Stig Brorson

Introduction: The Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were developed to improve the completeness and transparency of reporting of reliability and agreement of health measurement instruments. However, since their publication in 2011 methodological standards, both for reporting guideline development and reliability, agreement and measurement error studies have advanced, highlighting the need for aligning and updating. In addition, related initiatives like COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) have emerged, offering opportunities to harmonise terminology and promote consistency across diverse types of measurement instruments. This method review aims to (1) systematically identify and synthesise commentaries on and evaluations of the original GRRAS and (2) map recent methodological developments in the planning, conduct and interpretation of reliability, agreement and measurement error studies in health science, psychology and education that should be reflected in the reporting, to inform the development of the GRRAS-COSMIN reporting guidelines. Methods and analysis: Two complementary search strategies will be employed. First, forward direct citation tracking of the original GRRAS publications will be conducted in Web of Science. We will include sources providing critique, commentaries or suggestions related to the GRRAS. We will exclude publications that used GRRAS just for structuring their report, withdrawn or retracted articles, textbooks, peer reviews, supplements and conference materials without full-text publications. Included articles will be analysed using descriptive content analysis. Second, we will perform a systematic search in MEDLINE, PsycInfo, Embase, ERIC and CINAHL supplemented by key references identified by or known to the author team. We will include studies, reviews, commentaries, editorials, methodological papers, tutorials and guidance documents that discuss or critically reflect on methodological aspects of the measurement properties reliability and/or agreement/measurement error published between 1 January 2015 and 30 June 2026 in health sciences, psychology or education. Eligibility will be assessed by two independent reviewers and included sources will be analysed using ‘codebook’ thematic analysis. Findings will be presented narratively supplemented by visuals and tables if appropriate. Ethics and dissemination: This study involves publicly available data. No ethical approval is needed. Results will be disseminated through an open-access journal publication following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension and conference presentations.

Introduction: The Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were developed to improve the completeness and transparency of reporting of reliability and agreement of health measurement instruments. However, since their publication in 2011 methodological standards, both for reporting guideline development and reliability, agreement, and measurement error studies, have advanced, highlighting the need for aligning and updating. In addition, related initiatives like COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) have emerged, offering opportunities to harmonize terminology and promote consistency across diverse types of measurement instruments. This methods review aims (1) to systematically identify and synthesize commentaries on and evaluations of the original GRRAS, and (2) to map recent methodological developments in the planning, conduct, and interpretation of reliability, agreement and measurement error studies in health science, psychology and education that should be reflected in the reporting, to inform the development of the GRRAS-COSMIN reporting guidelines. Methods and analysis: Two complementary search strategies will be employed. First, forward direct citation tracking of the original GRRAS publications will be conducted in Web of Science. We will include sources providing critique, commentaries, or suggestions related to the GRRAS. We will exclude publications that used GRRAS just for structuring their report, withdrawn or retracted articles, textbooks, peer reviews, supplements, and conference materials without full-text publications. Included articles will be analysed using descriptive content analysis. Second, we will perform a systematic search in Medline, PsycINFO, Embase, Eric, and Cinahl supplemented by key references identified by or known to the author team. We will include studies, reviews, commentaries, editorials, methodological papers, tutorials and guidance documents that discuss or critically reflect on methodological aspects of the measurement properties reliability and/or agreement/measurement error published between 01.01.2015 and 30.06.2026 in health sciences, psychology, or education. Eligibility will be assessed by two independent reviewers and included sources will be analysed using ‘codebook’ thematic analysis. Findings will be presented narratively supplemented by visuals and tables if appropriate.Ethics and dissemination: This study involves publicly available data. No ethical approval is needed. Results will be disseminated through an open-access journal publication following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension and conference presentations.

