Beyond Joint Implant Registries A Patient-Centered Research Consortium for Comparative Effectiveness in Total Joint Replacement
Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655, USA.JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/2012; 308(12):1217-8. DOI: 10.1001/jama.2012.12568
Discusses the Function and Outcomes Research for Comparative Effectiveness in TJR (FORCE-TJR) research program for total joint replacement funded by the Agency for Healthcare Research and Quality. Led by a team of researchers at the University of Massachusetts Medical School in cooperation with a national network of surgeons, FORCE-TJR assembled a consortium of orthopedic practices to serve as a research laboratory to generate comparative effectiveness research to guide surgeon and patient decisions. The FORCE-TJR has a national scope, is representative of US practices, includes longitudinal patient-reported outcomes, and has the ability to measure implant failure as well as important clinical outcomes and complications.
Article: Letter to the editor.Orthopaedic nursing / National Association of Orthopaedic Nurses 01/2013; 32(1):4-5. DOI:10.1097/NOR.0b013e31827ecf28 · 0.56 Impact Factor
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ABSTRACT: The integrity of behavioral intervention trials depends on consistent intervention delivery, and uniform, comprehensive process data collection. It can be challenging in practice due to complex human interactions involved. We sought to design a system to support the fidelity of intervention delivery and efficient capture of qualitative and quantitative process data for a telephone-delivered behavioral counseling intervention to increase physical activity and function after total knee replacement surgery. A tailored system was designed to prompt the intervention coach in the delivery of a 5 step counseling protocol to support intervention fidelity across patients. System features included structured data components, automated data exchange functions, user-friendly data capture screens, and real-time surveillance reporting. The system structured the capture of patient goals and open-ended conversation. The system recorded intervention process data from each of 12 sessions held with the 92 intervention patients. During the trial, 992 telephone sessions were conducted, and more than 97% (4816/4960) of intervention process data fields were completed in the system. The coach spent 5-10 minutes preparing for each counseling call using system-generated summaries of historical data and 10-15 minutes entering intervention process data following each telephone session. This intervention delivery system successfully supported the delivery of a structured behavioral counseling intervention and collection of intervention process data. It addressed the unique needs of clinical behavioral intervention trials, and had promising potential to facilitate high-fidelity translation of the intervention to broad clinical practice and Web-based multicenter clinical trials in the future.Journal of Medical Internet Research 04/2013; 15(4):e58. DOI:10.2196/jmir.2375 · 3.43 Impact Factor
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ABSTRACT: Purpose: The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of the Balgrist total hip replacement cup. Methods: We report the results of a retrospective review of 195 total hip prostheses with Balgrist cup implanted in 178 patients. There were 59 men and 119 women with a mean age at surgery of 52.3 years (range, 19-72). Cox regression was used to determine the influence of independent variables on the survivorship of the prosthesis. Results: There were 117 (66 %) of 178 patients, and 131 (67 %) of 195 hips available for assessment at a mean follow-up of 17.4 years. A total of 21 patients (22 hips) were lost from follow-up (12 %). A total of 25 patients (27 hips) required some type of re-operation during the follow-up period. Eight of 27 re-operations (30 %) were directly caused by the Balgrist cup failure due to fatigue fracture of the metallic shell (n = 5; 19 %), polyethylene wear (n = 2; 7 %) and aseptic loosening (n = 1; 4 %). The mean polyethylene wear rate was 0.068 mm/year (range, 0.008-0.230; SD = 0.043). The risk of re-operation for any reason was decreased with dysplastic hip as a primary diagnosis (hazard ratio; HR = 0.250; 95 % CI 0.086-0.725) and with greater age at the time of surgery (HR = 0.923; 95 % CI 0.880-0.969). The 19-year survivorship with re-operation for any reason was 75.6 % (95 % CI 67.0-84.2). The 19-year survivorship with re-operation for the Balgrist cup failure was 90.5 % (95 % CI 83.4-97.6). Conclusions: The Balgrist cup continues to provide excellent clinical and radiological outcomes. This is associated at least in part with a low polyethylene wear rate. The main reason for the Balgrist cup failure is fatigue fracture of the metallic shell.International Orthopaedics 06/2013; 37(8). DOI:10.1007/s00264-013-1946-x · 2.11 Impact Factor
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