The Experts below are selected from a list of 132 Experts worldwide ranked by ideXlab platform
Kevin C. Chung - One of the best experts on this subject based on the ideXlab platform.
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Reconstructing the Rheumatoid Wrist: A Utility Analysis Comparing Total Wrist Fusion and Total Wrist Arthroplasty from the Perspectives of Rheumatologists and Hand Surgeons
HAND, 2010Co-Authors: Christi M. Cavaliere, Adam J. Oppenheimer, Kevin C. ChungAbstract:Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical intervention, either total Wrist fusion or total Wrist arthroplasty, for the rheumatoid Wrist. A utility analysis was conducted to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management of severe rheumatoid Wrist Disease. A web-based trade-off utility survey was developed, and participants were presented with survey scenarios comparing well-controlled rheumatoid arthritis with operative and non-operative management. Utility values were calculated for each scenario, and a decision analytic model was constructed. Utility values for rheumatologists and hand surgeons did not differ significantly for any scenario. Total Wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup. This decision analytic model demonstrates similar opinions between two subspecialties that have historically demonstrated divergent attitudes towards rheumatoid hand surgery.
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a cost utility analysis of nonsurgical management total Wrist arthroplasty and total Wrist arthrodesis in rheumatoid arthritis
Journal of Hand Surgery (European Volume), 2010Co-Authors: Christi M. Cavaliere, Kevin C. ChungAbstract:Purpose Management of end-stage rheumatoid Wrist Disease remains controversial. Total Wrist arthrodesis provides reliable pain relief and stability and is the most commonly applied management strategy. Total Wrist arthroplasty is a motion-preserving alternative that is gaining popularity. The purpose of this study was to perform a cost-utility analysis comparing nonsurgical management, total Wrist arthroplasty, and total Wrist arthrodesis for the rheumatoid Wrist. Methods A time trade-off utility survey was developed to investigate patient and physician preferences for the potential outcomes of total Wrist arthroplasty and total Wrist arthrodesis. The study sample consisted of rheumatoid patients (N = 49) recruited as part of an ongoing prospective study and a national random sample of hand surgeons and rheumatologists (N = 109). A decision tree was created using utility values derived from the survey, and the expected quality-adjusted life-years (QALYs) for each procedure were determined. Using the societal perspective, costs were based on the Medicare fee schedules for the Current Procedural Terminology codes associated with total Wrist arthroplasty and total Wrist arthrodesis and their potential complications. Costs per QALY were calculated and compared. Results Patients and physicians both showed a preference for surgical management over nonsurgical management. Application of cost data indicated that the incremental cost per additional QALY gained for total Wrist arthroplasty over nonsurgical management was $2,281 and the incremental cost per QALY gained with total Wrist arthroplasty over total Wrist arthrodesis was $2,328, which is substantially less than the national standard of $50,000/QALY deemed acceptable for adoption. Conclusions In the absence of rigorous outcome data, cost-utility analysis is a useful tool to guide treatment decisions. Total Wrist arthroplasty and total Wrist arthrodesis are both extremely cost-effective procedures. This study incorporated patient and physician utilities to demonstrate that total Wrist arthroplasty has only a small incremental cost over the traditional total Wrist arthrodesis procedure. Based on this economic model, total Wrist arthroplasty may be worthy of further consideration, and cost should not be considered prohibitive. Type of study/level of evidence Decision Analysis II.
Christi M. Cavaliere - One of the best experts on this subject based on the ideXlab platform.
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Reconstructing the Rheumatoid Wrist: A Utility Analysis Comparing Total Wrist Fusion and Total Wrist Arthroplasty from the Perspectives of Rheumatologists and Hand Surgeons
HAND, 2010Co-Authors: Christi M. Cavaliere, Adam J. Oppenheimer, Kevin C. ChungAbstract:Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical intervention, either total Wrist fusion or total Wrist arthroplasty, for the rheumatoid Wrist. A utility analysis was conducted to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management of severe rheumatoid Wrist Disease. A web-based trade-off utility survey was developed, and participants were presented with survey scenarios comparing well-controlled rheumatoid arthritis with operative and non-operative management. Utility values were calculated for each scenario, and a decision analytic model was constructed. Utility values for rheumatologists and hand surgeons did not differ significantly for any scenario. Total Wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup. This decision analytic model demonstrates similar opinions between two subspecialties that have historically demonstrated divergent attitudes towards rheumatoid hand surgery.
