Validity and reliability of Thai version of the International Knee Documentation Committee Subjective Knee Form.

BACKGROUND: Self-administered questionnaires have become an important aspect for clinical outcome assessment of knee-related surgery. The International Knee Documentation Committee (IKDC) Subjective Knee Form is a knee-specific questionnaire that is widely used and translated to many languages. The purposes of the present study were: (1) to translate the questionnaire into Thai; and (2) to assess the validity and reliability of the Thai version of the International Knee Documentation Committee (IKDC) Subjective Knee Form. MATERIAL AND METHOD: The IKDC Subjective Knee Form was translated into Thai using forward-backward translation protocol. Afterward, reliability and validity were tested The responses of 55 consecutive patients on two questionnaires, the Thai IKDC Subjective Knee Form and the Short Form-36, were used. The validity was tested by correlating the scores from both questionnaires. The reliability was adopted by measuring the test-retest reliability and internal consistency. RESULTS: The Thai IKDC Subjective Knee Form showed good correlations with the physical functioning and bodily pain domains of the SF-36 (Pearson's correlation coefficient = 0.75 and 0.76 respectively). The reliability proved excellent with an intra-class correlation coefficient of 0.92 for test-retest. The internal consistency was strong (Cronbach alpha = 0.92). CONCLUSION: The Thai version of IKDC Subjective Knee Form showed good value to retain the characteristic of the original version. In addition, it was a reliable evaluation instrument for patients with knee-related problems.

Difference in isokinetic strength of the muscles around dominant and nondominant shoulders.

BACKGROUND: Muscle training usually plays an important role in the treatment of shoulder disorders. Clinicians traditionally predict the pre-injury strength of an injured shoulder by using the contralateral uninjured side as the baseline data. OBJECTIVE: The primary purpose of the present study was to determine the difference in isokinetic peak torque of dominant and nondominant shoulders. MATERIAL AND METHOD: Both shoulders of 39 healthy subjects (24 men, 15 women) were tested isokinetically by using the CON-TREX MJ dynamometer at two angular velocities (60 and 180 degrees/sec) during abduction, adduction, flexion, extension, internal rotation and external rotation. RESULT: There were statistical differences of contralateral peak torque in almost all directions of shoulder muscle contractions except in shoulder flexion at both speeds. Peak torque of shoulder adduction, extension, and internal rotation were greater in the dominant side. Shoulder abduction and external rotation peak torque were greater in the nondominant side. CONCLUSION: Therefore, clinicians should not directly use the isokinetic strength of the contralateral shoulder as normal baseline data for an injured side without consideration.

Medical utilization review by indicators “ORTHOPAEDICS” in orthopaedic inpatients under universal coverage policy admitted to Siriraj Hospital.

Objective: Utilization review is very important especially in universal coverage policy. In Siriraj Hospital the utilization review began in 2002, and the Department of Orthopaedic Surgery developed the indicators “ORTHOPAEDICS” to assess the appropriateness of medical utilization. This study is designed to study the effectiveness of medical utilization review by using indicators “ORTHOPAEDICS” in orthopaedics, public inpatients under universal coverage policy in terms of expenses, the appropriateness, length of hospital stay and the satisfaction of the patients. Methods: 301 orthopaedic inpatients were divided in 2 groups: Group A included 149 patients, 100 men and 49 women. Their average age was 32.7 years old. From June 1, 2003 – May 31, 2004, each patient was prospectively reviewed regarding their daily utilization in terms of expenses, appropriateness of medical utilization by using indicators “ORTHOPAEDICS”. Their length of hospitalization was measured, as well as and their satisfaction evaluated. Group B was the control which included 152 patients, 98 men and 54 women. Their average age was 34.8 years old. No intervention was performed and the data was collected only in expenses and the length of hospital stay for each patient retrospectively from June 1, 2002– May 31, 2003. The expenses and the length of hospital stay of both groups were compared and analyzed. The appropriateness in Group A was studied by using indicators “ORTHOPAEDICS” which were: O = Operation; R = Relative weight rate; T = Type of treatment; H = Hospital stay; O = Occurrence of complication; P = procedures; A = admission; E = expenses; D = drugs; I = Investigation; C = Care map according to CPG of 12 diseases; S = Satisfactions score from 0-10 minimum to maximum, by asking the patients about the satisfaction in term of results of treatment. Results: The total expenses per patient in group A was 24,566.74 baht but in group B was 30,484.53 baht. The expense in group A was 5,917.79 baht reduction which was statistically significant difference (P<0.05). The average length of hospital stay in group A was 8.24 days, whereas in group B was 10.93 days. It reduced 2.69 days after utilization review was implemented. The appropriateness of utilization was found in the procedures, drugs and investigation without inappropriateness (0%). The inappropriateness in admission was 26.9% because the physician forgot to take blood examination and laboratory investigation before admission and it was done in the ward without any effect the treatment. And the average satisfaction score in group A was 9.6. Conclusion: “ORTHOPAEDICS” was useful and helpful indicator to significantly reduce the expense per patient and the length of hospitalization without reducing patient satisfaction and quality of treatment.