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Article ; Online: Long-term outcomes after terminalization for acute fingertip injuries.

Smith, Mathew B / Stirling, Paul H C / McEachan, Jane E

The Journal of hand surgery, European volume

2024 , Page(s) 17531934241247276

Abstract: The primary aim of this study was to report outcomes after fingertip terminalization in 90 patients over a 19-year period. We report excellent functional outcomes and satisfaction, but a 33% incidence of neuropathic pain. ...

Abstract	The primary aim of this study was to report outcomes after fingertip terminalization in 90 patients over a 19-year period. We report excellent functional outcomes and satisfaction, but a 33% incidence of neuropathic pain.
Language	English
Publishing date	2024-04-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/17531934241247276
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Article: Outcomes of Surgical Treatment of Vaughan-Jackson Syndrome

Mcintyre, Joshua L. / Stirling, Paul H.C. / Mceachan, Jane

Journal of Wrist Surgery

2024

Abstract: Background: Vaughan-Jackson syndrome (VJS) is the attritional rupture of the extensor tendons secondary to arthritis or inflammation affecting the distal radioulnar joint. The surgical outcomes following Darrach's procedure and tendon transfers are not ... ...

Abstract	Background: Vaughan-Jackson syndrome (VJS) is the attritional rupture of the extensor tendons secondary to arthritis or inflammation affecting the distal radioulnar joint. The surgical outcomes following Darrach's procedure and tendon transfers are not well described. The primary aim of this study was to report patient-reported functional outcome measures after surgery for VJS. Secondary aims were to report health-related quality-of-life scores, patient satisfaction, and complications Methods: A single-center retrospective study was performed to identify patients who underwent surgical intervention for the management of VJS. Patient-reported outcomes were measured using the Patient-Rated Wrist and Hand Evaluation (PRWHE), Quick version of the Disability of the Arm, Shoulder, and Hand (QuickDASH), EuroQoL 5-dimensions 5-Likert (EQ-5D-5L), and calculation of the Net Promoter Score (NPS). Results: We report postoperative patient-reported functional outcome measures for 12 cases of VJS treated with distal ulna excision and extensor tendon transfer. The mean age was 69 years (range: 45–87 years; standard deviation [SD]: 14.1), and eight patients were females. Five patients had rheumatoid arthritis, and there was one case each of seronegative polyarthritis, ankylosing spondylitis, and CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.) syndrome; the rest of the patients had osteoarthritis. At a mean of 53 months of follow-up, the mean PRWHE score was 34.5 (SD: 17.9), the mean QuickDASH score was 28.2 (SD: 18.6), and the mean EQ-5D-5L score was 0.71 (SD: 0.203). Ten patients were satisfied and the NPS was 42. Postoperatively eight patients had pain scores reported as none or mild, three as moderate, and one as severe. Two patients required further operations, both undergoing total wrist arthrodesis. Conclusion: Although a degree of functional deficit persists after Darrach's procedure and tendon transfer for treatment of VJS, there are also high levels of patient satisfaction, a good NPS, and a low rate of operative reintervention. Level IV: evidence.
Keywords	Vaughan-Jackson ; distal radioulnar joint ; tendon rupture ; tendon transfer
Language	English
Publishing date	2024-01-16
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2678060-4
ISSN	2163-3924 ; 2163-3916 ; 2163-3924
ISSN (online)	2163-3924
ISSN	2163-3916 ; 2163-3924
DOI	10.1055/s-0043-1775994
Database	Thieme publisher's database

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Article: Modified Scoring of the QuickDASH Can Achieve Previously-unattained Interval-level Measurement in Dupuytren Disease and Carpal Tunnel Syndrome.

Stirling, Paul H C / McEachan, Jane E / Rodrigues, Jeremy N / Geoghegan, Luke / Harrison, Conrad J

Plastic and reconstructive surgery. Global open

2024 Volume 12, Issue 2, Page(s) e5372

Abstract: Background: Rasch measurement theory can be used to identify scales within questionnaires and to map responses to more precise continuous scales. The aim of this article was to use RMT to refine the scoring of the QuickDASH in patients with Dupuytren ... ...

