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5. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review

Author

Elliot-Gibson, V., Bogoch, E.R., Jamal, S.A., and Beaton, D.E.

Subjects
Fractures -- Causes of, Fractures -- Care and treatment, Osteoporosis -- Risk factors, Osteoporosis -- Diagnosis, Osteoporosis -- Care and treatment, Women -- Health aspects, Health
Abstract

Byline: V. Elliot-Gibson (1), E. R. Bogoch (1,2,4,5), S. A. Jamal (3,4), D. E. Beaton (1,4) Keywords: Diagnosis; Fragility fracture; Osteoporosis; Risk factor; Treatment Abstract: Fragility fractures are a strong indicator of underlying osteoporosis (OP). With the risk of future fracture being increased 1.5- to 9.5-fold following a fragility fracture, the diagnosis and treatment of OP in men and women with fragility fractures provides the opportunity to prevent future fragility fractures. This review describes the current status of practice in investigation and diagnosis of OP in men and women with fragility fractures, the rates and types of postfracture treatment in patients with fragility fractures and OP, interventions undertaken in this population, and the barriers to OP identification and treatment. A literature search performed in Medline, Healthstar, CINAHL, EMBASE, PreMedline, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews identified 37 studies on OP diagnosis, treatment, and interventions. The studies varied in design methodology, study facilities, types of fractures, and pharmacological treatments. Some studies revealed that no patients with fragility fractures received investigation or treatment for underlying OP. Investigation of OP by bone mineral density was low: 14 of 16 studies reported investigation of less than 32% of patients. Investigation by bone mineral density resulted in high rates of OP diagnosis (35--100%), but only moderate use of calcium and vitamin D (8--62%, median 18%) and bisphosphoates (0.5--38%) in patients investigated postfracture. Studies on barriers to OP identification and treatment focused on various groups of health practitioners. Barriers included the cost of therapies, time and cost of resources for diagnosis, concerns about medications, and the lack of clarity regarding the responsibility to undertake this care. Author Affiliation: (1) Mobility Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (2) Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (3) Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (4) Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (5) St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, Ontario, M5C 1R6, Canada Article History: Registration Date: 18/05/2004 Received Date: 05/03/2004 Accepted Date: 11/05/2004 Online Date: 16/07/2004

Published
2004

7. Identifying Provisional Generic Contextual Factor Domains for Clinical Trials in Rheumatology: Results from an OMERACT Initiative

Author

Nielsen, S.M., Tugwell, P., Wit, M.P.T. de, Boers, M., Beaton, D.E., Woodworth, T.G., Escorpizo, R., Shea, B., Toupin-April, K., Guillemin, F., Strand, V., Singh, J.A., Kloppenburg, M., Furst, D.E., Wells, G.A., Smolen, J.S., Vesely, R., Boonen, A., Storgaard, H., Voshaar, M., March, L., Christensen, R., Contextual Factors Working Grp, University of Ottawa [Ottawa] (uOttawa), Department of Clinical Epidemiology and Biostatistics, VU University Medical Center [Amsterdam], Institute for Work and Health (IWH), University of Toronto-St. Michael's Hospital-Institute of Medical Sciences, University of California [Los Angeles] (UCLA), University of California, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Stanford University School of Medicine [Stanford], Stanford University [Stanford], Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Maastricht University Medical Center (MUMC), Maastricht University [Maastricht], Institute of Bone & Joint Research, Royal North Shore Hospital (RNSH)-The University of Sydney, The Parker Institute, University of Copenhagen = Københavns Universitet (KU), Interne Geneeskunde, MUMC+: MA Reumatologie (9), RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, Ethics, Law & Medical humanities, APH - Methodology, Epidemiology and Data Science, University of Ottawa [Ottawa], Stanford School of Medicine [Stanford], Stanford Medicine, Stanford University-Stanford University, Maastricht University Medical Centre (MUMC), and Psychology, Health & Technology

