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Purpose: The computerized Animated Activity Questionnaire (AAQ) for assessing activity limitations in hip and knee osteoarthritis (HKOA) consists of video animations from which patients can choose the animation that best matches their own performance. The AAQ has demonstrated good validity and reliability. Application of the AAQ in international studies, requires good cross-cultural validity, i.e., minimal Differential Item Functioning (DIF) across countries. The aim of this study was to evaluate cross-cultural validity. Methods: Patients in 7 European countries patients completed the AAQ on a computer. Ordinal logistic regression analysis was used to evaluate DIF across languages (Dutch versus 6 other languages). DIF is defined as follows: If a patient in a country has the same level of activity limitation as a patient in the Netherlands (the reference country in which the AAQ is developed), they should score the same on each item of the AAQ. If there is a statistical significant difference between countries, there is DIF. We used frequently described criteria in literature to assess DIF between countries. Criteria for non-uniform DIF were set as a statistical significance (p

Objectives Patient-reported outcome measures (PROMs) are often used to evaluate the outcome of treatment in patients with distal radial fractures. Which PROM to select is often based on assessment of measurement properties, such as validity and reliability. Measurement properties are assessed in clinimetric studies, and results are often reviewed without considering the methodological quality of these studies. Our aim was to systematically review the methodological quality of clinimetric studies that evaluated measurement properties of PROMs used in patients with distal radial fractures, and to make recommendations for the selection of PROMs based on the level of evidence of each individual measurement property. Methods A systematic literature search was performed in PubMed, EMbase, CINAHL and PsycINFO databases to identify relevant clinimetric studies. Two reviewers independently assessed the methodological quality of the studies on measurement properties, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Level of evidence (strong / moderate / limited / lacking) for each measurement property per PROM was determined by combining the methodological quality and the results of the different clinimetric studies. Results In all, 19 out of 1508 identified unique studies were included, in which 12 PROMs were rated. The Patient-rated wrist evaluation (PRWE) and the Disabilities of Arm, Shoulder and Hand questionnaire (DASH) were evaluated on most measurement properties. The evidence for the PRWE is moderate that its reliability, validity (content and hypothesis testing), and responsiveness are good. The evidence is limited that its internal consistency and cross-cultural validity are good, and its measurement error is acceptable. There is no evidence for its structural and criterion validity. The evidence for the DASH is moderate that its responsiveness is good. The evidence is limited that its reliability and the validity on hypothesis testing are good. There is no evidence for the other measurement properties. Conclusion According to this systematic review, there is, at best, moderate evidence that the responsiveness of the PRWE and DASH are good, as are the reliability and validity of the PRWE. We recommend these PROMs in clinical studies in patients with distal radial fractures; however, more clinimetric studies of higher methodological quality are needed to adequately determine the other measurement properties. Cite this article: Dr Y. V. Kleinlugtenbelt. Are validated outcome measures used in distal radial fractures truly valid?: A critical assessment using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Bone Joint Res 2016;5:153–161. DOI: 10.1302/2046-3758.54.2000462.

Background: The Animated Activity Questionnaire (AAQ) measures activity limitations in hip and knee osteoarthritis (HKOA), and demonstrated good validity and reliability [1]. The AAQ shows stylized video animations of different levels of activity performance. Patients are asked to choose which video best matches their own performance. Accordingly, for international studies, the AAQ should show minimal Differential Item Functioning (DIF) across countries, which means that patients from different countries with the same level of activity limitations should have the same score on each item. Objectives: To evaluate cross-cultural validity of the AAQ. Methods: In 7 European countries patients were asked to complete the AAQ. An example of an item of the AAQ is shown on: http://kmin-vumc.nl/-14-0.html. Ordinal logistic regression was used to evaluate DIF across languages (Dutch versus 6 other languages). As a criterion for uniform DIF we used an odds ratio outside the interval 0.53-1.89. An significant interaction term (p-value

