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WHAT WE DO
M-CHOIR performs a wide array of clinical and health services research. Primary methodologies include decision analyses, large database studies, and clinical trials.
ONGOING PROJECTS
Clinical Trial of Surgery for Ulnar Nerve at the Elbow (SUN)
SUN is a collaborative randomized clinical trial comprised of 10 participating sites across the United States. It is a double-blind superiority trial to compare the effectiveness of in-situ (simple) decompression and subcutaneous anterior transposition for treating ulnar neuropathy at the elbow (UNE) . Participants aged 18 years or over treated with either procedure will be evaluated with self-reported and functional and sensory testing at 2-weeks, 6-weeks, 3-months, and 12-months after surgery. Baseline assessments will also be performed prior to surgery. SUN is funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) through a U01 grant.
COMPLETED PROJECTS
Finger Replantation ANd amputation CHallenges in assessing Impairment, Satisfaction, and Effectiveness (FRANCHISE)
FRANCHISE is a collaborative cohort study comprised of 14 sites in the United States and 10 international sites to evaluate patients with traumatic finger amputations. Participants treated with revision amputation or replantation will be compared to arrive at better treatment choice for an individual patient. Patient-reported outcomes alongside functional assessments performed at a single follow-up visit will help us develop a triage algorithm for the initial care of traumatic finger amputation patients. FRANCHISE is funded by the Plastic Surgery Foundation.
Wrist and Radius Injury Surgical Trial (WRIST)
Funded jointly by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Institute on Aging (NIA) via an R01 grant, WRIST is a randomized controlled trial with 21 participating sites across the United States and Canada. Participants aged 60 years or older with displaced distal radius fractures (DRFs) are randomized into one of three surgical treatment modalities: internal fixation, external fixation (with or without pinning), and percutaneous pinning.
Participants who opted to not have surgery were followed as an observation group. WRIST ended enrollment December 31, 2016 and participants follow-up ended February 28, 2019.
National Variations in Treatment of Elderly Distal Radius Fractures
Funded via an R21 grant from NIAMS, we used 20% sample and 100% Medicare data to identify variations in treatment modality across the US. This project has resulted in 9 publications so far. Findings include a steady increase in the use of internal fixation over time and increased use of internal fixation by younger surgeons and by members of the American Society for Surgery of the Hand. This project has also increased the understanding of the use of post-acute care, postoperative x-rays, and occupational therapy after DRF.
Silicone Arthroplasty in Rheumatoid Arthritis (SARA)
The SARA study was the first NIH R01 award for Dr. Chung, funded by the NIAMS. SARA is a multi-center prospective cohort study of rheumatoid arthritis (RA) patients with severe hand deformities. Early research by the team found wide area variations in surgical management of rheumatoid arthritis (RA) in the US. Some of this variation was attributed to the disagreement among rheumatologists and hand surgeons on outcomes for RA hand surgery. Our research has focused on silicone metacarpophalangeal arthroplasty (SMPA) that has been used for many years to correct the alignment and appearance of fingers in the rheumatoid hand. This unique study is a collaborative effort between rheumatologists and hand surgeons to evaluate outcomes of SMPA by comparing participants treated with or without surgical intervention over a 7 year period. We found significant improvement for the surgical group in the arc of motion and degree of ulnar deviation as well as patient-reported function. The non-surgical group’s function did not deteriorate during the early follow-up interval. This study has resulted in over 15 publications and shows the importance of including patient-reported outcomes in assessing RA surgical outcomes.
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