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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2021

Open Access 01-12-2021 | Shoulder Instability | Research article

Implications for the design of a Diagnostic Decision Support System (DDSS) to reduce time and cost to diagnosis in paediatric shoulder instability

Authors: Fraser Philp, Alice Faux-Nightingale, Sandra Woolley, Ed de Quincey, Anand Pandyan

Published in: BMC Medical Informatics and Decision Making | Issue 1/2021

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Abstract

Background

Currently the diagnosis of shoulder instability, particularly in children, is difficult and can take time. These diagnostic delays can lead to poorer outcome and long-term complications. A Diagnostic Decision Support System (DDSS) has the potential to reduce time to diagnosis and improve outcomes for patients. The aim of this study was to develop a concept map for a future DDSS in shoulder instability.

Methods

A modified nominal focus group technique, involving three clinical vignettes, was used to elicit physiotherapists decision-making processes.

Results

Twenty-five physiotherapists, (18F:7 M) from four separate clinical sites participated. The themes identified related to ‘Variability in diagnostic processes and lack of standardised practice’ and ‘Knowledge and attitudes towards novel technologies for facilitating assessment and clinical decision making’.

Conclusion

No common structured approach towards assessment and diagnosis was identified. Lack of knowledge, perceived usefulness, access and cost were identified as barriers to adoption of new technology. Based on the information elicited a conceptual design of a future DDSS has been proposed. Work to develop a systematic approach to assessment, classification and diagnosis is now proposed.
Trial Registraty This was not a clinical trial and so no clinical trial registry is needed.
Appendix
Available only for authorised users
Footnotes
1
Hypothetical descriptions of patients developed by a specialist author (FP) and structured to reflect a range of subjective and objective features associated with shoulder instability and used to elicit decision making processes [21].
 
