human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and purpose The Artelon CMC spacer is design ed for surgical treatment of osteoarthritis ( OA ) in the carpometacarpal joint of the thumb ( CMC-I ) . Good results using this degradable device were previously presented in a pilot study . We now present results from a larger r and omized , controlled , multicenter study . Patients and methods 109 patients ( 94 females ) with a mean age of 60 ( 42–83 ) years , suffering from painful CMC OA , were included in the study at 7 centers in Sweden . The patients were r and omized to Artelon CMC spacer ( test , n = 72 ) or tendon arthroplasty ( control , n = 37 ) at a ratio of 2:1 . Perceived pain was recorded on a visual analog scale ( VAS ) before treatment and after 3 , 6 , and 12 months , when measuring maximal tripod pinch strength ( primary outcome measure ) . In addition , range of motion , radiographic findings , and functional testing were recorded pre- and postoperatively . Results Swelling and pain were more common in the test group and 6 implants were removed because of such symptoms . 5 of these patients did not receive antibiotics preoperatively according to the study protocol . In a per- protocol analysis , i.e. patients without signs of concomitant OA in the scaphoid-trapezium-trapezoid ( STT ) joint and those in the test group who received antibiotics , the mean difference in tripod pinch strength increase , adjusted for baseline , was 1.4 kg in favor of the test group ( not statistically significant ) . Statistically significant pain relief was achieved in both groups , with perceived pain gradually decreasing during the follow-up period . In the intention-to-treat analysis but not in the per- protocol analysis , significantly better pain relief ( VAS ) was obtained in the control group . Patient-perceived disability evaluated by the DASH question naire improved in both groups . Interpretation The Artelon CMC spacer did not show superior results compared to tendon interposition arthroplasty . Proper use of preoperative antibiotics and a thorough patient selection appear to be important for the results OBJECTIVE : To compare the functional results of carpectomy and four‐corner fusion surgical procedures for treating osteoarthrosis following carpal trauma . METHODS : In this prospect i ve r and omized study , 20 patients underwent proximal row carpectomy or four‐corner fusion to treat wrist arthritis and their functional results were compared . The midcarpal joint was free of lesions in all patients . RESULTS : Both proximal row carpectomy and four‐corner fusion  reduced the pain . All patients had a decreased range of motion after surgery . The differences between groups were not statistically significant . CONCLUSIONS : Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non‐union advanced collapse ( SLAC/SNAC ) wrist without degenerative changes in the midcarpal joint This prospect i ve study compared the outcome --subjective , objective and radiographic -- of two surgical techniques for treating basal joint arthritis of the thumb : a " simple " trapeziectomy ( group I ) and a ligament reconstruction/tendon ( group II ) interposition technique . There were respectively 22 patients in group I and 34 in group II , all women with primary osteoarthritis . Both techniques gave favourable results and there were no significant differences for pain relief , patient satisfaction , mobility , DASH-score , key pinch force and gripping force . However in group II , the trapezial height was better preserved indicating that the proximal migration of the thumb was prevented or limited . There was also a significant correlation between the remaining trapezial space and key pinch force Background Assessment s of change in subjective patient reported outcomes such as health-related quality of life ( HRQoL ) are a key component of many clinical and research evaluations . However , conventional longitudinal evaluation of change may not agree with patient perceived change if patients ' underst and ing of the subjective construct under evaluation changes over time ( response shift ) or if patients ' have inaccurate re collection ( recall bias ) . This study examined whether older adults ' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay . It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced . Methods A prospect i ve longitudinal cohort design nested within a larger r and omised controlled trial was implemented . 103 hospitalised older adults participated in this investigation at a tertiary hospital facility . The  EQ-5D utility and Visual Analogue Scale ( VAS ) scores  were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable ( within three days of admission ) then again immediately prior to discharge . Three methods of change score calculation were used ( conventional change , patient perceived change and patient perceived change adjusted for recall bias ) . Agreement was primarily investigated using intraclass correlation coefficients ( ICC ) and limits of agreement . Results Overall 101 ( 98 % ) participants completed both admission and discharge assessment s. The mean ( SD ) age was 73.3 ( 11.2 ) . The median ( IQR ) length of stay was 38 ( 20 - 60 ) days . For agreement between conventional longitudinal change and patient perceived change : ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively . For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias : ICCs were 0.98 