine functional outcomes following trauma-related lower-extremity amputation and to compare outcomes according to the amputation levels. We hypothesized that above-the-knee amputations would result in less favorable outcomes than would through-the-knee or below-the-knee amputations. A secondary aim was to examine the factors, in addition to amputation level, that influence outcome, including the type of soft-tissue coverage, selected patient characteristics, and the technological sophistication of the prosthetic device. Methods: A cohort of 161 patients who had undergone an above-the-ankle amputation at a trauma center within three months following the injury was followed prospectively at three, six, twelve, and twenty-four months after the injury. The Sickness Impact Profile, a self-reported measure of functional status, was used as the principal measure of outcome. Secondary outcomes included pain; degree of independence in transfers, walking, and climbing stairs; self-selected walking speed; and the physician's satisfaction with the clinical, functional, and cosmetic recovery of the limb. Longitudinal multivariate regression techniques were used to determine whether outcomes differed according to the level of amputation after we controlled for covariates. Results: There was no significant difference in the scores on the Sickness Impact Profile between the patients treated with above-the-knee and those treated with below-the-knee amputation. However, patients with a below-the-knee amputation performed better than did patients with an above-the-knee amputation on the timed test for walking speed (p = 0.04). Patients with a through-the-knee amputation had worse regression-adjusted Sickness Impact Profile scores (p = 0.05) and slower self-selected walking speeds (p = 0.004) than did patients with either a below-the-knee or an above-the-knee amputation. Differences according to the level of amputation were most pronounced for physical function. In general, physicians were less satisfied with the clinical, cosmetic, and functional recovery of the patients with a through-the-knee amputation. Except for problems encountered with insufficient gastrocnemius coverage of the stump in many patients with a through-the-knee amputation, neither the soft-tissue coverage nor the technological sophistication of the prosthesis correlated with outcome. Conclusions: Severe disability accompanies above-the-ankle lower-extremity amputation following trauma, regardless of the level of amputation. Clinicians should critically evaluate the need for a through-the-knee amputation in patients with a traumatic injury. The results of this study also underscore the need for controlled studies that examine the relationship between the type and fit of prosthetic devices and functional outcomes. Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.
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an analysis of outcomes of reconstruction or amputation of leg threatening injuries
The New England Journal of Medicine, 2002Co-Authors: Michael J. Bosse, Marc F Swiontkowski, Ellen J. Mackenzie, James F Kellam, Andrew R Burgess, Lawrence X Webb, Roy Sanders, Alan L Jones, Mark P Mcandrew, Brendan M PattersonAbstract:Background Limb salvage for severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated. Methods We performed a multicenter, prospective, observational study to determine the functional outcomes of 569 patients with severe leg injuries resulting in reconstruction or amputation. The principal outcome measure was the Sickness Impact Profile, a multidimensional measure of self-reported health status (scores range from 0 to 100; scores for the general population average 2 to 3, and scores greater than 10 represent severe disability). Secondary outcomes included limb status and the presence or absence of major complications resulting in rehospitalization. Results At two years, there was no significant difference in scores for the Sickness Impact Profile between the amputation and reconstruction groups (12.6 vs. 11.8, P=0.53). After adjustment for the characteristics of the patients and t...
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validating the functional capacity index as a measure of outcome following blunt multiple trauma
Quality of Life Research, 2002Co-Authors: Ellen J. Mackenzie, W J Sacco, S Luchter, John F Ditunno, C F Staz, Gary S Gruen, D W Marion, William SchwabAbstract:Background: The validity of the Functional Capacity Index (FCI) is evaluated by examining its distributional characteristics, its correlation with other well-known measures of outcome and its ability to discriminate among persons with injuries of varying type and severity. Methods: A telephone survey which included the FCI and the SF-36 was administered 1 year post-injury to 1240 blunt trauma patients discharged from 12 trauma centers. A subsample of 656 patients also completed the Sickness Impact Profile (SIP) by mail. Results: FCI scores correlated well with the physical health subscores of the SIP and SF-36. They also correlated well with self-reported change in health status and return to work. The FCI, when compared to either the SF-36 or the SIP, however, appears to discriminate better among patients according to the presence and severity of head trauma. Conclusions: While further testing of the FCI is needed, it holds promise as a preference based measure for assessing the physical Impact of trauma.
Ruth Bullas - One of the best experts on this subject based on the ideXlab platform.