Subjects
RHEUMATIC DISEASES, medicine.medical_specialty, Consensus, Immunology, Applied psychology, Session (web analytics), 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Risk Factors, Internal medicine, Outcome Assessment, Health Care, Humans, Immunology and Allergy, Medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, 030203 arthritis & rheumatology, OUTCOMES, business.industry, OMERACT, Special Interest Group, Prognosis, n/a OA procedure, Clinical trial, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, CLINICAL TRIALS, Healthcare system
Abstract

Objective.The Contextual Factors Working Group aims to provide guidance on addressing contextual factors in rheumatology trials within OMERACT.Methods.During the Special Interest Group session at OMERACT 2018, preliminary results were presented from a case scenario survey and semistructured interviews, including contextual factors mentioned in these. A group-based exercise sought to identify and rank important generic contextual factors.Results.A total of 79 candidate factors were listed. Across the 3 groups, gender/sex, comorbidities, and the healthcare system were ranked as most important.Conclusion.The identified important contextual factor domains may be considered a provisional list pending further research.

Published
2019
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8. Patients' experience of shoulder disorders

Author

Page, M.J. (Matthew J.), O'Connor, D.A. (Denise), Malek, M. (Mary), Haas, R. (Romi), Beaton, D.E. (Dorcas E.), Huang, H. (Hsiaomin), Ramiro, S. (Sofia), Richards, P. (Pamela), Voshaar, M.J.H. (Marieke), Shea, B. (Beverley), Verhagen, A.P. (Arianne), Whittle, S.L. (Samuel L), Windt, D.A.W.M. (Daniëlle) van der, Gagnier, J.J. (Joel J), Buchbinder, R. (Rachelle), Page, M.J. (Matthew J.), O'Connor, D.A. (Denise), Malek, M. (Mary), Haas, R. (Romi), Beaton, D.E. (Dorcas E.), Huang, H. (Hsiaomin), Ramiro, S. (Sofia), Richards, P. (Pamela), Voshaar, M.J.H. (Marieke), Shea, B. (Beverley), Verhagen, A.P. (Arianne), Whittle, S.L. (Samuel L), Windt, D.A.W.M. (Daniëlle) van der, Gagnier, J.J. (Joel J), and Buchbinder, R. (Rachelle)

Abstract

Objectives: To describe the experiences (including symptoms and perceived impacts on daily living) of people with a shoulder disorder. Methods: Systematic review of qualitative studies. We searched for eligible qualitative studies indexed in Ovid MEDLINE, Ovid Embase, CINAHL (EBSCO), SportDiscus (EBSCO) and Ovid PsycINFO up until November 2017. Two authors independently screened studies for inclusion, appraised their methodological quality using the Critical Appraisal Skills Programme checklist, used thematic synthesis methods to generate themes describing the experiences reported by participants and assessed the confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from

Published
2019
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11. Multiple simultaneous fractures are associated with higher all-cause mortality: results from a province-wide fracture liaison service.

Author

Sujic, R., Luo, J., Beaton, D.E., Bogoch, E.R., Sale, J.E.M., Jaglal, S., Jain, R., and Mamdani, M.

Subjects
AGE distribution, CONFIDENCE intervals, CAUSES of death, BONE fractures, HIP joint injuries, MEDICAL records, MEDICAL screening, RISK assessment, HUMERUS injuries, PROPORTIONAL hazards models, RETROSPECTIVE studies, DESCRIPTIVE statistics, KAPLAN-Meier estimator, ACQUISITION of data methodology
Abstract