and 0.90 respectively . Discrepancy between conventional longitudinal change and patient perceived change was considered clinical ly meaningful for 84 ( 83.2 % ) of participants , after adjusting for recall bias this reduced to 8 ( 7.9 % ) . Conclusions Agreement between conventional change and patient perceived change was not strong . A large proportion of this disagreement could be attributed to recall bias . To overcome the invalidating effect of response shift ( on conventional change ) and recall bias ( on patient perceived change ) a method of adjusting patient perceived change for recall bias has been described We r and omly selected 39 patients undergoing excision of the trapezium for osteoarthritis of the first carpometacarpal joint into two groups , with mobilisation either at one or at four weeks after operation . The patients were review ed at a median of six months ( 6 to 8) . The clinical details , the severity of the disease and the preoperative clinical measurements of both groups were similar . Excision of the trapezium result ed in significant improvement in objective and subjective function . Comparison of the outcomes of the two groups showed no differences except that patients found early mobilisation significantly more convenient . Although there was no significant difference in the range of movement between the groups , there was a small loss of movement at the metacarpophalangeal joint in the late mobilisation group . Our findings show that simple excision of the trapezium is an effective procedure for patients with carpometacarpal osteoarthritis of the thumb and that prolonged splintage is neither necessary nor desirable Background Clinical practice and clinical research has made a concerted effort to move beyond the use of clinical indicators alone and embrace patient focused care through the use of patient reported outcomes such as health-related quality of life . However , unless patients give consistent consideration to the health states that give meaning to measurement scales used to evaluate these constructs , longitudinal comparison of these measures may be invalid . This study aim ed to investigate whether patients give consideration to a st and ard health state rating scale ( EQ-VAS )  and whether consideration of good and poor health state descriptors immediately changes their self-report . Methods A r and omised crossover trial was implemented amongst hospitalised older adults ( n = 151 ) . Patients were asked to consider descriptions of extremely good ( Description-A ) and poor ( Description-B ) health states . The EQ-VAS  was administered as a self-report at baseline , after the first descriptors ( A or B ) , then again after the remaining descriptors ( B or A respectively ) . At baseline patients were also asked if they had considered either EQ-VAS anchors . Results Overall 106/151 ( 70 % ) participants changed their self-evaluation by ≥5 points on the 100 point VAS , with a mean ( SD ) change of + 4.5 ( 12 ) points ( p < 0.001 ) . A total of 74/151 ( 49 % ) participants did not consider the best health VAS anchor , of the 77 who did 59 ( 77 % ) thought the good health descriptors were more extreme ( better ) then they had previously considered . Similarly 85/151 ( 66 % ) participants did not consider the worst health anchor of the 66 who did 63 ( 95 % ) thought the poor health descriptors were more extreme ( worse ) then they had previously considered . Conclusions Health state self-reports may not be well considered . An immediate significant shift in response can be elicited by exposure to a mere description of an extreme health state despite no actual change in underlying health state occurring . Caution should be exercised in research and clinical setting s when interpreting subjective patient reported outcomes that are dependent on brief anchors for meaning . Trial Registration Australian and New Zeal and Clinical Trials Registry ( # ACTRN12607000606482 ) Background Expectations held by patients and health professionals may affect treatment choices and participation ( by both patients and health professionals ) in therapeutic interventions in contemporary patient-centered healthcare environments . If patients in rehabilitation setting s overestimate their discharge health-related quality of life , they may become despondent as their progress falls short of their expectations . On the other h and , underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit . There is a scarcity of empirical evidence evaluating whether patients ’ expectations of future health states are accurate . The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life . Methods A prospect i ve longitudinal cohort investigation of agreement between patients ’ anticipated discharge health-related quality of life ( as reported on the EQ-5D instrument at admission to a rehabilitation unit ) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken . The  mini-mental state examination  was used as an indicator of patients ’ cognitive ability . Results Overall , 232(85 % ) patients had all assessment data completed and were included in analysis . Kappa scores ranged from 0.42 - 0.68 across the five EQ-5D domains and two patient cognition groups . The percentage of exact correct matches within each domain ranged from 69 % to 85 % across domains and cognition groups . Overall 40 % of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses . Conclusions Patients admitted for subacute