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the effect of elective total hip replacement on health related quality of life
Journal of Bone and Joint Surgery American Volume, 1993Co-Authors: Andreas Laupacis, Robert B Bourne, Cecil H Rorabeck, David Feeny, Cindy J Wong, Peter Tugwell, Karen Leslie, Ruth BullasAbstract:The effect of total hip replacement on the health-related quality of life of patients who have osteoarthrosis was examined as part of a randomized, controlled trial comparing femoral head prostheses that were inserted with or without cement. One hundred and eighty-eight patients were followed for three months: 179 of them, for six months; 156, for one year; and ninety, for two years. The health-related quality of life was assessed with use of the Harris hip score, the Merle d'Aubigne hip score, the Sickness Impact Profile, the Western Ontario and McMaster University (WOMAC) Osteoarthritis Index, the McMaster--Toronto Arthritis (MACTAR) Patient Preference Disability Questionnaire, and the time trade-off technique as a measure of utility. Patients also took the six-minute-walk test. The mean age of the patients in the study was sixty-four years (range, forty to seventy-five years); ninety-seven patients (53 per cent) were men and ninety-four (50 per cent) had a prosthesis inserted with cement. Only three of 188 patients refused to return for quality-of-life assessments. There was significant improvement in all health-related quality-of-life measures and in the six-minute-walk test after the operation (p < 0.01 for all items, except for the work dimension of the Sickness Impact Profile at three months [p = 0.07]). Most of the improvement had occurred by three months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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the effect of elective total hip replacement on health related quality of life
Journal of Bone and Joint Surgery American Volume, 1993Co-Authors: Andreas Laupacis, Robert B Bourne, Cecil H Rorabeck, David Feeny, Cindy J Wong, Peter Tugwell, Karen Leslie, Ruth BullasAbstract:The effect of total hip replacement on the health-related quality of life of patients who have osteoarthrosis was examined as part of a randomized, controlled trial comparing femoral head prostheses that were inserted with or without cement. One hundred and eighty-eight patients were followed for three months: 179 of them, for six months; 156, for one year; and ninety, for two years. The health-related quality of life was assessed with use of the Harris hip score, the Merle d'Aubigne hip score, the Sickness Impact Profile, the Western Ontario and McMaster University (WOMAC) Osteoarthritis Index, the McMaster--Toronto Arthritis (MACTAR) Patient Preference Disability Questionnaire, and the time trade-off technique as a measure of utility. Patients also took the six-minute-walk test. The mean age of the patients in the study was sixty-four years (range, forty to seventy-five years); ninety-seven patients (53 per cent) were men and ninety-four (50 per cent) had a prosthesis inserted with cement. Only three of 188 patients refused to return for quality-of-life assessments. There was significant improvement in all health-related quality-of-life measures and in the six-minute-walk test after the operation (p < 0.01 for all items, except for the work dimension of the Sickness Impact Profile at three months [p = 0.07]). Most of the improvement had occurred by three months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
Anne M Damiano - One of the best experts on this subject based on the ideXlab platform.
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reproducibility and responsiveness of the vf 14 an index of functional impairment in patients with cataracts
Archives of Ophthalmology, 1995Co-Authors: Sandra D Cassard, Marcia W Legro, Anne M Damiano, Marie Dienerwest, Jonathan C Javitt, Oliver D Schein, James M Tielsch, Donald L Patrick, Eric B BassAbstract:Objective: To assess the test-retest reliability and responsiveness of the VF-14, which is an index of functional impairment in patient with cataracts. Design: Observational longitudinal study. Patients were enrolled prior to undergoing their first cataract surgery between July 15 and December 15, 1991, and they were followed up for 1 year after surgery. Setting: Patients were recruited from 72 ophthalmologists' practices in three US cities. Patients: Five hundred fifty-two patients who had undergone a surgical procedure in only one eye by the 4-month postoperative follow-up (responsiveness analyses) and a subset of these (n=426) who had not subsequently undergone surgery for the second eye by the 12-month postoperative follow-up (reproducibility analyses). Main Outcome Measures: Two health status measures (the VF-14 and the Sickness Impact Profile, two global measures of a patient's trouble and satisfaction with his or her vision, and best corrected visual acuity in each eye. Results: The VF-14 is highly reproducible, with an intraclass correlation coefficient of.79 when patientrated criteria are used to define stable patients. The intraclass correlation coefficient was lower (.57 to.71) when various measures of visual acuity were used to define stable patients. The VF-14 is also about three times more responsive to a change in vision than the Sickness Impact Profile, which is a generic health status measure (effect size of approximately 1.00 vs 0.30). Estimates of the responsiveness of the VF-14 and the Sickness Impact Profile were not associated with preoperative visual acuity in the operated on or better eye. Responsiveness of the VF-14, however, was higher in patients with greater self-rated trouble with vision preoperatively. Conclusions: The VF-14 was reproducible in stable patients during an 8-month period, and it was more responsive to clinically significant changes in vision than was a generic health status measure (ie, the Sickness Impact Profile).