Background and purpose: Distal radius fractures (DRFs) are common in older adults and are associated with osteoporosis and underlying frailty. While hip and spine fractures are associated with increased mortality, the association between DRFs and all-cause mortality remains less clear. We aimed to assess all-cause mortality risk following DRF in Denmark compared with age- and sex-matched controls.Methods: We conducted a nationwide, register-based matched cohort study using data from the Danish National Patient Register and Civil Registration System (1998–2018). Adults (≥ 18 years) with a DRF were matched 1:5 to controls by sex and birthdate ± 30 days. Mortality rates per 103 persons and mortality rate ratios with 95% confidence intervals (CIs) were calculated at 30, 90, 365, and 730 days after the fracture.Results: We included 190,513 patients with DRF and 952,565 controls (70% female, mean age 59 years). Mortality rates were higher for patients with DRF compared with controls across all age categories, particularly in men and within the first 30 days. Among men, mortality rates ranged from 0.36 to 52.9 per 1,000 persons in patients with DRF and from 0.07 to 20.0 per 1,000 persons in controls. Among women, mortality ranged from 0.16 to 26.3 per 1,000 persons in patients with DRF and from 0.04 to 15.9 per 1,000 persons in controls. Mortality rate ratios were highest for the 50–59 age category (male: 4.60, CI 3.95–5.35, female 3.08, CI 2.80–3.39), decreasing with higher age. Mortality rate ratios stabilized after 365 and 730 days.Conclusion: This nationwide study shows increased all-cause mortality among patients with DRF compared with sex and age-matched controls, with the highest mortality rate within the first 30 days after the fracture. The mortality rate ratio was consistently higher in the age-group 50–59 and among males.

Objectives: Healthcare contributes considerably to greenhouse gas emissions, particularly from operating theatres. The global demand for total hip replacements (THR) is rising, highlighting the need to understand its impact on the environment. The study aims to assess the environmental impact of THRs using life cycle assessment (LCA) and to identify key contributors. Design: A process-based LCA focusing on the surgical procedure was conducted in accordance with global standards (ISO 14040:2006 and ISO 14044:2006). Eleven sensitivity scenarios were performed to assess the robustness of the results. Setting: A Danish University Hospital. Participants: The empirical data involved the quantity and type of surgical equipment, material composition, energy usage and clinical infrastructure. There were no study participants. Interventions: No study interventions were performed. Primary and secondary outcome measures: 18 environmental impact scores, such as global warming, human toxicity and water consumption, were assessed. Results: The carbon footprint of a THR was 62.0 kg CO ₂ e, with major contributors being single-use disposable utensils (54 %), implants (22 %), and sterilisation of non-disposable utensils (18 %). Operating theatre energy usage, non-disposable utensils and clinical infrastructure contributed less, at 3 %, 2 % and 1 % each. Although the results of the other 17 environmental impact scores varied, they were predominantly influenced by the same factors as the carbon footprint. The sensitivity analysis showed that the overall carbon footprint varied by no more than 6 % unless the energy system shifted to less renewable energy, potentially increasing the footprint by 47 %. Conclusion: THRs impose a substantial environmental burden, and sustainable solutions should focus on the primary drivers of this impact: disposable utensils, implants and the sterilisation process. In contrast, clinical infrastructure and non-disposable utensils appear to have a relatively minimal environmental impact.

Two-part surgical neck fractures are the most common displaced proximal humeral fractures in the elderly. Most fractures can be categorized into varus-impacted or medially translated fracture patterns. The natural healing process often involves secondary displacement and partial resorption of the humeral head, but these changes are poorly correlated with shoulder function and patient satisfaction. Randomized trials have been unable to identify any benefits from surgery but report a high proportion of implant-related complications. In large prospective cohort studies, patients aged 60 or older with two-part surgical neck fractures treated non-operatively report shoulder function and quality of life close to the background population six months post-injury. Evidence-based and eminence-based approaches to interventions for osteoporotic proximal humeral fractures appear to collide.