Abstract	Background: Rasch measurement theory can be used to identify scales within questionnaires and to map responses to more precise continuous scales. The aim of this article was to use RMT to refine the scoring of the QuickDASH in patients with Dupuytren disease and carpal tunnel syndrome (CTS). Methods: Data were collected between 2013 and 2019 from a single center in the UK. Preoperative QuickDASH responses from patients diagnosed with Dupuytren disease and CTS were used. RMT was used to reduce the number of items in the QuickDASH and examine the reliability and validity of each subscale. Results: The preoperative QuickDASH responses of 750 patients with Dupuytren disease and 1916 patients with CTS were used. The median age of participants was 61 years, and 46% were men. Exploratory factor analysis suggested two distinct subscales within the QuickDASH: task items 1-6 and symptom items 9-11. These items were fitted to the Rasch model, and disordered response thresholds were collapsed. In Dupuytren disease, the two worst responses or each item were disordered. After collapsing these options, good Rasch model fit was demonstrated. CTS responses fitted without modification. Item targeting was more appropriate for CTS than Dupuytren disease. Conclusions: This study proposes a modification to the scoring system for the QuickDASH that provides high-quality, continuous, and condition-specific scales for the QuickDASH. The identification of distinct subscales within the QuickDASH can be used to identify distinct improvements in hand function and/or symptoms in previous, current, and future work.
Language	English
Publishing date	2024-02-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000005372
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Article ; Online: Should 6- or 12-month outcomes be used after carpal tunnel decompression?

Stirling, Paul H C / Yapp, Liam Z / McEachan, Jane E

The Journal of hand surgery, European volume

2023 Volume 49, Issue 4, Page(s) 504–506

Abstract: Preoperative and 6- and 12-month postoperative Quick version of the Disablities of the Arm, Shoulder and Hand (QuickDASH) scores for 336 patients undergoing carpal tunnel decompression were 43.2, 18.2 and 15.9, respectively. There was no significant ... ...

Abstract	Preoperative and 6- and 12-month postoperative Quick version of the Disablities of the Arm, Shoulder and Hand (QuickDASH) scores for 336 patients undergoing carpal tunnel decompression were 43.2, 18.2 and 15.9, respectively. There was no significant improvement in QuickDASH between 6 and 12 months. Postoperative scores should not be collected at both end points.
MeSH term(s)	Humans ; Carpal Tunnel Syndrome/surgery ; Hand/surgery ; Shoulder ; Decompression
Language	English
Publishing date	2023-11-17
Publishing country	England
Document type	Letter
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/17531934231210067
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Article ; Online: In vitro testing of flexor tendon repair models: variability in the current literature.

Stirling, Paul H C / McEachan, Jane E

The Journal of hand surgery, European volume

2022 Volume 48, Issue 2, Page(s) 162–168

MeSH term(s)	Humans ; Tendons/surgery ; Tendon Injuries/surgery ; In Vitro Techniques ; Suture Techniques
Language	English
Publishing date	2022-11-25
Publishing country	England
Document type	Editorial
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/17531934221139068
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Article ; Online: The effect of diabetes mellitus on the outcome of surgery for cubital tunnel syndrome.

Stirling, Paul H C / Harrison, Simon J / McEachan, Jane E

The Journal of hand surgery, European volume

2022 Volume 48, Issue 4, Page(s) 316–320

Abstract: The aims of this study were to investigate the effect of diabetes mellitus (DM) on patient-reported outcome measures (PROMs) and satisfaction after surgery for cubital tunnel syndrome (CuTS). Pre- and 1-year postoperative QuickDASH, normal hand, and ... ...

Abstract	The aims of this study were to investigate the effect of diabetes mellitus (DM) on patient-reported outcome measures (PROMs) and satisfaction after surgery for cubital tunnel syndrome (CuTS). Pre- and 1-year postoperative QuickDASH, normal hand, and satisfaction scores were prospectively collected from 107 patients over a 6-year period. Patients without DM reported a significant QuickDASH improvement after surgery (preoperative 34.1 versus postoperative 20.5;
MeSH term(s)	Humans ; Cubital Tunnel Syndrome/surgery ; Diabetes Mellitus/surgery ; Patient Satisfaction ; Decompression, Surgical ; Treatment Outcome
Language	English
Publishing date	2022-12-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/17531934221143500
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Article ; Online: Self-Reported Disability Following Surgery for Dupuytren Contracture in Diabetic and Non-Diabetic Patients.

