Development and validation of the hand assessment tool

The role of patient-reported outcomes in peripheral nerve surgery

Measuring the outcome of peripheral nerve surgery is challenging because of the spectrum of functional impairment is dependent on the level and severity of the lesion. There are no nerve-specific patient-reported outcome measures, and no universally accepted outcome measurement both in terms of the parameters to be assessed and the methods and timing of the assessment. Nevertheless, the use of patient-reported outcome measures is fundamental to better understand the needs and expectations of patients, to take advantage of all treatment opportunities to offer the best possible support to these patients. This paper outlines current concepts in the measurement of outcome in peripheral nerve surgery.

Ultrasound evaluation of surgically repaired hand tendons during rehabilitation and its relation to clinical and functional assessment

Objectives

This study aimed to evaluate the contribution of musculoskeletal ultrasound to the follow-up of surgically repaired hand tendons during rehabilitation programs and correlate ultrasound findings with the clinical outcome.

Patients and methods

In the prospective observational study, 40 patients (29 males, 11 females; mean age: 27.4±10.7 years; range, 15 to 55 years) who presented with postoperative hand tendon repair between January 2019 and March 2020 were randomized into two groups: Group 1 included 15 subjects with 16 repaired flexor tendons, whereas Group 2 consisted of 25 subjects with repaired extensor tendons. Afterward, the assessment was performed at the four, eight, and 12 weeks of rehabilitation utilizing the total active motion of injured fingers, Visual Analog Scale (VAS), grip strength, ultrasound, and hand assessment tool (HAT).

Results

The study's findings revealed a substantial improvement in pain based on the evaluation of grip strength, total active motion, VAS, and the affected hand's HAT score in both groups (p<0.001). In both groups, ultrasonographic evaluation of healing tendons revealed considerable enhancement in margination, defect size, thickness, echogenicity, and vascularity. A positive correlation was detected between VAS and healing tendon margination as well as the HAT score and handgrip margination in Group 1.

Conclusion

High-frequency ultrasound is an easily accessible modality in the follow-up and evaluation of tendon healing after surgical repair and during a rehabilitation program.

Patient-reported outcome measures for patients with hand-specific impairments-A scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly used to provide evidence for treatment effects and to guide rehabilitation. To our knowledge, no disease-specific PROM exists for the assessment of patients with flexor tendon lesions of the hand. We believe that PROMs used to assess hand function, regardless of diagnosis, contain relevant items for patients with flexor tendon lesions of the hand.

PURPOSE

The aim of our study was to identify and collect items from pre-existing PROMs used by clinical experts to assess the health status and function in patients with reduced hand function.

STUDY DESIGN

A scoping review searching for PROMs with hand-specific content was conducted to ensure face validity. As these items are assumed to have been through an evaluation process by the clinical specialists, they have the advantage and likelihood of being useful.

METHODS

We searched five bibliographic databases. All PROMs with hand-specific content used to assess hand function were considered for inclusion. Questionnaires written in English, Danish, Swedish, and Norwegian were included. An analysis of content redundancy was conducted, and items were grouped according to The World Health Organization's International Classification of Functioning, Disability and Health.

RESULTS

Seventy-three PROMs were included with a total of 1,582 items. The majority of the items were redundant across measurement instruments, and redundant items were consolidated, resulting in 179 nonredundant items. All nonredundant items were classified according to the International Classification of Functioning, Disability and Health components.

CONCLUSIONS

This review presents a collection of 179 items ensuring face validity for patients with hand-related disease/injury.

Construct validity of the Patient-Rated Wrist and Hand Evaluation questionnaire (PRWHE) for nerve repair in the hand

BACKGROUND

Many tools have been described for outcome assessment after nerve repair. The Patient-Rated Wrist and Hand Evaluation (PRWHE) have been shown to be valid for several hand conditions.

OBJECTIVES

To explore the construct validity of the PRWHE in comparison to cold intolerance, pain and dysfunction questionnaires; the Rosén score and its subcomponents; and threshold sensibility, dynamometry and dexterity tests for nerve repair of the hand.

STUDY DESIGN

Clinical measurement.