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the vf 14 an index of functional impairment in patients with cataract
Archives of Ophthalmology, 1994Co-Authors: Earl P Steinberg, Phoebe Sharkey, Sandra D Cassard, Marcia W Legro, Eric B Bass, Marie Dienerwest, Jonathan C Javitt, Oliver D Schein, James M Tielsch, Anne M DamianoAbstract:Objective: To describe the development and the performance of a brief questionnaire designed to measure functional impairment caused by cataract (the VF-14). Design: Observational cross-sectional study. Patients were recruited between July 15 and December 15, 1991. Setting: Patients were recruited from the practices of 70 ophthalmologists, located in Columbus, Ohio (N=21), St Louis, Mo (N=26), and Houston, Tex (N=23). Patients: Seven hundred sixty-six patients undergoing cataract surgery for the first time. Main Outcome Measures: Preoperative best corrected visual acuity in each eye; scores on the VF-14, a new index of functional impairment in patients with cataract; patient reports of overall trouble and satisfaction with their vision; and scores on the Sickness Impact Profile, a measure of general health status. Results: The VF-14 has high internal consistency (Cronbach's α=.85) and correlates more strongly with the overall self-rating of the amount of trouble and satisfaction patients have with their vision than do several measures of visual acuity or the Sickness Impact Profile score. The VF-14 score is moderately correlated with visual acuity in the better eye. Conclusions: The VF-14 is a reliable and valid measure of functional impairment caused by cataract and provides information not conveyed by visual acuity or a general measure of health status.
Eric B Bass - One of the best experts on this subject based on the ideXlab platform.
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reproducibility and responsiveness of the vf 14 an index of functional impairment in patients with cataracts
Archives of Ophthalmology, 1995Co-Authors: Sandra D Cassard, Marcia W Legro, Anne M Damiano, Marie Dienerwest, Jonathan C Javitt, Oliver D Schein, James M Tielsch, Donald L Patrick, Eric B BassAbstract:Objective: To assess the test-retest reliability and responsiveness of the VF-14, which is an index of functional impairment in patient with cataracts. Design: Observational longitudinal study. Patients were enrolled prior to undergoing their first cataract surgery between July 15 and December 15, 1991, and they were followed up for 1 year after surgery. Setting: Patients were recruited from 72 ophthalmologists' practices in three US cities. Patients: Five hundred fifty-two patients who had undergone a surgical procedure in only one eye by the 4-month postoperative follow-up (responsiveness analyses) and a subset of these (n=426) who had not subsequently undergone surgery for the second eye by the 12-month postoperative follow-up (reproducibility analyses). Main Outcome Measures: Two health status measures (the VF-14 and the Sickness Impact Profile, two global measures of a patient's trouble and satisfaction with his or her vision, and best corrected visual acuity in each eye. Results: The VF-14 is highly reproducible, with an intraclass correlation coefficient of.79 when patientrated criteria are used to define stable patients. The intraclass correlation coefficient was lower (.57 to.71) when various measures of visual acuity were used to define stable patients. The VF-14 is also about three times more responsive to a change in vision than the Sickness Impact Profile, which is a generic health status measure (effect size of approximately 1.00 vs 0.30). Estimates of the responsiveness of the VF-14 and the Sickness Impact Profile were not associated with preoperative visual acuity in the operated on or better eye. Responsiveness of the VF-14, however, was higher in patients with greater self-rated trouble with vision preoperatively. Conclusions: The VF-14 was reproducible in stable patients during an 8-month period, and it was more responsive to clinically significant changes in vision than was a generic health status measure (ie, the Sickness Impact Profile).