Stirling, Paul H C / Duckworth, Andrew D / McEACHAN, Jane E

The journal of hand surgery Asian-Pacific volume

2022 Volume 27, Issue 3, Page(s) 453–458

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Diabetes Mellitus ; Dupuytren Contracture/surgery ; Hand ; Humans ; Patient Satisfaction ; Self Report
Language	English
Publishing date	2022-07-09
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	2848651-1
ISSN	2424-8363 ; 2424-8355
ISSN (online)	2424-8363
ISSN	2424-8355
DOI	10.1142/S2424835522500473
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Article ; Online: Improving the structural validity of the QuickDASH questionnaire: Exploratory factor analysis and structural equation modelling in 1798 patients with carpal tunnel syndrome.

Stirling, Paul H C / McEachan, Jane E / Rodrigues, Jeremy N / Harrison, Conrad J

Journal of hand therapy : official journal of the American Society of Hand Therapists

2023 Volume 36, Issue 3, Page(s) 523–527

Abstract: Study design: Retrospective cohort.: Background: The QuickDASH is a commonly used questionnaire for the assessment of carpal tunnel patients, although it is unclear whether the questionnaire has suitable structural validity PURPOSE: This study aimed ... ...

Abstract	Study design: Retrospective cohort. Background: The QuickDASH is a commonly used questionnaire for the assessment of carpal tunnel patients, although it is unclear whether the questionnaire has suitable structural validity PURPOSE: This study aimed to evaluate the structural validity of the QuickDASH patient-reported outcome measure (PROM), when used in CTS, through exploratory factor analysis (EFA) and structural equation modelling (SEM). Methods: Between 2013 and 2019, we recorded preoperative QuickDASH scores of 1916 patients undergoing carpal tunnel decompressions at a single unit. One hundred and eighteen patients with incomplete datasets were excluded leaving a final study group of 1798 patients with complete data. EFA was undertaken using the R statistical computing environment. We then conducted SEM in a random sample of 200 patients. Model fit was assessed using the chi-square (χ Results: EFA revealed a 2-factor model: items 1-6 represented the first factor ("function") and items 9-11 measured a different factor ("symptoms"). SEM demonstrated excellent fit (χ Conclusions: This study demonstrates that the QuickDASH PROM measures 2 distinct factors in CTS. This is comparable with the findings of a previous EFA that assessed the full-length Disabilities of the Arm, Shoulder and Hand PROM in patients with Dupuytren's disease.
Language	English
Publishing date	2023-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	639284-2
ISSN	1545-004X ; 0894-1130
ISSN (online)	1545-004X
ISSN	0894-1130
DOI	10.1016/j.jht.2022.09.004
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Article: Total Hip Arthroplasty When Utilised in Young Adults Is a Cost-Effective Procedure: A 10-Year and Lifetime Cost-Utility Analysis.

Stirling, Paul H C / Makaram, Navnit S / Clement, Nick D / Macdonald, Deborah / Macpherson, Gavin J

Cureus

2022 Volume 14, Issue 2, Page(s) e22651

Abstract: Purpose The primary aim of this study was to determine the cost-effectiveness of total hip arthroplasty (THA) in patients aged 25 years and under by calculating the cost per quality-adjusted life year (QALY) gained at 10 years post-operatively, and over ... ...