Literature
1.
Deitch J, Mehlman CT, Foad SL, Obbehat A, Mallory M. Traumatic anterior shoulder dislocation in adolescents. Am J Sports Med. 2003;31(5):758–63.CrossRef
2.
Leroux T, Ogilvie-Harris D, Veillette C, Chahal J, Dwyer T, Khoshbin A, et al. The epidemiology of primary anterior shoulder dislocations in patients aged 10 to 16 years. Am J Sports Med. 2015;43(9):2111–7.CrossRef
3.
Longo UG, van der Linde JA, Loppini M, Coco V, Poolman RW, Denaro V. Surgical versus nonoperative treatment in patients up to 18 years old with traumatic shoulder instability: a systematic review and quantitative synthesis of the literature. Arthroscopy. 2016;32(5):944–52.CrossRef
4.
Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res. 2002;400:65–76.CrossRef
5.
Kuhn JE. A new classification system for shoulder instability. Br J Sports Med. 2010;44(5):341.CrossRef
6.
Moroder P, Danzinger V, Maziak N, Plachel F, Pauly S, Scheibel M, et al. Characteristics of functional shoulder instability. J Shoulder Elbow Surg. 2020;29(1):68–78.CrossRef
7.
Rockwood C, editor Subluxation of the shoulder-classification, diagnosis and treatment. journal of bone and joint surgery-british volume; 1980: british editorial soc bone joint surgery 22 Buckingham Street, London ….
8.
Schneeberger AG, Gerber C. Classification and therapy of the unstable shoulder. Ther Umsch. 1998;55(3):187–91.PubMed
9.
Thomas SC. An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J Bone Joint Surg Am vol. 1989;71(4):506–13.CrossRef
10.
Bateman M, Jaiswal A, Tambe AA. Diagnosis and management of atraumatic shoulder instability. J Arthrosc Joint Surg. 2018;5(2):79–85.CrossRef
11.
Brownson P, Donaldson O, Fox M, Rees JL, Rangan A, Jaggi A, et al. BESS/BOA patient care pathways: traumatic anterior shoulder instability. Shoulder Elbow. 2015;7(3):214–26.CrossRef
12.
Watson L, Warby S, Balster S, Lenssen R, Pizzari T. The treatment of multidirectional instability of the shoulder with a rehabilitation program: part 1. Shoulder Elbow. 2016;8(4):271–8.CrossRef
13.
Bateman M, Osborne SE, Smith BE. Physiotherapy treatment for atraumatic recurrent shoulder instability: updated results of the Derby Shoulder Instability Rehabilitation Programme. J Arthrosc Joint Surg. 2019;6(1):35–41.CrossRef
14.
Royal College of Physicians. Rebuilding the NHS - Resetting outpatient services for the 21st century in the context of COVID-19. 2020.
15.
Osheroff J, Teich J, Levick D, Saldana L, Velasco F, Sittig D, et al. Improving outcomes with clinical decision support: an implementer's guide: HIMSS Publishing; 2012.
16.
Musen MA, Middleton B, Greenes RA. Clinical Decision-Support Systems. In: Shortliffe EH, Cimino JJ, editors. Biomedical Informatics: Computer Applications in Health Care and Biomedicine. London: Springer London; 2014. p. 643–74.
17.
Gross DP, Armijo-Olivo S, Shaw WS, Williams-Whitt K, Shaw NT, Hartvigsen J, et al. Clinical decision support tools for selecting interventions for patients with disabling musculoskeletal disorders: a scoping review. J Occup Rehabil. 2016;26(3):286–318.CrossRef
18.
Brunner MC, Sheehan SE, Yanke EM, Sittig DF, Safdar N, Hill B, et al. Joint design with providers of clinical decision support for value-based advanced shoulder imaging. Appl Clin Inf. 2020;11(1):142–52.CrossRef
19.
Lane S, O’Raghallaigh P, Sammon D. Requirements gathering: the journey. J Decis Syst. 2016;25(sup1):302–12.CrossRef
20.
Harvey N, Holmes CA. Nominal group technique: an effective method for obtaining group consensus. Int J Nurs Pract. 2012;18(2):188–94.CrossRef
21.
Tsuda K, Higuchi A, Yokoyama E, Kosugi K, Komatsu T, Kami M, et al. Physician Decision-making patterns and family presence: cross-sectional online survey study in Japan. Interact J Med Res. 2019;8(3):e12781–e.
22.
Braun V, Clarke V. Thematic analysis. 2012.
23.
Kuhn JE, Helmer TT, Dunn WR, Throckmorton VT. Development and reliability testing of the frequency, etiology, direction, and severity (FEDS) system for classifying glenohumeral instability. J Shoulder Elbow Surg. 2011;20(4):548–56.CrossRef
24.
Lewis A, Kitamura T, Bayley J. (ii) The classification of shoulder instability: new light through old windows! Curr Orthop. 2004;18(2):97–108.CrossRef
25.
Stucki G. International Classification of Functioning, Disability, and Health (ICF): a promising framework and classification for rehabilitation medicine. Am J Phys Med Rehabil. 2005;84(10):733–40.CrossRef
26.
Gotlin MJ, Kingery MT, Baron SL, McCafferty J, Jazrawi LM, Meislin RJ. Recall bias in retrospective assessment of preoperative patient-reported American shoulder and elbow surgeons scores in arthroscopic rotator cuff repair surgery. Am J Sports Med. 2020;48(6):1471–5.CrossRef
27.
Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42(2):80–92.CrossRef
28.
Philp F, Blana D, Chadwick EK, Stewart C, Stapleton C, Major K, et al. Study of the measurement and predictive validity of the Functional Movement Screen. BMJ Open Sport Exerc Med. 2018;4(1).
29.
Jaspers MW, Smeulers M, Vermeulen H, Peute LW. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. J Am Med Inform Assoc. 2011;18(3):327–34.CrossRef
30.
Davis FD, Bagozzi RP, Warshaw PR. User acceptance of computer technology: a comparison of two theoretical models. Manag Sci. 1989;35(8):982–1003.CrossRef
31.
Laracca E, Stewart C, Postans N, Roberts A. The effects of surgical lengthening of hamstring muscles in children with cerebral palsy–the consequences of pre-operative muscle length measurement. Gait Posture. 2014;39(3):847–51.CrossRef
32.
Arnold A, Liu M, Ounpuu S, Swartz M, Delp S. The role of estimating hamstrings lengths and velocities in planning treatments for crouch gait. Gait Posture. 2006;23(3):273–81.CrossRef
33.
Kiss J, Damrel D, Mackie A, Neumann L, Wallace W. Non-operative treatment of multidirectional shoulder instability. Int Orthopaed. 2001;24(6):354–7.CrossRef
34.
Rowe CR, Pierce DS, Clark JG. Voluntary dislocation of the shoulder. A preliminary report on a clinical, electromyographic, and psychiatric study of twenty-six patients. J Bone Joint Surg Am Vol. 1973;55(3):445–60.
35.
Doody C, McAteer M. Clinical reasoning of expert and novice physiotherapists in an outpatient orthopaedic setting. Physiotherapy. 2002;88(5):258–68.CrossRef
36.
Jones MA. Clinical reasoning in manual therapy. Phys Therapy. 1992;72(12):875–84.CrossRef
37.
38.
39.
Clavering EK, McLaughlin J. Crossing multidisciplinary divides: exploring professional hierarchies and boundaries in focus groups. Qual Health Res. 2007;17(3):400–10.CrossRef
40.
Gianfrancesco MA, Tamang S, Yazdany J, Schmajuk G. Potential biases in machine learning algorithms using electronic health record data. JAMA Internal Med. 2018;178(11):1544–7.CrossRef
Metadata
Title
Implications for the design of a Diagnostic Decision Support System (DDSS) to reduce time and cost to diagnosis in paediatric shoulder instability
Authors
Fraser Philp
Alice Faux-Nightingale
Sandra Woolley
Ed de Quincey
Anand Pandyan
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2021
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-021-01446-5

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