| Lost password
128 users onlineYou are not loggend in.  Login
Finally a controlled study!
 1 2 3 4 5 .. 7
 1 2 3 4 5 .. 7
08/23/06 02:31
Randy H.

not registered

08/23/06 02:31
Randy H.

not registered

Finally a controlled study!

Finally a controlled study comparing NA with Limited Fasciectomy (OS) has been reported in the prestigious Journal of Hand Surgery (American):

“Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy And Limited Fasciectomy for Dupuytren's Disease: a 6-Week Follow-Up Study

By van Rijssen, Annet L; Gerbrandy, Feike S J; Linden, Hein Ter; Klip, Helen; Werker, Paul M N

120 hands were randomly assigned to either NA of OS (Limited Fasciectomy). Two surgeons did all the procedures. Improvements in the PIP were reported as better using OS, though not with statistical significance. Improvement in the MCP was better with OS and was stat. significant. So, overall, this study indicated OS was more effecting in getting fingers straight. (There are three major reasons for this outcome I’ll discuss below)

“Major Complications” were reported at a rate of 5% with OS and ZERO percent with NA, showing that NA is far safer. This claim was vigorously made here on this Forum some time ago and was harshly debated. However, it is now backed up with a proper study. We had known about safety by tracking Eaton’s results. But now, for the first time, any one of us can refer a skeptical CHS to a study in their own most respected journal.
The Major Complications created by OS in this study were: “infection, skin slough, hematoma, transected artery, suspected digital nerve injury, re-exploration, and suspected division of a flexor tendon.”

The controversy of NA’s greater safety over OS is now *over*.

Now, regarding the reported greater effectiveness of OS over NA. Three flaws in the study design are evident:

1) All subjects had > 30 degrees contraction before entering the trial. However, NA can be done sooner than 30 D and with better results. When you stop a PIP contraction at 20 degrees and bring it back to straight with NA, that’s a powerful aspect of NA that did not show up in this study. The exclusion of NA’s ability to be done sooner than OS would unfairly skew the results away from NA.

2) Only one session of NA was allowed per hand. For Stages III and greater, NA is often done *more* than once to get the full benefit. This strength of NA was disallowed by the study design. To their credit, the authors acknowledge this. At the same time they state that OS proved more effective in later stages than NA, especially with the MCP. In rebuttal, it will be interesting to know Eaton’s now extensive clinical data on this.

3) The authors admit their inexperience with NA: “French rheumatologists were visited by the senior author before the commencement of the study.” Whoopee. Though easy to learn (and be safe), it is safe to say that more experienced NA CHS would have had better results with the tougher cases that were encountered by these NA beginners.

Nevertheless, in spite of the fact that NA went up against OS with two hands tied behind it’s back, NA came out fairly well. The timing of the article could not be better. Drs. Eaton/ Denkler and crew are due to speak to the ASSH on Friday, September 8th from 4:30 to 6 PM.

Ask your still skeptical CHS to read the article and go hear the presentation in September. They’ve wanted hard evidence published in their Journal. Fine. Here it is.

Knowing the intransigent rigidly of this profession, we can’t expect this one study to create a Sea Change overnight. But we as patients are increasingly being given the tools we need to finish the job we started in adding NA to our caregiver’s toolbox.
*****************************************************************************

08/23/06 02:52
Frances

not registered

08/23/06 02:52
Frances

not registered

Study

Wow. Thanks for the post Randy. Great info. Frances

08/23/06 02:56
No Name

not registered

08/23/06 02:56
No Name

not registered

Study

Randy,

This is interesting, but you should not interject too much of your own opinion. No offense, but it would be best to promote the research without an editorial.

Its interesting, but I don't think means OS is wrong or unsafe. It does seem to reinforce the need to choose the best treatment for your particular case.

But, its a good fine.

08/23/06 02:51
SusieQ 
08/23/06 02:51
SusieQ 
Good News

Hi Randy,

Personally, I find your remarks (about the weaknesses and strengths of the study you refer to) to be interesting and valuable. You've been following N.A. issues in some depth for a long time and are quite knowledgeable.

Many studies (as well as news stories) are flawed or skewed, so it's always "reader beware." The more background knowledge you have the better you can analyze what's being presented.

The study, with any shortcomings, does nicely put to rest certain issues which have been hotly debated on this forum, which is a huge step forward, and gives something "credible" for patients to present to uninformed medical professionals for their enlightenment.

I trust that vastly more credible material and a clearer perspective will emerge from the ASSH Conference.

Thank you for your valuable contributions to this forum!

Susan

08/24/06 02:18
John

not registered

08/24/06 02:18
John

not registered

No Name

No Name,
For thirty dollars you can buy the article yourself and place your own citique online. Put your money where your mouth is!

