Embracing the biopsychosocial and psychosocial characteristics of our patients

I write extensively about shared-decision making and patient´preferences as part of our decision making orthopaedics. Hence I considered this Invited Paper by Quaile, Mavrogenis and Scarlat in the International Orthopaedics as truly excellent piece: Managing patients’ expectations in orthopaedics. Authors write among other things: There is a problem with patient-reported outcome measurements, PROMs, as depressive symptoms and […]

Core elements in shared decision making process

Shared decision making is becoming a fundamental part of clinical practice also in orthopaedics. This should not be a problem in our field because many different questionnaires are used in SDM and our field have decades of experience in patient rated outcome measures (PROM). Valintine et al. investigated how a certain SDM questionnaire “Shared Decision […]

Example of change of attitude

As I wrote yesterday, in some injuries and conditions, it is very hard for us surgeons to say is it better to operate or treat nonoperatively. Echalier et al. conclude in their study: This study supports open reduction and internal fixation with an anatomical plate of displaced fractures of the middle third of the clavicle […]

Change of attitude

Objective superiority between treatment options is becoming rarer in orthopaedics. This means that in numerous conditions, such as in Achilles tendon ruptures, distal radius fractures in the elderly patients and midshaft clavicle fractures, superiority of treatment options, namely operative and nonoperative, is based on patient values and preferences. Patient may not value slightly reduced risk […]

How to communicate risk?

Risk communication is crucial part of doctor-patient interaction. This is also true for field of orthopaedics and traumatology. As we move towards shared decision making in our field, research about different methods for risk communication is very relevant. Waters et al. investigated different methods for risk communication in the study “Risk Ladder, Table, or Bulleted […]

Views of orthopaedics – part 2

I continue discussing an excellent editorial published in the BJJ. Alex Trompeter writes: We are now seeing the pendulum swing in terms of treatments we select, as our understanding of the science of fracture fixation improves. Moreimportant, however, is the recognition that the patient’s own experience is the most vital outcome when measuring the success […]

Treatment outcomes and shared decision making

Key points Clinical equipoise will become more common in orthopaedics When treatment outcomes are subjective and have large heterogeneity, shared decision making should be used Clinical equipoise means a situation when there is no objective superiority between two choices. The lack of superiority may be due to complete lack of data or evidence about certain […]

Propensity scores, orthopaedics and shared decision making

This is something I posted on Twitter last October. Extended discussion can be found below the tweets Propensity score matching is often used when two cohorts of patient are compared. Aim is to have somewhat comparable groups so effect of treatment or intervention could be estimated reliably. In short, two groups of patient tread by […]