We have reviewed the long-term results of 22 patients (23 fusions) with fractures of the os calcis, who had subtalar arthrodesis with correction of the deformity between 1975 and 1991. The mean follow-up was nine years (5 to 20). All patients were evaluated according to a modified foot score. A radiological assessment was used in which linear and angular variables were measured including the fibulocalcaneal abutment, the height of the heel and fat pad, the angle of the arch and the lateral talocalcaneal and the lateral talar declination angles. The technique used restores the normal relationship between the hindfoot and midfoot and corrects the height of the heel. This leads to better biomechanical balance of the neighbouring joints and gives a favourable clinical outcome. The modified foot score showed a good or excellent result in 51% of the feet. Residual complaints were mostly due to problems with the soft tissues. Subjectively, an excellent or good score was achieved in 78% of the cases. After statistical analysis, except for the height of the heel and the degenerative changes in the calcaneocuboid joint, no significant difference was found in the measured variables between the operated and the contralateral side.

Patient satisfaction is an important goal in orthopaedic surgery; however, it may not always reflect the surgical result that is obtained. By means of a systematic review according to the QUOROM criteria, we investigated how often satisfaction measured by a single question was used in trials reporting on the clinical outcome of total hip arthroplasty. This review showed that in 2006, 24.4% of these trials reported on satisfaction obtained by a single question. To assess the validity of satisfaction as a single question, a randomly selected group of 106 patients were questioned at an average of 15.5 years after a total hip arthroplasty (THA; range 4.2 -29.8 years). Questioning consisted of a Likert 5 scale satisfaction question and the Harris Hip Score. Satisfaction as a single question showed to have a poor construct and content validity. Despite the fact that satisfaction may be an important outcome measure, it cannot be judged as a reflection of a good result of the surgical intervention alone when evaluated using a single question

OBJECTIVE: To gain insight into the shortage in health care capacity for patients who require immediate admission to hospital. DESIGN: Prospective, descriptive. METHOD: During the period 1 March-30 November 2001, data were collected on all patients presenting at the casualty department at the Sint Lucas Andreas Hospital in Amsterdam, the Netherlands, who had a surgical, internal medicine or neurological condition which required immediate admission and who could not be admitted due to a shortage in health care capacity. The following data were registered: date of transfer, age, gender, diagnosis, referring specialty, time of telephone call, accepting hospital and time of acceptance. During the same period, the surgery department also noted details of patients requiring immediate admission or transfer whom they turned away after presentation via the telephone by either the general practitioner or a different hospital. RESULTS: 131 patients could not be admitted, 68 men and 63 women with a mean age of 69 years. The distribution across the specialties was as follows: surgery: 63 patients (48%; mean age: 68 years); internal medicine: 48 patients (37%; 65 years); neurology: 20 patients (15%; 74 years). The most common reasons for admission were proximal femur fractures (24; 18%) and gastrointestinal disorders (27; 21%). Mean duration from making the telephone call until acceptance elsewhere was 70 min (range: 1-330) for surgery, 42 min (5-180) for internal medicine and 116 min (10-870) for neurology. The transfer of patients with proximal femur fractures (97 min) and cerebrovascular accident (129 min) took the longest. During the same period, 170 patients were refused by the department of surgery for first-time admission or transfer.

This thesis aims to evaluate the benefits and risks of two already widely implemented innovations in hip arthroplasty: minimally invasive approaches and short stems. In the first part, the amount of soft tissue damage after 5 different hip approaches is compared in a cadaver study, followed by a report of the clinical outcome of a series of patients who received a total hip arthroplasty through a minimally invasive two-incision hip approach. The second part of this thesis starts with a description of some of the challenges in hip implant related trials. The revision rates, as reported in clinical studies, of short stem total hip arthroplasty is summarized in a systematic review. The learning curve of the surgical technique of a short stem hip arthroplasty, the Collum Femoris Preserving (CFP) stem, is analysed through video analysis and pitfalls identified through direct feedback by the surgeons. The thesis is concluded with a report of the functional outcome up to two years of a randomized controlled trial comparing the short curved CFP stem to a straight and longer Zweymuller Alloclassic hip stem.