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Treating burn scar contracture remains a challenging problem for reconstructive surgeons. At present, no consensus exists on when to use what kind of technique. Therefore, a systematic review was performed on the effectiveness of the different surgical techniques after burn scar contracture release. Electronic databases were searched using a predefined search strategy. Studies evaluating the outcome of surgical techniques for the treatment of burn scar contractures were included. The methodological quality was tested and the data were summarized. One thousand six hundred fourty-nine papers were identified of which 17 met the inclusion criteria. Three papers reported on a controlled trial, 14 were cohort studies, including 10 of a pre-post operative design and 4 of a comparative design. The papers described outcomes of grafts, flaps with random or defined vascularization, and dermal substitutes. All studies had methodological shortcomings and most used inappropriate statistical methods. The current evidence on the effectiveness of reconstruction techniques for burn scar contractures was summarized. Due to the scarcity and low quality of the included studies, no definitive conclusions could be reached about the effectiveness of different techniques. Therefore, no direct implications for daily practice could be made. However, recommendations could be given for improvement of the quality of further primary research on the effectiveness of surgical treatment strategies for burn scar contracture release.

The objective of this study was to compare sick leave data obtained from questionnaires with data from company records. During a period of 12 months, questionnaires were completed monthly for 6 months and then at 9 and 12 months. The sensitivity and specificity of questionnaires for detecting an episode of sick leave were determined, using the company records as a reference standard. In addition, the duration of sick leave episodes reported in the two data sets was compared. In this analysis, company records were not assumed to be superior, and agreement was assessed with intraclass correlation coefficients (ICCs). The sensitivity of questionnaires for detecting an episode of sick leave was 55% (95% CI = 0.50-0.60) and the specificity 83% (95% CI = 0.72-0.94). The ICC for all episodes was 0.58 (95% CI = 0.47-0.67). The only satisfactory ICC (0.87; 95% CI = 0.74-0.93) was found for the questionnaires at 9 and 12 months. No large systematic differences were found between the duration of episodes reported in the two data sets. In conclusion, in our study, the sensitivity of questionnaires for detecting an episode of sick leave was very low. Furthermore, when episodes were recalled, there was little agreement on the duration of the episode between questionnaire data and data in the company records. Based on these results and considering the risk of missing questionnaires, data on sick leave gathered from company records are clearly preferable as an outcome measure in research.

Fried’s phenotype frailty criteria include three self-report questions (weight loss, exhaustion and low physical activity) and two performance-based measures (slowness (walk time) and weakness (handgrip strength)). The present study investigates whether the two performance-based criteria could be replaced by self-report questions. A cross-sectional validation study was conducted among 135 community-dwelling older people (65+) with different stages of frailty. Eleven questions related to walk time and ten questions about handgrip strength were selected. Both the self-report questions and performance-based measurements of walk time (time needed to walk 15 feet at own pace) and handgrip strength (maximum handgrip strength using a hand dynamometer) were assessed. Backward logistic regression analyses showed that four questions for walk time and two questions for handgrip strength were optimal. This indicates that it seems possible to replace the two performance-based measures by a small set of self-report questions, which can particularly be helpful in Iarge-scale research.

Although there is a lively ongoing debate on the nature and definition of frailty, researchers agree that the more frail older persons are, the higher their risk of adverse frailty outcomes is. Nevertheless, there are pre-frail and frail people who do not suffer from these adverse outcomes. This suggests that more factors play a role in the occurrence of these outcomes. Research on the potential moderating effect of resources on frailty outcomes among pre-frail and frail persons is, however, scarce. The present prospective cohort study (n=2420) investigates the moderating effects of level of education, income, availability of informal care, living situation, sense of mastery, and self-management abilities on the relation between the level of frailty and the adverse outcomes mortality, hospitalization and (I)ADL disability over a 2-year period. Results show that frail older people have increased odds for mortality and hospitalization, and a higher risk for increased disability compared to pre-frail older people. Only for the development of disability, two resources (income and living situation) had a moderating effect of the impact of frailty. However, overall the included resources had no consistent and convincing moderating effects. The results of the present study indicate (a) that the impact of the level of frailty on adverse outcomes can be generally considered as main effects, and (b) that it is not yet clear whether, and how presumed resources impact the pathway from frailty to adverse outcomes.

BackgroundCarpal tunnel syndrome (CTS) is a common disorder for which several surgical treatment options are available. However, there is no consensus on the most effective method of treatment. The object of this systematic review is to compare the efficacy of the various surgical techniques in relieving the symptoms of CTS and promoting return to work and/or activities of daily living.MethodsComputer-aided searches of Medline, EMBASE and the Cochrane Controlled Trials Register were conducted, together with reference checking. A rating system, based on the number of studies and their methodological quality and findings, was used to determine the strength of the available evidence for the efficacy of the treatment.ResultsFourteen studies were included in the review. None of the alternatives to standard open carpal tunnel release (OCTR) seems to offer better relief of symptoms. There is conflicting evidence about whether endoscopic carpal tunnel release results in earlier return to work and/or activities of daily living.ConclusionStandard OCTR is still the preferred method of treatment for CTS. It is just as effective as the alternatives, but is technically less demanding, so incurs a lower risk of complications and of added costs.