Summary: Mortality rates in our fracture liaison service ranged from 2.7% at year 1 to 14.8% at year 5 post-screening. Presentation with multiple simultaneous fractures at screening was associated with higher risk of death. This finding indicates the need for increased focus on this high-risk group. Purpose: To examine all-cause mortality rates in a provincial fracture liaison service (FLS) and the association between the index fracture type, particularly multiple simultaneous fractures, and the risk of death at follow-up. Methods: This cohort study includes fragility fracture patients aged 50+, enrolled in a provincial FLS in Ontario, Canada, between 2007 and 2010. All-cause mortality was assessed using administrative data. Multivariable Cox proportional hazards model was used to examine the risk of death 5 years after screening. Results: Crude mortality rates for 6543 fragility fracture patients were 2.7% at year 1, 5.6% at year 2, and 14.8% at year 5 after screening. After adjusting for age and sex, and relative to distal radius fracture, patients with multiple (simultaneous) fractures at screening had a higher risk of dying (HR = 1.8, 95%CI 1.3–2.4), followed by those with a hip fracture (HR = 1.5, 95%CI 1.3–1.8), a proximal humerus fracture (HR = 1.4, 95%CI 1.2–1.7), and other single fractures (HR = 1.4, 95%CI 1.1–1.7). Having an index ankle fracture was not associated with the risk of death over a distal radius fracture. As compared to the 50–65 age group, patients 66 years and older had a higher risk of death (for 66–70 age group: HR = 2.5, 95%CI 1.9–3.3; for 71–80: HR = 4.3, 95%CI 3.5–5.4; and for 81+: HR = 10.6, 95%CI 8.7–13.0). Females had a lower risk of death (HR = 0.5, 95%CI 0.5–0.6) than males. Conclusions: Presenting with multiple fractures was an indicator of higher risk of death relative to a distal radius fracture. This finding indicates the need for increased focus on this high-risk group. [ABSTRACT FROM AUTHOR]

Published
2020
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12. A preliminary core domain set for clinical trials of shoulder disorders: A report from the OMERACT 2016 shoulder core outcome set special interest group

Author

Buchbinder, R. (Rachelle), Page, M.J. (Matthew J.), Huang, H. (Hsiaomin), Verhagen, A.P. (Arianne), Beaton, D.E. (Dorcas E.), Kopkow, C. (Christian), Lenza, M. (Mario), Jain, N.B. (Nitin B.), Richards, B. (Bethan), Richards, P. (Pamela), Voshaar, M. (Marieke), Windt, D.A.W.M. (Daniëlle) van der, Gagnier, J.J. (Joel J.), Buchbinder, R. (Rachelle), Page, M.J. (Matthew J.), Huang, H. (Hsiaomin), Verhagen, A.P. (Arianne), Beaton, D.E. (Dorcas E.), Kopkow, C. (Christian), Lenza, M. (Mario), Jain, N.B. (Nitin B.), Richards, B. (Bethan), Richards, P. (Pamela), Voshaar, M. (Marieke), Windt, D.A.W.M. (Daniëlle) van der, and Gagnier, J.J. (Joel J.)

Abstract

Objective. The Outcome Measures in Rheumatology (OMERACT) Shoulder Core Outcome Set Special Interest Group (SIG) was established to develop a core outcome set (COS) for clinical trials of shoulder disorders. Methods. In preparation for OMERACT 2016, we systematically examined all outcome domains and measurement instruments reported in 409 randomized trials of interventions for shoulder disorders published between 1954 and 2015. Informed by these data, we conducted an international Delphi consensus study including shoulder trial experts, clinicians, and patients to identify key domains that should be included in a shoulder disorder COS. Findings were discussed at a stakeholder premeeting of OMERACT. At OMERACT 2016, we sought consensus on a preliminary core domain set and input into next steps. Results. There were 13 and 15 participants at the premeeting and the OMERACT 2016 SIG meeting, respectively (9 attended both meetings). Consensus was reached on a preliminary core domain set consisting of an inner core of 4 domains: pain, physical function/activity, global perceived effect, and adverse events including death. A middle core consisted of 3 domains: emotional well-being, sleep, and participation (recreation and work). An outer core of research required to inform the final COS was also formulated. Conclusion. Our next steps are to (1) analyze whether participation (recreation and work) should be in the inner core, (2) conduct a third Delphi round to finalize definitions and wording of domains and reach final endorsement for the domains, and (3) determine which instruments fulfill the OMERACT criteria for measuring each domain.

