Abstract: An Expertise-Based Prospective Feasibility Study Comparing Trapeziectomy with Ligament Reconstruction and Tendon Interposition (T+LRTI) Versus Partial Trapeziectomy and Tendon Interposition Arthroplasty (PT) in Patients with Basal Thumb Joint Arthritis
Bibliographic record
Abstract
Numerous surgical techniques exist for the treatment of first carpometacarpal joint osteoarthritis, however it unclear if outcomes differ between the available techniques. Our feasibility study aimed to determine the practicality of recruiting patients for, and performing, a larger-scale health-related quality of life and functional outcomes study comparing two surgical techniques: complete trapeziectomy with ligament reconstruction and tendon interposition (T+LRTI) and partial trapeziectomy and tendon interposition (PT) arthroplasty. Sixty patients with advanced stage arthritis (Eaton stages II-IV) of the thumb, were invited to undergo either T+LRTI or PT at one of two hand surgery practices. Feasibility outcomes included: 1) Process: recruitment rate, 2) Resources: eligibility rate and sufficiency of eligibility criteria, retention and compliance rates (completion of HRQOL questionnaires, DASH, EQ-5D, and SF-36, and functional measurements, grip, key pinch, and tip pinch strength, at 1-week pre-operatively and 1, 3, 6, and 12 months post-operatively), 3) Management: determining the practices’ commitment to the study, and 4) Scientific: calculation of the variance and effect size (ES) of differences between procedures. Of 60 patients screened, 34 (57%) were eligible for surgery. Of the 26 ineligible patients, 21 (81%) met exclusion criteria for previous/imminent surgery on same hand, particularly carpal tunnel release (n=17). Of those who participated in the study, 14 (41%) attended at least one of the four follow-up visits, 24% and 89% from the T+LRTI and PT group, respectively. Attrition rate was 59%. The highest compliance rate was at 6 months. Large differences in loss to follow-up were seen between the two practices (16/25 vs 1/9); three different research assistants participated in the study. The estimate of treatment effect is large for some outcomes (SF-36 Mental Score =1.044, DASH disability score = 0.83, EQ-5D anxiety/depression = 1.106, and EQ-5D state of health = 0.84 and) and minimal to none for others (SF-36 Physical Score = 0.21, EQ-5D mobility, self-care, and pain/discomfort = 0, EQ-5D usual activities = 0.26). The authors concluded that a large-scale study is feasible; however, the following changes are recommended: 1) increase sample size to account for attrition 2) remove exclusion of participants with carpal tunnel syndrome, 3) ensure rapport between office personnel and study patients, and 4) main stability with research assistants during the study period or ensure overlap in the transition period.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".