METHODS

Construct validity was analysed through Pearson's correlation coefficient in a convenience sample of 32 adult patients after long-term median and ulnar nerve repair.

RESULTS

The PRWHE total score was highly to moderately associated with the Disability of Arm, Shoulder and Hand (r = 0.83), Cold Intolerance Symptom Severity (r = -0.60) and McGill's Pain (r = 0.58) questionnaires. In addition, it was correlated to motor (r = -0.55) and sensor subdomains (r = -0.56) of the Rosén score. Substantial to high associations were found for the motor, sensory impairment and dexterity test.

CONCLUSIONS

The PRWHE was shown to be valid, based on construct validity, for patients with nerve repair of the hand.

Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties

BACKGROUND

Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair.

METHODS

This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence.

RESULTS

Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity.

CONCLUSIONS

Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective.

Do hand outcome measures reflect cultural influences?

OBJECTIVE

The aim of this study was to compare the activities listed in DASH, MHQ, QuickDASH with the activities listed in Canadian Occupational Performance Measure (COPM) in a Turkish patient population with hand injury.

METHODS

COPM questionnaire was administered to 163 participants (61 male and 102 female; mean age 40.72 ± 13.70 years). The activities that were stated in COPM were categorized and checked whether they were present in DASH-T, MHQ, QuickDASH.

RESULTS

The highest rated stated activities were "carrying a heavy object" (39.2%), "cleaning the house" (25.7%) and "writing" (15.9%). DASH reflects 30% whereas MHQ and QuickDASH reflect 16.32% and 10.2% of the problematic activities, respectively.

CONCLUSION

None of three questionnaires have satisfactory results for reflecting the problematic activities among hand injured Turkish people. Open ended interviews should be irrevocable part of assessment process in order to describe a person-center treatment program.

Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow

Background

The aim of this study was to develop and validate a novel self-administered questionnaire for assessing the patient’s own range of motion (ROM) of the wrist and the elbow.

Methods

In a prospective clinical study from January 2015 to June 2015, 101 consecutive patients were evaluated with a novel, self-administered, diagram-based, wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS). The questionnaire was statistically evaluated for test-retest reliability, patient-physician agreement, comparison with healthy population, and influence of covariates (age, gender, affected side and involvement in workers’ compensation cases).

Results

Assessment of patient-physician agreement demonstrated almost perfect agreement (k > 0.80) with regard to six out of eight items. There was substantial agreement with regard to two items: elbow extension (k = 0.76) and pronation (k = 0.75). The assessment of the test-retest reliability revealed at least substantial agreement (k = 0.70). The questionnaire revealed a high discriminative power when comparing the healthy population with the study group (p = 0.007 or lower for every item). Age, gender, affected side and involvement in workers’ compensation cases did not in general significantly influence the patient-physician agreement for the questionnaire.

Conclusion

The W-MAS and E-MAS are valid and reliable self-administered questionnaires that provide a high level of patient-physician agreement for the assessments of wrist and elbow ROM.

Level of evidence: Diagnostic study, Level II

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1171-z) contains supplementary material, which is available to authorized users.

A cross-cultural adaptation of the Upper Limb Functional Index in French Canadian

STUDY DESIGN

Clinical measurement.

INTRODUCTION

The Upper Limb Functional Index (ULFI) is a self-report questionnaire assessing activity limitations/participation restrictions resulting from an upper limb musculoskeletal disorder (UL-MSD). It is suitable for use in a rehabilitation context where clinicians have important time constraints due to a heavy caseload. However, no French version was available until now.

PURPOSE/METHODS

To perform a cross-cultural adaptation of the ULFI in French Canadian and examine the psychometric properties and clinical applicability of the adapted version (ULFI-FC) among 50 bilingual patients.

RESULTS

The ULFI-FC showed high internal consistency (Cronbach α = 0.93), good convergent validity with the original ULFI (r = 0.85) and with the French Canadian version of the Disabilities of the Arm, Shoulder and Hand (r = -0.85) and good applicability.

CONCLUSION

This study supports the suitability of the ULFI-FC for use in a busy rehabilitation setting for French-speaking patients with UL-MSD.