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the vf 14 an index of functional impairment in patients with cataract
Archives of Ophthalmology, 1994Co-Authors: Earl P Steinberg, Phoebe Sharkey, Sandra D Cassard, Marcia W Legro, Eric B Bass, Marie Dienerwest, Jonathan C Javitt, Oliver D Schein, James M Tielsch, Anne M DamianoAbstract:Objective: To describe the development and the performance of a brief questionnaire designed to measure functional impairment caused by cataract (the VF-14). Design: Observational cross-sectional study. Patients were recruited between July 15 and December 15, 1991. Setting: Patients were recruited from the practices of 70 ophthalmologists, located in Columbus, Ohio (N=21), St Louis, Mo (N=26), and Houston, Tex (N=23). Patients: Seven hundred sixty-six patients undergoing cataract surgery for the first time. Main Outcome Measures: Preoperative best corrected visual acuity in each eye; scores on the VF-14, a new index of functional impairment in patients with cataract; patient reports of overall trouble and satisfaction with their vision; and scores on the Sickness Impact Profile, a measure of general health status. Results: The VF-14 has high internal consistency (Cronbach's α=.85) and correlates more strongly with the overall self-rating of the amount of trouble and satisfaction patients have with their vision than do several measures of visual acuity or the Sickness Impact Profile score. The VF-14 score is moderately correlated with visual acuity in the better eye. Conclusions: The VF-14 is a reliable and valid measure of functional impairment caused by cataract and provides information not conveyed by visual acuity or a general measure of health status.
Marcia W Legro - One of the best experts on this subject based on the ideXlab platform.
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reproducibility and responsiveness of the vf 14 an index of functional impairment in patients with cataracts
Archives of Ophthalmology, 1995Co-Authors: Sandra D Cassard, Marcia W Legro, Anne M Damiano, Marie Dienerwest, Jonathan C Javitt, Oliver D Schein, James M Tielsch, Donald L Patrick, Eric B BassAbstract:Objective: To assess the test-retest reliability and responsiveness of the VF-14, which is an index of functional impairment in patient with cataracts. Design: Observational longitudinal study. Patients were enrolled prior to undergoing their first cataract surgery between July 15 and December 15, 1991, and they were followed up for 1 year after surgery. Setting: Patients were recruited from 72 ophthalmologists' practices in three US cities. Patients: Five hundred fifty-two patients who had undergone a surgical procedure in only one eye by the 4-month postoperative follow-up (responsiveness analyses) and a subset of these (n=426) who had not subsequently undergone surgery for the second eye by the 12-month postoperative follow-up (reproducibility analyses). Main Outcome Measures: Two health status measures (the VF-14 and the Sickness Impact Profile, two global measures of a patient's trouble and satisfaction with his or her vision, and best corrected visual acuity in each eye. Results: The VF-14 is highly reproducible, with an intraclass correlation coefficient of.79 when patientrated criteria are used to define stable patients. The intraclass correlation coefficient was lower (.57 to.71) when various measures of visual acuity were used to define stable patients. The VF-14 is also about three times more responsive to a change in vision than the Sickness Impact Profile, which is a generic health status measure (effect size of approximately 1.00 vs 0.30). Estimates of the responsiveness of the VF-14 and the Sickness Impact Profile were not associated with preoperative visual acuity in the operated on or better eye. Responsiveness of the VF-14, however, was higher in patients with greater self-rated trouble with vision preoperatively. Conclusions: The VF-14 was reproducible in stable patients during an 8-month period, and it was more responsive to clinically significant changes in vision than was a generic health status measure (ie, the Sickness Impact Profile).
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the vf 14 an index of functional impairment in patients with cataract
Archives of Ophthalmology, 1994Co-Authors: Earl P Steinberg, Phoebe Sharkey, Sandra D Cassard, Marcia W Legro, Eric B Bass, Marie Dienerwest, Jonathan C Javitt, Oliver D Schein, James M Tielsch, Anne M DamianoAbstract:Objective: To describe the development and the performance of a brief questionnaire designed to measure functional impairment caused by cataract (the VF-14). Design: Observational cross-sectional study. Patients were recruited between July 15 and December 15, 1991. Setting: Patients were recruited from the practices of 70 ophthalmologists, located in Columbus, Ohio (N=21), St Louis, Mo (N=26), and Houston, Tex (N=23). Patients: Seven hundred sixty-six patients undergoing cataract surgery for the first time. Main Outcome Measures: Preoperative best corrected visual acuity in each eye; scores on the VF-14, a new index of functional impairment in patients with cataract; patient reports of overall trouble and satisfaction with their vision; and scores on the Sickness Impact Profile, a measure of general health status. Results: The VF-14 has high internal consistency (Cronbach's α=.85) and correlates more strongly with the overall self-rating of the amount of trouble and satisfaction patients have with their vision than do several measures of visual acuity or the Sickness Impact Profile score. The VF-14 score is moderately correlated with visual acuity in the better eye. Conclusions: The VF-14 is a reliable and valid measure of functional impairment caused by cataract and provides information not conveyed by visual acuity or a general measure of health status.
