HTA - Sahlgrenska Universitetssjukhuset
HTA - Sahlgrenska Universitetssjukhuset HTA - Sahlgrenska Universitetssjukhuset
Number of studies Activity of daily living 6 Surgical revision 4 Appendix 4 SoF table. Total shoulder arthroplasty versus hemiarthroplasty Design Limitations Consistency Directness Precison Publication bias 1 RCT 5 Nonrandomised studies 2 RCT 2 Nonrandomised studies Some limitations (?) Some limitations (?) No inconsistency No inconsistency No indirectness o indirectness Very serious imprecision (-2) Very serious imprecision (-2) Unlikely Unlikely Magnitude of effect Not relevant Not relevant No. of pts with TSA 20 8 64 No. of pts with HA 21 5 59 Relative effect (95% CI) No difference between study groups No difference between study groups Quality ⊕OOO ⊕OOO
Appendix 5. ETHICAL ANALYSIS OF IMPLEMENTATION OF PROSTHETIC ATHROPLASTY IN PATIENTS WITH PRIMARY GLENOHUMERAL OSTEOARTHRITIS Question Answer/ comment 1. From the patient's perspective, how does prosthetic arhroplasty affect the patient's quality of life and life expectancy? 2012-10-23/os Uncontrolled studies report marked reductions in pain, improved mobility and increased quality of life with rather few complications following prosthetic arthroplasty. However, also other, less costly and less invasive interventions, has also reported beneficial effects in uncontrolled studies. Based on the marked beneficial effects in uncontrolled studies an important question is whether it is ethically acceptable to refrain from implantation of prosthesis in patients with severe symptoms? On the other hand, it may not be acceptable to introduce shoulder arthroplasty in the clinical routine on a large scale without convincing documentation of its effects in comparison to other interventions. In individual patients the need of alleviating the shoulder symptoms of glenohumeral ostheoarthritis is substantial. No. 2. How severe is the patient's need that the prosthetic arhroplasty must meet? 3. Does prosthetic arhroplasty have any influence on how others view the patient (concerning humanity and human dignity), or on how the patient views himself or herself (concerning humanity and human dignity)? 4. Can prosthetic arhroplasty affect the No, most probably a patient’s autonomy will not be negatively affected by prosthetic arthroplasty. patient’s ability and possibility to be independent? 5. If implemented, does prosthetic No. All patients in need of any intervention for glenohumeral ostheoarthritis must be fully informed of arhroplasty require any special steps to not the procedures and be able to give their informed consent prior to any kind of treatment. compromise the patient's autonomy? 6. How does prosthetic arhroplasty affect the Since there are alternative interventions that are less invasive than the implantation of a prosthesis there patient’s physical, moral and personal is definitely some concern that prosthethic arthroplasty may affect the physical integrity of the patient to integrity? an unnecessary large extent. Most probably the moral and personal integrity of the patient will not be negatively affected by the surgical intervention. 7. Is prosthetic arhroplasty cost-effective? It is presently unknown whether prosthetic arthroplasty is cost-effective or not. 1 2012-07-11/OS
- Page 5 and 6: Complications Any kind of early com
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- Page 11 and 12: 3d PICO P= Patients, I= Interventio
- Page 13 and 14: Total shoulder arthroplasty versus
- Page 15 and 16: Ethical aspects 7 Ethical consequen
- Page 17 and 18: Unanswered Questions 10a Important
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- Page 41 and 42: Appendix 1:7b. 12-11-09 Mortality,
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- Page 45 and 46: Appendix 3, Search strategy, study
- Page 47 and 48: Search strategies Database: PubMed
- Page 49 and 50: Database: The Cochrane Library Date
- Page 51 and 52: Lo IK, Litchfield RB, Griffin S, Fa
- Page 53 and 54: Other references: AMSTAR [checklist
- Page 55: Number of studies Shoulder score -
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Appendix 5.<br />
ETHICAL ANALYSIS OF IMPLEMENTATION OF PROSTHETIC ATHROPLASTY IN PATIENTS<br />
WITH PRIMARY GLENOHUMERAL OSTEOARTHRITIS<br />
Question Answer/ comment<br />
1. From the patient's perspective, how does<br />
prosthetic arhroplasty affect the patient's<br />
quality of life and life expectancy?<br />
2012-10-23/os<br />
Uncontrolled studies report marked reductions in pain, improved mobility and increased quality of life<br />
with rather few complications following prosthetic arthroplasty. However, also other, less costly and<br />
less invasive interventions, has also reported beneficial effects in uncontrolled studies. Based on the<br />
marked beneficial effects in uncontrolled studies an important question is whether it is ethically<br />
acceptable to refrain from implantation of prosthesis in patients with severe symptoms? On the other<br />
hand, it may not be acceptable to introduce shoulder arthroplasty in the clinical routine on a large scale<br />
without convincing documentation of its effects in comparison to other interventions.<br />
In individual patients the need of alleviating the shoulder symptoms of glenohumeral ostheoarthritis is<br />
substantial.<br />
No.<br />
2. How severe is the patient's need that the<br />
prosthetic arhroplasty must meet?<br />
3. Does prosthetic arhroplasty have any<br />
influence on how others view the patient<br />
(concerning humanity and human dignity),<br />
or on how the patient views himself or<br />
herself (concerning humanity and human<br />
dignity)?<br />
4. Can prosthetic arhroplasty affect the No, most probably a patient’s autonomy will not be negatively affected by prosthetic arthroplasty.<br />
patient’s ability and possibility to be<br />
independent?<br />
5. If implemented, does prosthetic<br />
No. All patients in need of any intervention for glenohumeral ostheoarthritis must be fully informed of<br />
arhroplasty require any special steps to not the procedures and be able to give their informed consent prior to any kind of treatment.<br />
compromise the patient's autonomy?<br />
6. How does prosthetic arhroplasty affect the Since there are alternative interventions that are less invasive than the implantation of a prosthesis there<br />
patient’s physical, moral and personal is definitely some concern that prosthethic arthroplasty may affect the physical integrity of the patient to<br />
integrity?<br />
an unnecessary large extent.<br />
Most probably the moral and personal integrity of the patient will not be negatively affected by the<br />
surgical intervention.<br />
7. Is prosthetic arhroplasty cost-effective? It is presently unknown whether prosthetic arthroplasty is cost-effective or not.<br />
1 2012-07-11/OS
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