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a cost utility analysis of nonsurgical management total Wrist arthroplasty and total Wrist arthrodesis in rheumatoid arthritis
Journal of Hand Surgery (European Volume), 2010Co-Authors: Christi M. Cavaliere, Kevin C. ChungAbstract:Purpose Management of end-stage rheumatoid Wrist Disease remains controversial. Total Wrist arthrodesis provides reliable pain relief and stability and is the most commonly applied management strategy. Total Wrist arthroplasty is a motion-preserving alternative that is gaining popularity. The purpose of this study was to perform a cost-utility analysis comparing nonsurgical management, total Wrist arthroplasty, and total Wrist arthrodesis for the rheumatoid Wrist. Methods A time trade-off utility survey was developed to investigate patient and physician preferences for the potential outcomes of total Wrist arthroplasty and total Wrist arthrodesis. The study sample consisted of rheumatoid patients (N = 49) recruited as part of an ongoing prospective study and a national random sample of hand surgeons and rheumatologists (N = 109). A decision tree was created using utility values derived from the survey, and the expected quality-adjusted life-years (QALYs) for each procedure were determined. Using the societal perspective, costs were based on the Medicare fee schedules for the Current Procedural Terminology codes associated with total Wrist arthroplasty and total Wrist arthrodesis and their potential complications. Costs per QALY were calculated and compared. Results Patients and physicians both showed a preference for surgical management over nonsurgical management. Application of cost data indicated that the incremental cost per additional QALY gained for total Wrist arthroplasty over nonsurgical management was $2,281 and the incremental cost per QALY gained with total Wrist arthroplasty over total Wrist arthrodesis was $2,328, which is substantially less than the national standard of $50,000/QALY deemed acceptable for adoption. Conclusions In the absence of rigorous outcome data, cost-utility analysis is a useful tool to guide treatment decisions. Total Wrist arthroplasty and total Wrist arthrodesis are both extremely cost-effective procedures. This study incorporated patient and physician utilities to demonstrate that total Wrist arthroplasty has only a small incremental cost over the traditional total Wrist arthrodesis procedure. Based on this economic model, total Wrist arthroplasty may be worthy of further consideration, and cost should not be considered prohibitive. Type of study/level of evidence Decision Analysis II.
Graham J W King - One of the best experts on this subject based on the ideXlab platform.
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The Capitate-to-Axis-of-Radius Distance (CARD): A New Radiographic Measurement for Wrist and Carpal Alignment in the Sagittal Plane.
The Journal of hand surgery, 2019Co-Authors: Stefanie Peggy Kuhnel, Graham J W King, Aaron T. Bigham, Robert Y. Mcmurtry, Kenneth J. Faber, Ruby GrewalAbstract:Purpose To determine the reliability of a new radiographic index evaluating sagittal radiocarpal alignment, the capitate-to-axis-of-radius distance (CARD). A secondary purpose was to validate this index by comparing values between normal Wrists and those with distal radial fractures (DRFs) and rheumatoid arthritis (RA). Methods The CARD is defined as the perpendicular distance from the center of the capitate head to the axis of the radius. Inter- and intraobserver reliability was tested. Cronbach alpha was calculated, and 2 methods of measurement were compared. The superior one (volar border of radial shaft) was used in the second part of the study. The normal CARD was then compared with unilateral DRFs with dorsal displacement DRF (n = 25) and RA (n = 25). Correlations between the CARD and other radiographic parameters (dorsal angulation, radial inclination, and ulnar variance) were calculated as well as between the CARD and the severity of Disease or fracture displacement (mild/moderate/severe). Results The CARD showed excellent intra- and interobserver reliability. The volar radius measurement method was superior to the midaxis method and was, therefore, used for the second portion of the study. The mean CARD for normal, fractured, and RA Wrists was significantly different (2.2 ± 2.5 mm, 15.7 ± 6.5 mm and 0.2 ± 4.4 mm, respectively). There was a strong side-to-side correlation in normal Wrists (r = 0.77) and a significant correlation between the CARD (mm) and the severity of deformity (RA, r = –0.7; DRF, r = 0.8). Conclusion The CARD is a reproducible, easy-to-use measurement of sagittal carpal alignment with a strong side-to-side correlation. The CARD increases with dorsal angulation of the distal radius and decreases as severity of deformity with RA increases. Clinical relevance The correlation of the CARD with severity of deformity in DRFs and RA makes it a useful method of assessing deformities in the sagittal plane. The normal Wrist can be used as a comparison when evaluating the CARD in the setting of unilateral Wrist Disease.