Published
2017
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14. Core domain and outcome measurement sets for shoulder pain trials are needed: Systematic review of physical therapy trials

Author

Page, M.J. (Matthew J.), McKenzie, J.E. (Joanne E.), Green, S.E. (Sally E.), Beaton, D.E. (Dorcas E.), Jain, N.B. (Nitin B.), Lenza, M. (Mario), Verhagen, A.P. (Arianne), Surace, S. (Stephen), Deitch, J. (Jessica), Buchbinder, R. (Rachelle), Page, M.J. (Matthew J.), McKenzie, J.E. (Joanne E.), Green, S.E. (Sally E.), Beaton, D.E. (Dorcas E.), Jain, N.B. (Nitin B.), Lenza, M. (Mario), Verhagen, A.P. (Arianne), Surace, S. (Stephen), Deitch, J. (Jessica), and Buchbinder, R. (Rachelle)

Abstract

Objectives To explore the outcome domains and measurement instruments reported in published randomized controlled trials of physical therapy interventions for shoulder pain (rotator cuff disease, adhesive capsulitis, or nonspecific shoulder pain). Study Design and Setting We included trials comparing physical therapy to any other intervention for shoulder pain, indexed up to March 2015 in CENTRAL, MEDLINE, EMBASE, or CINAHL Plus. Two authors independently selected trials for inclusion and extracted information on the domains and measurement instruments reported. Results We included 171 trials. Most trials measured pain (87%), function (72%), and range of movement (67%), whereas adverse events, global assessment of treatment success, strength, and he

Published
2015
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16. Assessment of health outcomes

Author

Beaton, D.E., Boers, M., Tugwell, P.S., Epidemiology and Data Science, and CCA - Quality of life

Published
2009

23. Steindler and pectoralis major flexorplasty: A comparative analysis

Author

Beaton, D.E., Dumont, A., Mackay, M.B., and Richards, R.R.

Abstract

Previously published studies on transfers to restore elbow flexion have rarely compared the outcomes among different techniques. We found no comparison between the Steindler procedure and pectoralis major tendon transfer. This study compared functional outcomes after these two types of elbow flexorplasty performed in conjunction with shoulder arthrodesis for patients with brachial plexus injuries. The same examiner assessed 14 patients who underwent shoulder fusion and elbow flexorplasty. Five had a pectoralis major tendon transfer, and nine underwent a modified Steindler procedure. All patients had brachial plexus lesions that were irreparable or had not responded to neurolysis, repair, or grafting. Average follow-up time was 60 months (range, 12 months-10 years). All patients completed a questionnaire (pain, function) and underwent an objective assessment of range of motion, isometric strength, isotonic power, grip, and pinch strength. The BTE Work Simular (Baltimore Therapeutic Equipment, Hanover, MD) was used for muscle strength testing. Improvement was noted in daily activities including dressing and bilateral activties and was reflected in a significant improvement over preoperative function. No differences (at p=.05 level of significance) were found in objective tests between the pectoralis major transfer and the Steindler groups. In the patients requiring stabilization of the shoulder and flexor-plasty, the pectoralis major tendon transfer was at least equivalent to the modified Steindler flexorplasty in terms of range of motion, strength, and subjective measures.

Published
1995
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24. Grip strength testing using the BTE work simulator and the jamar dynamometer: A comparative study

Author

Beaton, D.E., O'Driscoll, S.W., and Richards, R.R.

Abstract

This study compared the results obtained from testing grip strength using the hydraulic Jamar dynamometer and the BTE Work Simulator. The grip strength of 14 adults was assessed with the Jamar at 90^o elbow flexion, Jamar at 45^o elbow flexion, and the BTE using the manufacturers recommended position. Greater strength measurements were generated with the elbow at 90^o rather than 45^o on the Jamar. The Jamar measurements at 90^o of elbow flexion were not significantly different from the BTE work simulator values. Intraclass correlation coefficients between the Jamar at 90^o and the BTE work simulator values were excellent. This study demonstrated that the results obtained from the BTE work simulator and the Jamar dynamometer are comparable. These findings validate the use of the BTE work simulator for grip strength testing.

Published
1995
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