in-hospital rehabilitation were able to anticipate their discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy . This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury . Accurate patient expectations of the impact of treatment ( or disease progression ) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved Objective : To evaluate the responsiveness of patient reported outcomes ( PROs ) , including fatigue , sleep , activity limitation , and quality of life , in patients with rheumatoid arthritis ( RA ) . Methods : Data were considered from a r and omised controlled trial comparing  abatacept ( n = 258 )  with placebo ( n = 133 ) on a background of DMARD treatment in RA patients who were inadequate responders to anti-TNF therapy ( ATTAIN study ) . PROs assessed included SF-36 , activity limitation , fatigue , and sleep . For each outcome the treatment difference , relative per cent improvement , st and ardised response mean ( SRM ) , and relative efficiency for assessing an outcome ’s ability to detect a treatment effect relative to tender joint count ( TJC ) were calculated . A relative efficiency > 1 suggests a measure that is more efficient than TJC in detecting treatment effect . Results : Moderate to large SRMs ( ⩾0.6 ) were observed for the PRO measures . In particular , SRMs ( 95 % confidence interval ) were : physician global , 0.72 ( 0.51 to 0.94 ) ; HAQ , 0.63 ( 0.42 to 0.85 ) ; SF-36 physical component score , 0.62 ( 0.40 to 0.83 ) ; SF-36 bodily pain , 0.68 ( 0.46 to 0.90 ) ; and fatigue , 0.59 ( 0.38 to 0.81 ) . Relative efficiencies for physician global ( 1.6 ) , SF-36 bodily pain domain ( 1.4 ) , pain intensity ( 1.4 ) , HAQ ( 1.2 ) , SF-36 physical component score ( 1.2 ) , fatigue ( 1.1 ) , and patient global assessment ( 1.04 ) were all more responsive than TJC . The SF-36 mental component score ( 0.3 ) , swollen joint count ( 0.6 ) , activity limitation ( 0.8 ) , sleep ( 0.7 ) , and C reactive protein ( 0.9 ) were less responsive . Conclusions : Using PROs for evaluating treatments for RA can detect improvements and will identify changes that are important to patients . In general , physical assessment s are more responsive to an effective treatment than mental assessment Forty-three h and s in 41 adults with osteoarthrosis of the trapeziometacarpal joint were allocated r and omly to undergo  a trapeziectomy through either an anterior approach or the posterior ( dorsoradial ) approach .  Forty h and s were available for review at a median of 33 months postoperatively . The demographic characteristics , severity 
    Output:
    
agent
The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness .
A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness .
The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness .
The PEM and PRWE also had favourable empirical evidence reported for these elements .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and purpose The Artelon CMC spacer is design ed for surgical treatment of osteoarthritis ( OA ) in the carpometacarpal joint of the thumb ( CMC-I ) . Good results using this degradable device were previously presented in a pilot study . We now present results from a larger r and omized , controlled , multicenter study . Patients and methods 109 patients ( 94 females ) with a mean age of 60 ( 42–83 ) years , suffering from painful CMC OA , were included in the study at 7 centers in Sweden . The patients were r and omized to Artelon CMC spacer ( test , n = 72 ) or tendon arthroplasty ( control , n = 37 ) at a ratio of 2:1 . Perceived pain was recorded on a visual analog scale ( VAS ) before treatment and after 3 , 6 , and 12 months , when measuring maximal tripod pinch strength ( primary outcome measure ) . In addition , range of motion , radiographic findings , and functional testing were recorded pre- and postoperatively . Results Swelling and pain were more common in the test group and 6 implants were removed because of such symptoms . 5 of these patients did not receive antibiotics preoperatively according to the study protocol . In a per- protocol analysis , i.e. patients without signs of concomitant OA in the scaphoid-trapezium-trapezoid ( STT ) joint and those in the test group who received antibiotics , the mean difference in tripod pinch strength increase , adjusted for baseline , was 1.4 kg in favor of the test group ( not statistically significant ) . Statistically significant pain relief was achieved in both groups , with perceived pain gradually decreasing during the follow-up period . In the intention-to-treat analysis but not in the per- protocol analysis , significantly better pain relief ( VAS ) was obtained in the control group . Patient-perceived disability evaluated by the DASH question naire improved in both groups . Interpretation The Artelon CMC spacer did not show superior results compared to tendon interposition arthroplasty . Proper use of preoperative antibiotics and a thorough patient selection appear to be important for the results OBJECTIVE : To compare the functional results of carpectomy and four‐corner fusion surgical procedures for treating osteoarthrosis following carpal trauma . METHODS : In this prospect i ve r and omized study , 20 patients underwent proximal row carpectomy or four‐corner fusion to treat wrist arthritis and their functional results were compared . The midcarpal joint was free of lesions in all patients . RESULTS : Both proximal row carpectomy and four‐corner