Abstract	Purpose The primary aim of this study was to determine the cost-effectiveness of total hip arthroplasty (THA) in patients aged 25 years and under by calculating the cost per quality-adjusted life year (QALY) gained at 10 years post-operatively, and over the course of a lifetime. Secondary aims were to describe the change in health-related quality of life (HRQoL), Oxford hip score (OHS), and satisfaction in these patients. Methods From 2000 to 2016, 33 patients undergoing THA aged 25 and under had pre-operative and one-year post-operative EuroQol five-dimensions (EQ-5D) scores and OHS recorded prospectively. Post-operative change in EQ-5D allowed calculation of a health-utility score, which, when combined with life expectancy, gave total QALYs gained. Results The mean age was 20 years (range 13.3-24.9), with 23 females (72.7%). Mean number of QALYs gained was 21.1 (95% CI 14.1-28.2). Total lifetime cost per patient was £14641, giving a mean cost per QALY of £4183 at 10 years post-operatively, and £694 over the total remaining lifetime. Discounting total QALYs gained at a rate of 3.5% and 5% per remaining year of life expectancy increased the mean cost per QALY to £1652 and £2187, respectively. Mean pre- and post-operative EQ-5D index were 0.27 (SD 0.27) and 0.63 (SD 0.29), respectively (p=0.0001). Mean pre-operative and post-operative OHS was 37.5 (SD 7.9) and 19.7 (SD 6.94), respectively (p<0.00001). Conclusion THA remains a cost-effective intervention for patients aged 25 years and under. It is also associated with significant improvement in HRQoL, OHS, and high levels of patient satisfaction in this unique patient group.
Language	English
Publishing date	2022-02-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.22651
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Article ; Online: Virtual management of clinically suspected scaphoid fractures.

Stirling, Paul H C / Simpson, Cameron J / Ring, David / Duckworth, Andrew D / McEachan, Jane E

The bone & joint journal

2022 Volume 104-B, Issue 6, Page(s) 709–714

Abstract: Aims: The aim of this study was to describe the introduction of a virtual pathway for the management of patients with a suspected fracture of the scaphoid, and to report patient-reported outcome measures (PROMs) and satisfaction following treatment ... ...

Abstract	Aims: The aim of this study was to describe the introduction of a virtual pathway for the management of patients with a suspected fracture of the scaphoid, and to report patient-reported outcome measures (PROMs) and satisfaction following treatment using this service. Methods: All adult patients who presented with a clinically suspected scaphoid fracture that was not visible on radiographs at the time of presentation during a one-year period were eligible for inclusion in the pathway. Demographic details, findings on examination, and routine four-view radiographs at the time of presentation were collected. All radiographs were reviewed virtually by a single consultant hand surgeon, with patient-initiated follow-up on request. PROMs were assessed at a minimum of one year after presentation and included the abbreviated version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), the EuroQol five-dimension five-level health questionnaire (EQ-5D-5L), the Net Promoter Score (NPS), and return to work. Results: A total of 221 patients were referred to the virtual pathway. Their mean age was 41 years (range 16 to 87) and there were 99 male patients (45%). A total of 189 patients (86%) were discharged with advice and 19 (9%) were recalled for clinical review: seven with an undisplaced scaphoid fracture, six with another fracture of the hand or wrist, two with a scapholunate ligament injury, and four in whom no abnormality was detected. A total of 13 patients (6%) initiated follow-up with the hand service: no fracture or ligament injury was identified in this group. PROMs were available for 179 patients (81%) at a mean follow-up of 19 months (range 13 to 33). The median QuickDASH score was 2.3 (interquartile range (IQR) 0 to 15.9), the median EQ-5D-5L was 0.85 (IQR 0.73 to 1.00), the NPS was 76, and 173 patients (97%) were satisfied with their treatment. There were no documented cases of symptomatic nonunion one year following injury. Conclusion: We describe the introduction of a virtual pathway for the management of patients with a suspected scaphoid fracture. We found high levels of patient satisfaction, excellent PROMs, and no detrimental effects in the vast majority of cases. Cite this article:
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Fractures, Bone/diagnostic imaging ; Fractures, Bone/surgery ; Hand Injuries ; Humans ; Male ; Middle Aged ; Radiography ; Scaphoid Bone/diagnostic imaging ; Scaphoid Bone/injuries ; Scaphoid Bone/surgery ; Wrist Injuries ; Young Adult
Language	English
Publishing date	2022-05-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2697156-2
ISSN	2049-4408 ; 2049-4394
ISSN (online)	2049-4408
ISSN	2049-4394
DOI	10.1302/0301-620X.104B6.BJJ-2021-1464.R2
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