Introduction: Non‐steroidal anti‐inflammatory drugs (NSAIDs) are commonly used for postoperative pain management after hip and knee arthroplasties but have been associated with renal adverse effects. The risk may increase when NSAIDs are combined with diuretics and angiotensin converting enzyme (ACE) inhibitors or Angiotensin‐II‐receptor antagonists. The aim of this substudy is to assess potential renal adverse effects of an eight‐day postoperative treatment with ibuprofen in patients undergoing hip or knee arthroplasty during 90‐days follow‐up. Methods and Analysis: This substudy is part of the PERISAFE trial—a randomized, placebo‐controlled, blinded multicenter trial including 2904 patients undergoing hip or knee arthroplasty. Patients are randomized to receive either ibuprofen 400 mg three times daily or identical placebo three times daily for 8 days postoperatively. The primary outcome is the number of patients with renal dysfunction according to RIFLE criteria Level 1–5, at any point during the 90‐day follow‐up. The substudy is powered at 86.3% to detect or discard a 40% relative risk reduction in the placebo group, assuming an incidence of acute renal injury of 6.2%. Ethics and Dissemination: The ethical approval for this substudy is included in the main PERISAFE trial, which has been approved by the Danish Medicine Agency, the National Committee on Health Research Ethics (EU CT no. 2022‐502502‐32‐00), and the Danish Data Protection Agency (REG‐149‐2022).

Background and purpose: Management of pediatric distal forearm fractures ranges from no or simple immobilization to surgical fixation. Treatment decisions depend on age and fracture severity, but practices vary widely across countries. As surgical intervention has increased internationally, we aimed to investigate national trends in incidence and treatment of pediatric distal forearm fractures in Denmark from 1999–2018Methods: We conducted a population-based register study of children aged 0–15 with distal forearm fractures (S525 + S526) registered in the Danish National Patient Registry from 1999–2018. Treatments within 1 week of injury were grouped into: non-surgical (no immobilization, soft bandage or cast immobilization), closed reduction and immobilization, and surgical fixation. Procedure codes included closed reduction, open reduction, K-wires, or other fixations such as external fixation, nail, plate, or screws.Results: There were 175,083 fractures over the 20 years, yielding a mean incidence of 829/100,000/year in children aged 0–15 years. The highest incidences were 1,494/100,000 among 11-year-old girls and 1,720/100,000 among 13-year-old boys. The primary treatment in all age groups was non-surgical treatment, though decreasing from 92% in 1999 to 89% in 2018. The proportion of closed reduction declined from 7% to 2%, while K-wire fixation increased from 1% to 8%. When stratified by age groups, the same trend was seen in all but the 0–3-year-olds.Conclusion: The overall incidence remained stable during the study period. Non-surgical treatment remained predominant, whereas closed reductions decreased in favor of more K-wire fixations.

Introduction Distal radius fractures (DRFs) are common injuries, especially in older adults due to age-related frailty. Most DRFs in patients aged 60 and older are treated non-operatively since surgery offers no clinically important benefits. Although anatomical alignment has traditionally been the goal of the treatment, evidence suggests that in older populations, radiographic outcomes do not reliably correlate with functional outcomes. Current evidence, including one randomised trial, shows no functional benefit of closed reduction compared with casting alone, calling into question the routine use of the procedure in older patients. The primary objective is to evaluate whether no reduction is equivalent to closed reduction in patients aged 65 years or older with a displaced DRF, based on wrist-related pain and disability measured by the Patient-Rated Wrist Evaluation (PRWE) score at 12 months. Methods and analysis This is a multi-centre, randomised controlled, equivalence trial conducted in hospitals in Finland, Denmark, Sweden and Estonia. We aim to enrol 532 patients aged ≥65 years with a displaced DRF (AO/OTA 23A/23C). Participants will be randomised (1:1) to receive either a dorsal cast without reduction (experimental intervention) or closed reduction followed by casting (control comparator). The primary endpoint is the difference between groups assessed using the PRWE outcome score at 12 months. The equivalence margin will be set at 6 PRWE points. Key secondary endpoints will include the Numeric Rating Scale for pain, patient satisfaction, quality of life (EQ-5D-5L Index) and serious adverse events at 3 months and 12 months and cosmesis at 3 months. Our main analyses will follow an intention-to-treat principle, analysed using repeated measures mixed model. Ethics and dissemination Ethical approval has been granted by the Ethics Committee of Tampere University Hospital (R25001). Results of the trial will be disseminated through peer-reviewed journals. Protocol version 6 July 2025, v1.0. Trial registration number NCT07042139.