LEVEL OF EVIDENCE

N/A.

Evaluation of Non Diseased Specified Outcome Measures in Hand Injuries to Assess Activity and Participation Based on ICF Content

The objective of the study is to provide information about non disease specified outcome measures which evaluate disability in patients who have impairments in hand and upper extremity and to find the extent to which they are evaluating "disability" based on ICF hand Core Set (activity limitation and participation restriction). MEDLINE, CINAHL, GOOGLE SCHOLAR , OVID and SCIENCE DIRECT databases were systematically searched for studies on non disease specified outcome measures used to evaluate upper extremity function; only studies written in English were considered. We reviewed titles and abstracts of the identified studies to determine whether the studies met predefined eligibility criteria (eg, non disease specified out come measures used in hand injured patients). All the outcome measures which had eligibility included. After full text review ,7 non disease specified outcome measures in hand were identified. Studies were extracted, and the information retrieved from them. All the outcome measures which had incuded, were linked with ICF hand core set disability part (activity and participation). All of them only linked to 16 (42 %) components of ICF hand Core Set, which were most activity and less participation from ICF. None of the non disease specified out come measures in hand injuries cover all domains of disability from the ICF Hand Core Set.

Outcomes of hand fracture treatments

There is no outcome measure designated as the gold standard when assessing the treatment results following fractures of the hand. Numerous measures have been described in the literature, but only a limited number have been validated to specifically evaluate functional recovery with respect to hand fractures. Of the outcome measures validated for use with hand fractures, few have been studied in comparative trials designed to analyze their ability to predict functional recovery. This review article provides an evidence-based description of the validated scales and scores frequently used in assessing the functional outcomes and their ability to predict recovery.

Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review

Background

Accurate values are a must in medicine. An important parameter in determining the quality of a medical instrument is agreement with a gold standard. Various statistical methods have been used to test for agreement. Some of these methods have been shown to be inappropriate. This can result in misleading conclusions about the validity of an instrument. The Bland-Altman method is the most popular method judging by the many citations of the article proposing this method. However, the number of citations does not necessarily mean that this method has been applied in agreement research. No previous study has been conducted to look into this. This is the first systematic review to identify statistical methods used to test for agreement of medical instruments. The proportion of various statistical methods found in this review will also reflect the proportion of medical instruments that have been validated using those particular methods in current clinical practice.

Methodology/Findings

Five electronic databases were searched between 2007 and 2009 to look for agreement studies. A total of 3,260 titles were initially identified. Only 412 titles were potentially related, and finally 210 fitted the inclusion criteria. The Bland-Altman method is the most popular method with 178 (85%) studies having used this method, followed by the correlation coefficient (27%) and means comparison (18%). Some of the inappropriate methods highlighted by Altman and Bland since the 1980s are still in use.

Conclusions

This study finds that the Bland-Altman method is the most popular method used in agreement research. There are still inappropriate applications of statistical methods in some studies. It is important for a clinician or medical researcher to be aware of this issue because misleading conclusions from inappropriate analyses will jeopardize the quality of the evidence, which in turn will influence quality of care given to patients in the future.

Reliability and validity of Milliken Activities of Daily Living Scale (MAS) in measuring activity limitations of a Turkish population

AIM

The Milliken Activities of Daily Living Scale (MAS) is a self-report scale to address limitation of ability to perform daily tasks in upper extremity injuries. It can address the necessity of each task, which makes MAS useful while planning individual treatment. The objective of this study was to perform cross-cultural adaptation of the MAS TURKISH and to evaluate its reliability and validity for Turkish-speaking patients with upper extremity conditions.

METHOD

A total of 99 patients were asked to complete the adapted MAS and DASH at baseline and one week after the initial assessment. Also grip strength was evaluated with an interval of one week.

RESULTS

The reliability of the adapted version was good, with high internal consistency (Cronbach's alpha = 0.964) and test-retest reliability (interclass correlation coefficient (ICC) = 0.772) for the total score. A statistically significant correlation between MAS and DASH scores and grip strength scores of the injured side was obtained.