Link

http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6WJK-4K0C7B0-8-1&_cdi=6881&_user=10&_orig=search&_coverDate=05%2F31%2F2006&_qd=1&_sk=999689994&view=c&_alid=438479879&_rdoc=1&wchp=dGLzVzz-zSkzS&md5=3e1a42696c9c63c1de3af1f61c80d7eb&ie=/sdarticle.pdf

08/24/06 02:17
No Name

not registered

08/24/06 02:17
No Name

not registered

John

John,

Your post is very immature. Please do not litter this site your comments anymore. I find the sharing of information very important, but I hope that information can be shared without any personal basis. The information Randy found is very interesting, but felt it would have been more powerful by itself and it did not need additonal comments.



08/24/06 02:42
Mark D.

not registered

08/24/06 02:42
Mark D.

not registered

New Study - Reaction to Randy~sq~s Comments

Randy:

I found your "editorial comments" about the study to be very helpful.

I also found it difficult to believe that one or two folks complained about your injecting your personal opinions.

Hey, I want to hear your opinions!

You are an incredible source of knowledge for us in the Dupuytrens Community. Why in the world would any intelligent person resist hearing what you have to say?

The Naysayers out there are entitled to post their opinions. In fact, I'd like to hear what they say too - especially if they demonstrate the same degree of knowledge & articulateness evidenced by your post.

Keep up the good work!

Mark


08/27/06 02:14
Randy H.

not registered

08/27/06 02:14
Randy H.

not registered

Additional Editorializing

I think we should all be excited to be a part of the only site in existence (besides Wolegang's) where the free and open discussion of the merits of NA have finally brought it to the ponit where it is about to be presented before the upcoming meeting of the ASSH. The only reason for this is that a long list of posters interjected a *lot* of their own opinions on NA. That's the reason Eaton learned about it in the first place, and the reason he was flooded with patients from all over the US. That gave him the experience and clinical data to bring NA to the ASSH powers that be.

It has been beneficial to all that the positive assertions regarding NA have not gone unchallenged here. Had they been, it might have appeared that this lone site broadcasting it's praise was just rigged. Instead we've all been treated to a fascinating informative ride.

NA hasn't begun it's long journey to general acceptance because of the eloquence of posters claiming the exact *opposite* of the authority represented by nearly all North American CHS. If NA didn't represent a significant breakthrough in the treatment of this disease, words on these pages would have fallen flat and accomplished zip.

Sadly, until now, about all we had to editorialize was each other's posts! :). I'm thrilled to find something we can dig our teeth into that is so on point to our discussions. I'd love to hear other's reactions, such as Wolfgang's. I can't post the article I refereed to as it is copyright ASSH. The abstract is at:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16713831&query_hl=10&itool=pubmed_docsum

OS is neither wrong or unsafe. It is however *less* safe than NA though less prone to recurrence in an as yet undetermined rate. Eaton will be making the case that in his view the data shows the automatic reliance solely on OS is now unfounded.

Gee. Y'a think?

08/27/06 02:45
No Name

not registered

08/27/06 02:45
No Name

not registered

NA v. OS

NA is safer than OS? Maybe, but it seems it also depends upon how advanced the disease is and that can only be measured on a patient-by-patient case and the claim that NA is safer is just not true.

It only be true if it is measuring "apples to apples" and clearly it is not.

So, what you are really saying is "we just don't know" and once again, the NA proponents are grabbing at straws.

08/28/06 02:53
Randy H.

not registered

08/28/06 02:53
Randy H.

not registered

NA is Safer.

The study in question assigned all test subjects to the OS or NA groups completely at random. They took all comers with no regard to severity other than a contraction must be >30D. All stages II+ of the disease were represented. Even those subjects that NA practitioners like Eaton or Denkler might have judged as poor NA candidates were shown no mercy as they faced the riggers of the needle :)

As such, there is no study design that could have compared these to procedures for safety more clearly or fairly, other than larger sample size as Wolfgang has pointed out. The 5% Vs 0% complication rates were nevertheless statistically significant.

Though this was the first scientific study of it's kind, it fully validates the clinical data of Eaton/Press/Denkler and others.

NA is safer than OS. I can point to clinical and scientific data to support this opinion. Those who disagree are welcome to do so, but biased merely on their learned opinion, nothing more. Nothing in the literature nor in the emerging North American clinical data supports such this long-standing misconception. It is fast becoming a relic of ignorant CHS-speak.

One can only marvel at the clawing and scratching toward the higher ground that simply isn't there on the part of those opposed to continued vigorous NA advocacy.

 1 2 3 4 5 .. 7
 1 2 3 4 5 .. 7
interesting   patient-by-patient   Surgery   db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list   information   imagekey=B6WJK-4K0C7B0-8-1&   Disease   rdoc=1&wchp=dGLzVzz-zSkzS&md5=3e1a42696c9c63c1de3af1f61c80d7eb&ie=   treatment   sk=999689994&view=c&   Lermusiaux   question   recurrence   because   uids=16713831&query   different   coverDate=05%2F31%2F2006&   industriousness-ie   hl=10&itool=pubmed   Fasciectomy