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reliability of range of motion measurement in the elbow and forearm
Journal of Shoulder and Elbow Surgery, 1998Co-Authors: April D Armstrong, Shrikant J Chinchalkar, Rob S Stevens, Joy C Macdermid, Graham J W KingAbstract:Abstract The purpose of this study was to examine intratester, intertester, and interdevice reliability of range of motion measurements of the elbow and forearm. Elbow flexion and extension and forearm pronation and supination were measured on 38 subjects with elbow, forearm, or Wrist Disease by 5 testers. Standardized test methods and a randomized order of testing were used to test groups of patients with universal standard goniometers, a computerized goniometer, and a mechanical rotation measuring device. Intratester reliability was high for all 3 measuring devices. Meaningful changes in intratester range of motion measurements taken with a universal goniometer occur with 95% confidence if they are greater than 6° for flexion, 7° for extension, 8° for pronation, and 8° for supination. Intertester reliability was high for flexion and extension measurements with the computerized goniometer and moderate for flexion and extension measurements with the universal goniometer. Meaningful change in interobserver range of motion measurements was expected if the change was greater than 4° for flexion and 6° for extension with the computerized goniometer compared with 10° and 10°, respectively, if the universal goniometer was used. Intertester reliability was high for pronation and supination with all 3 devices. Meaningful change in forearm rotation is characterized by a minimum of 10° for pronation and 11° for supination with the universal goniometer. Reliable measurements of elbow and forearm arm movement are obtainable regardless of the level of experience when standardized methods are used. Measurement error was least for repeated measurements taken by the same tester with the same instrument and most when different instruments were used. (J Shoulder Elbow Surg 1998;7:573-80)
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Reliability of range-of-motion measurement in the elbow and forearm***
Journal of shoulder and elbow surgery, 1998Co-Authors: April D Armstrong, Shrikant J Chinchalkar, Rob S Stevens, Joy C Macdermid, Graham J W KingAbstract:The purpose of this study was to examine intratester, intertester, and interdevice reliability of range of motion measurements of the elbow and forearm. Elbow flexion and extension and forearm pronation and supination were measured on 38 subjects with elbow, forearm, or Wrist Disease by 5 testers. Standardized test methods and a randomized order of testing were used to test groups of patients with universal standard goniometers, a computerized goniometer, and a mechanical rotation measuring device. Intratester reliability was high for all 3 measuring devices. Meaningful changes in intratester range of motion measurements taken with a universal goniometer occur with 95% confidence if they are greater than 6 degrees for flexion, 7 degrees for extension, 8 degrees for pronation, and 8 degrees for supination. Intertester reliability was high for flexion and extension measurements with the computerized goniometer and moderate for flexion and extension measurements with the universal goniometer. Meaningful change in interobserver range of motion measurements was expected if the change was greater than 4 degrees for flexion and 6 degrees for extension with the computerized goniometer compared with 10 degrees and 10 degrees, respectively, if the universal goniometer was used. Intertester reliability was high for pronation and supination with all 3 devices. Meaningful change in forearm rotation is characterized by a minimum of 10 degrees for pronation and 11 degrees for supination with the universal goniometer. Reliable measurements of elbow and forearm arm movement are obtainable regardless of the level of experience when standardized methods are used. Measurement error was least for repeated measurements taken by the same tester with the same instrument and most when different instruments were used.
Ruby Grewal - One of the best experts on this subject based on the ideXlab platform.
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The Capitate-to-Axis-of-Radius Distance (CARD): A New Radiographic Measurement for Wrist and Carpal Alignment in the Sagittal Plane.
The Journal of hand surgery, 2019Co-Authors: Stefanie Peggy Kuhnel, Graham J W King, Aaron T. Bigham, Robert Y. Mcmurtry, Kenneth J. Faber, Ruby GrewalAbstract:Purpose To determine the reliability of a new radiographic index evaluating sagittal radiocarpal alignment, the capitate-to-axis-of-radius distance (CARD). A secondary purpose was to validate this index by comparing values between normal Wrists and those with distal radial fractures (DRFs) and rheumatoid arthritis (RA). Methods The CARD is defined as the perpendicular distance from the center of the capitate head to the axis of the radius. Inter- and intraobserver reliability was tested. Cronbach alpha was calculated, and 2 methods of measurement were compared. The superior one (volar border of radial shaft) was used in the second part of the study. The normal CARD was then compared with unilateral DRFs with dorsal displacement DRF (n = 25) and RA (n = 25). Correlations between the CARD and other radiographic parameters (dorsal angulation, radial inclination, and ulnar variance) were calculated as well as between the CARD and the severity of Disease or fracture displacement (mild/moderate/severe). Results The CARD showed excellent intra- and interobserver reliability. The volar radius measurement method was superior to the midaxis method and was, therefore, used for the second portion of the study. The mean CARD for normal, fractured, and RA Wrists was significantly different (2.2 ± 2.5 mm, 15.7 ± 6.5 mm and 0.2 ± 4.4 mm, respectively). There was a strong side-to-side correlation in normal Wrists (r = 0.77) and a significant correlation between the CARD (mm) and the severity of deformity (RA, r = –0.7; DRF, r = 0.8). Conclusion The CARD is a reproducible, easy-to-use measurement of sagittal carpal alignment with a strong side-to-side correlation. The CARD increases with dorsal angulation of the distal radius and decreases as severity of deformity with RA increases. Clinical relevance The correlation of the CARD with severity of deformity in DRFs and RA makes it a useful method of assessing deformities in the sagittal plane. The normal Wrist can be used as a comparison when evaluating the CARD in the setting of unilateral Wrist Disease.