fusion  reduced the pain . All patients had a decreased range of motion after surgery . The differences between groups were not statistically significant . CONCLUSIONS : Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non‐union advanced collapse ( SLAC/SNAC ) wrist without degenerative changes in the midcarpal joint This prospect i ve study compared the outcome --subjective , objective and radiographic -- of two surgical techniques for treating basal joint arthritis of the thumb : a " simple " trapeziectomy ( group I ) and a ligament reconstruction/tendon ( group II ) interposition technique . There were respectively 22 patients in group I and 34 in group II , all women with primary osteoarthritis . Both techniques gave favourable results and there were no significant differences for pain relief , patient satisfaction , mobility , DASH-score , key pinch force and gripping force . However in group II , the trapezial height was better preserved indicating that the proximal migration of the thumb was prevented or limited . There was also a significant correlation between the remaining trapezial space and key pinch force Background Assessment s of change in subjective patient reported outcomes such as health-related quality of life ( HRQoL ) are a key component of many clinical and research evaluations . However , conventional longitudinal evaluation of change may not agree with patient perceived change if patients ' underst and ing of the subjective construct under evaluation changes over time ( response shift ) or if patients ' have inaccurate re collection ( recall bias ) . This study examined whether older adults ' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay . It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced . Methods A prospect i ve longitudinal cohort design nested within a larger r and omised controlled trial was implemented . 103 hospitalised older adults participated in this investigation at a tertiary hospital facility . The  EQ-5D utility and Visual Analogue Scale ( VAS ) scores  were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable ( within three days of admission ) then again immediately prior to discharge . Three methods of change score calculation were used ( conventional change , patient perceived change and patient perceived change adjusted for recall bias ) . Agreement was primarily investigated using intraclass correlation coefficients ( ICC ) and limits of agreement . Results Overall 101 ( 98 % ) participants completed both admission and discharge assessment s. The mean ( SD ) age was 73.3 ( 11.2 ) . The median ( IQR ) length of stay was 38 ( 20 - 60 ) days . For agreement between conventional longitudinal change and patient perceived change : ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively . For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias : ICCs were 0.98 and 0.90 respectively . Discrepancy between conventional longitudinal change and patient perceived change was considered clinical ly meaningful for 84 ( 83.2 % ) of participants , after adjusting for recall bias this reduced to 8 ( 7.9 % ) . Conclusions Agreement between conventional change and patient perceived change was not strong . A large proportion of this disagreement could be attributed to recall bias . To overcome the invalidating effect of response shift ( on conventional change ) and recall bias ( on patient perceived change ) a method of adjusting patient perceived change for recall bias has been described We r and omly selected 39 patients undergoing excision of the trapezium for osteoarthritis of the first carpometacarpal joint into two groups , with mobilisation either at one or at four weeks after operation . The patients were review ed at a median of six months ( 6 to 8) . The clinical details , the severity of the disease and the preoperative clinical measurements of both groups were similar . Excision of the trapezium result ed in significant improvement in objective and subjective function . Comparison of the outcomes of the two groups showed no differences except that patients found early mobilisation significantly more convenient . Although there was no significant difference in the range of movement between the groups , there was a small loss of movement at the metacarpophalangeal joint in the late mobilisation group . Our findings show that simple excision of the trapezium is an effective procedure for patients with carpometacarpal osteoarthritis of the thumb and that prolonged splintage is neither necessary nor desirable Background Clinical practice and clinical research has made a concerted effort to move beyond the use of clinical indicators alone and embrace patient focused care through the use of patient reported outcomes such as health-related quality of life . However , unless patients give consistent consideration to the health states that give meaning to measurement scales used to evaluate these constructs , longitudinal comparison of these measures may be invalid . This study aim ed to investigate whether patients give consideration to a st and ard health state rating scale ( EQ-VAS )  and whether consideration of good and poor health state descriptors immediately changes their self-report . Methods A r and omised crossover trial was implemented amongst hospitalised older adults ( n = 151 ) . Patients were asked to consider descriptions of extremely good ( Description-A ) and poor ( Description-B ) health states . The EQ-VAS  