From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, Duke University; the Department of Pediatrics, McMaster University; and the Patient Reported Outcomes, Value & Experience Center and the Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital.
Plast Reconstr Surg. 2020 May;145(5):1292-1301. doi: 10.1097/PRS.0000000000006760.
Severe lower extremity injuries are challenging to treat. The aspects of limb salvage and amputation most important to patients are not well-defined. This study's aim is to develop a conceptual framework for a patient-reported outcome instrument for lower extremity trauma patients, by defining issues and concepts most important to this patient population.
This is an interpretative description of transcripts collected from semistructured qualitative interviews at a single institution. High-energy lower extremity trauma patients were recruited by means of purposeful sampling to maximize variability. Thirty-three participant interviews were needed to reach content saturation. These participants were aged 19 to 79 years; 21 were men (63.6 percent); participation was after reconstruction [n= 15 (45.5 percent)], after amputation [n = 11 (33.3 percent)], or after amputation after failed reconstruction [n = 7 (21.2 percent)]. Interviews were recorded, transcribed, and coded line-by-line. Concepts were labeled with major and minor themes and refined through a process of constant comparison. Analysis led to the development of a conceptual framework and item pool to inform the development of a patient-reported outcome measure.
In total, 2430 unique codes were identified and used to generate the conceptual framework covering 10 major themes: appearance, environment, finances, physical, process of care, prosthesis, psychological, sexual, social, and treatment.
This study establishes a comprehensive set of concepts, identifying what is most important to severe lower extremity trauma patients. These findings can be used to inform and focus research and clinical care, and provides the framework to develop a lower extremity trauma-specific patient-reported outcome instrument: the LIMB-Q.
严重的下肢损伤难以治疗。对于患者而言，保肢与截肢最重要的方面尚不清楚。本研究旨在通过确定下肢创伤患者最关心的问题和概念，为下肢创伤患者制定一个患者报告结局量表的概念框架。
这是在一家机构进行的半结构式定性访谈中收集的转录本的解释性描述。通过有目的的抽样招募了高能下肢创伤患者，以最大限度地增加变异性。需要 33 名参与者的访谈才能达到内容饱和。这些参与者年龄在 19 至 79 岁之间；21 名男性（63.6％）；参与的是重建后[15 名（45.5％）]、截肢后[11 名（33.3％）]或重建失败后截肢[7 名（21.2％）]。访谈进行了录音、转录和逐行编码。使用主要和次要主题对概念进行标记，并通过不断比较的过程进行细化。分析导致了概念框架和项目库的开发，为患者报告结局测量的发展提供信息。
共确定了 2430 个独特的代码，并用于生成涵盖 10 个主要主题的概念框架：外观、环境、财务、身体、护理过程、假肢、心理、性、社会和治疗。
本研究确定了一套全面的概念，确定了严重下肢创伤患者最重要的内容。这些发现可用于为研究和临床护理提供信息和重点，并为开发下肢创伤特定的患者报告结局量表 LIMB-Q 提供框架。