David A Cabral - One of the best experts on this subject based on the ideXlab platform.
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the early pattern of joint involvement predicts Disease progression in children with oligoarticular pauciarticular juvenile rheumatoid arthritis
Arthritis & Rheumatism, 2002Co-Authors: Mohammad J Almatar, Ross E Petty, Lori B Tucker, Peter N Malleson, Marialouise Schroeder, David A CabralAbstract:Objective To evaluate features during the first 6 months of Disease that may be associated with a poor outcome as measured principally by extension to a polyarticular Disease course in patients with oligoarticular-onset juvenile rheumatoid arthritis (oligo-JRA). Methods This study was a retrospective review of patients who fulfilled the American College of Rheumatology criteria for oligo-JRA, were followed up for at least 5 years, and did not have juvenile psoriatic arthritis, spondylarthropathy-like Disease, or rheumatoid factor positivity. Data from the first 6 months of Disease were collected. Continuous variables were dichotomized and then screened by univariate analysis for association with poor outcome at the last followup visit, as measured by extension of involvement (>4 accumulated involved joints) and by “clinically meaningful” extension (≥10 accumulated joints). Variables significantly associated with this latter outcome, with the addition of Disease duration as a confounding independent variable, were included in a multiple logistic regression analysis. The same variables were then examined in separate multiple logistic regression models to look at other measures of outcome, including use of Disease-modifying antirheumatic drugs (DMARDs) at any time, erosive Disease on radiographs, any remission of Disease ever occurring, physician's global assessment of Disease activity at the last visit, and disability as measured by the Childhood Health Assessment Questionnaire (C-HAQ)/HAQ. Results Of the 205 patients (160 of whom were female) studied for a median of 10.8 years (range 5–26.6 years), 39.5% developed extension to >4 joints and 17.6% developed arthritis in ≥10 joints. Using the logistic regression model, symmetric Disease was predictive of all measures of poor outcome: extension to ≥10 joints (odds ratio [OR] 19.2), the need to use DMARDs (OR 11.5), radiographic demonstration of erosive Disease (OR 4.73), inflammatory activity at last followup visit (OR 3.23), no remission of Disease (OR 4.73), and disability as measured by a C-HAQ score >0.12 (OR 2.95). Ankle and/or Wrist Disease was predictive of extension (OR 6.61) and erosions (OR 3.59). Wrist Disease alone was predictive of the need to use DMARDs (OR 5.87) and of inflammatory Disease activity at the last followup visit (OR 4.01). An elevated erythrocyte sedimentation rate (ESR) was predictive of extension (OR 3.76), the need to use DMARDs (OR 6.47), and no remission of Disease (OR 2.30). Disease duration was a confounding variable for extension (OR 1.18) and erosive Disease (OR 1.19). Conclusion The early presence of ankle and/or Wrist Disease, symmetric joint involvement, and an elevated ESR in a child with oligo-JRA indicates the likelihood of Disease progression.
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Patterns of joint involvement at onset differentiate oligoarticular juvenile psoriatic arthritis from pauciarticular juvenile rheumatoid arthritis.
The Journal of rheumatology, 2002Co-Authors: Christian Huemer, Peter N Malleson, David A Cabral, Martina Huemer, Jutta Falger, Thomas Zidek, Ross E PettyAbstract:OBJECTIVE: To compare the patterns of joint involvement of patients with oligoarticular onset juvenile psoriatic arthritis (Oligo-JPsA) and pauciarticular onset juvenile rheumatoid arthritis (Pauci-JRA) in order to estimate the predictive performance of specific patterns for the diagnosis of Oligo-JPsA. METHODS: Twenty-three children who fulfilled the diagnostic criteria for JPsA (Vancouver criteria) and who had fewer than 5 joints involved in the first 6 months of Disease (Oligo-JPsA), and 64 children with Pauci-JRA (ACR criteria) were enrolled. Patients were also classified with respect to the ILAR criteria for juvenile idiopathic arthritis (JIA). Patient characteristics and clinical features at onset and during followup were determined. Patterns of joint involvement at onset of Disease and their ability to differentiate between Oligo-JPsA and Pauci-JRA/Oligo-JIA were evaluated. RESULTS: Small joint Disease (defined as involvement of any of the metatarsophalangeal or proximal or distal interphalangeal joints of the foot, or metacarpophalangeal or proximal or distal interphalangeal joints of the hand) was significantly more frequent in Oligo-JPsA than in Pauci-JRA at Disease onset. The odds of patients with Oligo-JPsA having small joint Disease or Wrist Disease within 6 months of Disease onset were much higher than those with Pauci-JRA or Oligo-JIA (p
