Development of Squat-and-Smile Test as Proxy for Femoral Shaft Fracture-Healing in Patients in Dar es Salaam, Tanzania

The Journal of Bone and Joint Surgery. American Volume
Hao-Hua WuDavid W Shearer

Abstract

There are few validated instruments that serve as a proxy for fracture-healing after lower-extremity trauma in low-resource settings. The squat-and-smile test (S&S) has been under development by SIGN (Surgical Implant Generation Network) Fracture Care International to monitor outcomes of lower-extremity long-bone fractures after intramedullary nailing in resource-limited settings. The goals of this study were to develop and identify domains of the S&S test. The S&S domains were developed through an iterative process, and consensus was achieved regarding 3: squat depth, support needed to squat, and facial expression. Adult patients with an OTA/AO type-32 femoral shaft fracture were included in this retrospective study and had the S&S administered at 6 weeks and 3, 6, and 12 months postoperatively. Two authors independently assessed photographs of the patients performing the S&S. S&S domains were correlated with the EuroQol 5-Dimensions (EQ-5D) index score, and comparisons were made between S&S domains and reoperation status. Interrater and test-retest reliability was assessed using the kappa statistic. Sensitivity and specificity analyses were performed. Six hundred and nine S&S images were evaluated for 231 patients. Each domai...Continue Reading

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Citations

Jul 6, 2019·The Journal of Bone and Joint Surgery. American Volume·Richard Gellman
Oct 28, 2019·Journal of Orthopaedic Trauma·Kristin M AlvesJeffrey N Katz
Aug 17, 2020·JBJS Reviews·Justin E HellwinkelZachary M Working
Mar 3, 2020·OTA International : the Open Access Journal of Orthopaedic Trauma·Joseph T PattersonDavid W Shearer
May 29, 2021·Journal of Clinical Orthopaedics and Trauma·Rajiv MaharjanDharanidhar Baral

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