To construct and validate a simple patient related outcome measure scheme to quantify the disability caused by Dupuytren's Disease thus enabling prioritisation of treatment, allow reliable audit of surgical outcome and support future research. The Southampton Dupuytren's Scoring System (SDSS) was developed in a staged fashion according to the recommendations of Derby Outcomes Conference. item generation from questionnaire filled in by 20 patients; item reduction to create a 20-question proforma; Internal consistency (Cronbach's alpha) Test-retest (3 week interval testing on 61 patients) Field management was used to assess the user friendliness of the scoring system. Sensitivity to change Standardised response mean Construct validity: ability of the SDSS to measure what it is supposed to measure. comparing SDSS with QuickDASH (Disability of Arm, Shoulder and Hand)Aim
Methods
We performed a systematic review and meta-analysis
to compare the efficacy of intermittent mechanical compression combined
with pharmacological thromboprophylaxis, against either mechanical
compression or pharmacological prophylaxis in preventing deep-vein
thrombosis (DVT) and pulmonary embolism in patients undergoing hip
or knee replacement. A total of six randomised controlled trials,
evaluating a total of 1399 patients, were identified. In knee arthroplasty,
the rate of DVT was reduced from 18.7% with anticoagulation alone
to 3.7% with combined modalities (risk ratio (RR) 0.27, p = 0.03;
number needed to treat: seven). There was moderate, albeit non-significant,
heterogeneity (I2 = 42%). In hip replacement, there was
a non-significant reduction in DVT from 8.7% with mechanical compression
alone to 7.2% with additional pharmacological prophylaxis (RR 0.84)
and a significant reduction in DVT from 9.7% with anticoagulation
alone to 0.9% with additional mechanical compression (RR 0.17, p
<
0.001; number needed to treat: 12), with no heterogeneity (I2 =
0%). The included studies had insufficient power to demonstrate
an effect on pulmonary embolism. We conclude that the addition of intermittent mechanical leg
compression augments the efficacy of anticoagulation in preventing
DVT in patients undergoing both knee and hip replacement. Further
research on the role of combined modalities in thromboprophylaxis
in joint replacement and in other high-risk situations, such as fracture
of the hip, is warranted.