CONCLUSION

The results of the study have shown that the Turkish version of MAS has excellent test-retest reliability and validity. It is a suitable assessment for evaluating function and giving an overview of activity limitations in many performance areas in a Turkish population.

Cross-cultural adaptation, validation, and reliability process of the Michigan Hand Outcomes Questionnaire in a Turkish population

PURPOSE

The Michigan Hand Outcomes Questionnaire (MHQ) is a domain-specific questionnaire that was developed to be used as a standardized instrument capable of measuring outcomes for patients with all types of hand disorders. The purpose of this study was to develop the Turkish version of the MHQ and to examine whether it is a valid and reliable tool for assessing the outcomes in hand disorders.

METHODS

Translation and back-translation of the MHQ were performed, according to published guidelines. A total of 70 patients with hand complaints completed the final version of the MHQ and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire Turkish version (DASH-T) twice, on their first visit and after an interval of 7 days. Visual analog scale (VAS) results for pain intensity and grip strength measurements of the individuals were also taken in both assessments consecutively.

RESULTS

Translation and back-translation revealed no major difficulties. The Turkish version of the MHQ met set criteria of reliability and validity. The intraclass correlation coefficient of the test-retest reliability for the 6 subscales ranged from 0.79 to 0.96. The internal consistency of the MHQ, estimated by Cronbach's alpha, ranged from 0.85 to 0.96 for all subscale scores. There were high to moderate correlations between MHQ and DASH scores and VAS and grip strength scores of the injured side.

CONCLUSIONS

The Turkish version of the MHQ has excellent test-retest reliability and validity, and it is an adequate and useful instrument for measuring functional disability in hand disorders of Turkish-speaking patients.

Interference screw failure in distal biceps endobutton repair: case report

Endobutton (Arthrex, Naples, FL) fixation of distal biceps rupture with interference screw fixation provides for a secure repair, allowing for early motion. We present a case in which Endobutton fixation failed with a loose interference screw, rendering the distal biceps attachment incompetent. Revision surgery with an extensile approach, mobilization of the biceps, and repeat Endobutton fixation at a more distal site provided a secure fixation with an excellent clinical outcome. An understanding of the mechanism of failure might allow surgeons to perform this procedure with a lower incidence of complications.

Evaluation of transdermal steroids for trapeziometacarpal arthritis

PURPOSE

One conservative treatment for trapeziometacarpal joint arthritis is the delivery of steroids transdermally. In prior transdermal studies on the elbow and foot, there are mixed reports of success. It appears that the benefits of the treatment might be limited to short-term relief (approximately one week). It was hypothesized that transdermal steroid delivery would yield short-term improvements for trapezial-metacarpal joint arthritis, although these improvements would not persist at later follow-up (3 or 6 months).

METHODS

Eighty-four consecutive trapeziometacarpal joints in 62 patients presenting to an orthopedic hand surgeon were randomized to receive either steroid delivery by iontophoresis or phonophoresis or placebo delivery via iontophoresis or phonophoresis. The researchers and patients were blinded as to the treatment assignment. Patients were evaluated before treatment and at 3 follow-up appointments. Subjects were assessed via the Michigan Hand Outcomes Questionnaire, Short Form 12, analog pain score, and provocative and strength testing. The subjects' study group, gender, and arthritic grade were statistically analyzed versus patient-reported and physician-assessed data over the different time points. Following subject recruitment, 17 joints discontinued the study due to joint discomfort, electing for other treatments. Approximately half of the 67 subject joints opted for alternative treatment after the first or second follow-up; 34 subject joints completed all follow-up time points.

RESULTS

There was no significant predictive relationship between the independent variables and their ability to predict the 9 dependent measures of pain, strength, and well-being. There were trends for the pain to decrease over time, although the trends were not uniform between the different pain metrics and groups. The strength for both iontophoresis groups tended to increase over time, whereas the phonophoresis groups tended to decline.

CONCLUSIONS

Although there were some trends in the follow-up data, the overall lack of significant differences in the data suggests that transdermal steroid delivery might not be helpful in providing short- or long-term relief of arthritic symptoms.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic II.