Search

Background. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary total knee replacement (TKR). Methods. A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients’ decisional needs and preferences. Results. 2526 articles were identified, of which 17 articles met the inclusion criteria. Of the 17 articles, ten had a qualitative study design and seven had a quantitative study design. All included articles focused on the decision whether to undergo TKR surgery or not. Ten articles (all qualitative) examined patients’ decisional needs and preferences. From these, we identified four domains that affected the patients’ decision to undergo TKR: (1) personal factors, (2) external factors, (3) information sources and (4) preferences towards outcome prediction. Seven studies (5) randomized controlled trials and 2 cohort studies) used quantitative analyses to probe the effect of decision aids on SDM and/or clinical outcomes. In general, existing decision aids did not appear to be tailored to patient needs and preferences, nor were the principles of SDM well-articulated in the design of decision aids. Conclusions. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery.

The motor system's natural tendency is to move the limbs over equal amplitudes, for example in walking. However, in many situations in which people must perform complex movements, a certain degree of amplitude differentiation of the limbs is required. Visual and haptic feedback have recently been shown to facilitate such independence of limb movements. However, it is unknown whether motor expertise moderates the extent to which individuals are able to differentiate the amplitudes of their limb-movements while being supported with visual and haptic feedback. To answer this question 14 pre-professional dancers were compared to 14 non-dancers on simultaneously generating a small displacement with one foot, and a larger one with the other foot, in four different feedback conditions. In two conditions, haptic guidance was offered, either in a passive or active mode. In the other two conditions, veridical and enhanced visual feedback were provided. Surprisingly, no group differences were found regarding the degree to which the visual or haptic feedback assisted the generation of the different target amplitudes of the feet (mean amplitude difference between the feet). The correlation between the displacements of the feet and the standard deviation of the continuous relative phase between the feet, reflecting the degree of independence of the feet movements, also failed to show between-group differences. Sample entropy measures, indicating the predictability of the foot movements, did show a group difference. In the haptically-assisted conditions, the dancers demonstrated more predictable coordination patterns than the non-dancers as reflected by lower sample entropy values whereas the reverse was true in the visual-feedback conditions. The results demonstrate that motor expertise does not moderate the extent to which haptic tracking facilitates the differentiation of the amplitudes of the lower limb movements in an asymmetrical bipedal coordination task.

Introduction Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a cardio-pulmonary bypass technique to provide life support in acute reversible cardiorespiratory failure when conventional management is not successful. Most neonates receiving ECMO suffer from meconium aspiration syndrome (MAS), congenital diaphragmatic hernia (CDH), sepsis or persistent pulmonary hypertension (PPH). In five-year-old children who underwent VA-ECMO therapy as neonates, we assessed motor performance related to growth, intelligence and behaviour, and the association with the primary diagnosis. Methods In a prospective population-based study (n = 224) 174 five-year-old survivors born between 1993 and 2000 and treated in the two designated ECMO centres in the Netherlands (Radboud University Medical Centre Nijmegen and Sophia Children's Hospital, Erasmus MC-University Medical Center Rotterdam) were invited to undergo follow-up assessment including a paediatric assessment, the movement assessment battery for children (MABC), the revised Amsterdam intelligence test (RAKIT) and the child behaviour checklist (CBCL). Results Twenty-two percent of the children died before the age of five, 86% (n = 149) of the survivors were assessed. Normal development in all domains was found in 49% of children. Severe disabilities were present in 13%, and another 9% had impaired motor development combined with cognitive and/or behavioural problems. Chi-squared tests showed adverse outcome in MABC scores (P < 0.001) compared with the reference population in children with CDH, sepsis and PPH, but not in children with MAS. Compared with the Dutch population height, body mass index (BMI) and weight for height were lower in the CDH group (P < 0.001). RAKIT and CBCL scores did not differ from the reference population. Total MABC scores, socioeconomic status, growth and CBCL scores were not related to each other, but negative motor outcome was related to lower intelligence quotient (IQ) scores (