was administered as a self-report at baseline , after the first descriptors ( A or B ) , then again after the remaining descriptors ( B or A respectively ) . At baseline patients were also asked if they had considered either EQ-VAS anchors . Results Overall 106/151 ( 70 % ) participants changed their self-evaluation by ≥5 points on the 100 point VAS , with a mean ( SD ) change of + 4.5 ( 12 ) points ( p < 0.001 ) . A total of 74/151 ( 49 % ) participants did not consider the best health VAS anchor , of the 77 who did 59 ( 77 % ) thought the good health descriptors were more extreme ( better ) then they had previously considered . Similarly 85/151 ( 66 % ) participants did not consider the worst health anchor of the 66 who did 63 ( 95 % ) thought the poor health descriptors were more extreme ( worse ) then they had previously considered . Conclusions Health state self-reports may not be well considered . An immediate significant shift in response can be elicited by exposure to a mere description of an extreme health state despite no actual change in underlying health state occurring . Caution should be exercised in research and clinical setting s when interpreting subjective patient reported outcomes that are dependent on brief anchors for meaning . Trial Registration Australian and New Zeal and Clinical Trials Registry ( # ACTRN12607000606482 ) Background Expectations held by patients and health professionals may affect treatment choices and participation ( by both patients and health professionals ) in therapeutic interventions in contemporary patient-centered healthcare environments . If patients in rehabilitation setting s overestimate their discharge health-related quality of life , they may become despondent as their progress falls short of their expectations . On the other h and , underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit . There is a scarcity of empirical evidence evaluating whether patients ’ expectations of future health states are accurate . The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life . Methods A prospect i ve longitudinal cohort investigation of agreement between patients ’ anticipated discharge health-related quality of life ( as reported on the EQ-5D instrument at admission to a rehabilitation unit ) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken . The  mini-mental state examination  was used as an indicator of patients ’ cognitive ability . Results Overall , 232(85 % ) patients had all assessment data completed and were included in analysis . Kappa scores ranged from 0.42 - 0.68 across the five EQ-5D domains and two patient cognition groups . The percentage of exact correct matches within each domain ranged from 69 % to 85 % across domains and cognition groups . Overall 40 % of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses . Conclusions Patients admitted for subacute in-hospital rehabilitation were able to anticipate their discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy . This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury . Accurate patient expectations of the impact of treatment ( or disease progression ) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved Objective : To evaluate the responsiveness of patient reported outcomes ( PROs ) , including fatigue , sleep , activity limitation , and quality of life , in patients with rheumatoid arthritis ( RA ) . Methods : Data were considered from a r and omised controlled trial comparing  abatacept ( n = 258 )  with placebo ( n = 133 ) on a background of DMARD treatment in RA patients who were inadequate responders to anti-TNF therapy ( ATTAIN study ) . PROs assessed included SF-36 , activity limitation , fatigue , and sleep . For each outcome the treatment difference , relative per cent improvement , st and ardised response mean ( SRM ) , and relative efficiency for assessing an outcome ’s ability to detect a treatment effect relative to tender joint count ( TJC ) were calculated . A relative efficiency > 1 suggests a measure that is more efficient than TJC in detecting treatment effect . Results : Moderate to large SRMs ( ⩾0.6 ) were observed for the PRO measures . In particular , SRMs ( 95 % confidence interval ) were : physician global , 0.72 ( 0.51 to 0.94 ) ; HAQ , 0.63 ( 0.42 to 0.85 ) ; SF-36 physical component score , 0.62 ( 0.40 to 0.83 ) ; SF-36 bodily pain , 0.68 ( 0.46 to 0.90 ) ; and fatigue , 0.59 ( 0.38 to 0.81 ) . Relative efficiencies for physician global ( 1.6 ) , SF-36 bodily pain domain ( 1.4 ) , pain intensity ( 1.4 ) , HAQ ( 1.2 ) , SF-36 physical component score ( 1.2 ) , fatigue ( 1.1 ) , and patient global assessment ( 1.04 ) were all more responsive than TJC . The SF-36 mental component score ( 0.3 ) , swollen joint count ( 0.6 ) , activity limitation ( 0.8 ) , sleep ( 0.7 ) , and C reactive protein ( 0.9 ) were less responsive . Conclusions : Using PROs for evaluating treatments for RA can detect improvements and will identify changes that are important to patients . In general , physical assessment s are more responsive to an effective treatment than mental assessment Forty-three h and s in 41 adults with osteoarthrosis of the trapeziometacarpal joint were allocated r and omly to undergo  a trapeziectomy through either an anterior approach or the posterior ( dorsoradial ) approach .  Forty h and s were available for review at a median of 33 months postoperatively . The demographic characteristics , severity 
    Output:
    