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Stirling PHC, Yapp LZ, McEachan JE. Responsiveness and validity of the Normal Hand Score in patients undergoing carpal tunnel decompression. J Hand Surg Eur Vol 2024; 49:965-969. [PMID: 38795395 DOI: 10.1177/17531934231226170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2024]
Abstract
LEVEL OF EVIDENCE II.
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Affiliation(s)
- Paul H C Stirling
- Fife Hand Clinic, Queen Margaret Hospital, Dunfermline, Fife, Scotland, UK
| | - Liam Z Yapp
- Fife Hand Clinic, Queen Margaret Hospital, Dunfermline, Fife, Scotland, UK
| | - Jane E McEachan
- Fife Hand Clinic, Queen Margaret Hospital, Dunfermline, Fife, Scotland, UK
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Harrison S, Ogollah R, Hollingworth W, Mills N, Karantana A, Blazeby J, Montgomery A, Shafayat A, Jarrett H, Davis T. Needle fasciotomy versus limited fasciectomy for the treatment of Dupuytren's contractures of the fingers (Hand-2): study protocol for a randomised controlled trial. Trials 2024; 25:398. [PMID: 38898458 PMCID: PMC11186219 DOI: 10.1186/s13063-024-08003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/21/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Dupuytren's contractures (DC) are fibrous cords under the skin of the hand that cause one or more fingers to curl gradually and irreversibly towards the palm. These contractures are usually painless but can cause a loss of hand function. Two treatments for Dupuytren's contractures are widely used within the National Health Service (NHS) in the UK: removal of the contractures via surgery (limited fasciectomy) and division of the contractures via a needle inserted through the skin (needle fasciotomy). This study aims to establish the clinical and cost-effectiveness of needle fasciotomy (NF) versus limited fasciectomy (LF) for the treatment of DC in the NHS, in terms of patient-reported hand function and resource utilisation. METHODS/DESIGN Hand-2 is a national multi-centre, two-arm, parallel-group randomised, non-inferiority trial. Patients will be eligible to join the trial if they are aged 18 years or older, have at least one previously untreated finger with a well-defined Dupuytren's contracture of 30° or greater that causes functional problems and is suitable for treatment with either LF or NF. Patients with a contracture of the distal interphalangeal joint only are ineligible. Eligible consenting patients will be randomised 1:1 to receive either NF or LF and will be followed up for 24 months post-treatment. A QuinteT Recruitment Intervention will be used to optimise recruitment. The primary outcome measure is the participant-reported assessment of hand function, assessed by the Hand Health Profile of the Patient Evaluation Measure (PEM) questionnaire at 12 months post-treatment. Secondary outcomes include other patient-reported measures, loss of finger movement, and cost-effectiveness, reported over the 24-month post-treatment. Embedded qualitative research will explore patient experiences and acceptability of treatment at 2 years post-surgery. DISCUSSION This study will determine whether treatment with needle fasciotomy is non-inferior to limited fasciectomy in terms of patient-reported hand function at 12 months post-treatment. TRIAL REGISTRATION International Standard Registered Clinical/soCial sTudy ISRCTN12525655. Registered on 18th September 2020.
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Affiliation(s)
- Samantha Harrison
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK.
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - William Hollingworth
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Nicola Mills
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Alexia Karantana
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - Jane Blazeby
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
- Bristol and Weston Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - Aisha Shafayat
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - Hugh Jarrett
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42 Applied Health Research, Nottingham, NG7 2, UK
| | - Tim Davis
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
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Pess GM, Hurley D, Verheyden JR, Benhaim P. Collagenase Clostridium Histolyticum for the Treatment of Dupuytren Disease: A Delphi-Based Consensus Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:151-158. [PMID: 38903838 PMCID: PMC11185883 DOI: 10.1016/j.jhsg.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose The aim of this study was to establish the consensus recommendations among hand surgeons who were experts in the use of collagenase clostridium histolyticum (CCH) on the appropriate treatment of Dupuytren disease in well-defined patient populations with varying degrees of disease severity and functional impairment. Methods A three-round, blinded, modified Delphi process examined panelists' approaches to CCH treatment of metacarpophalangeal (MP) or proximal interphalangeal (PIP) joint contractures involving one or two fingers with varying degrees of severity. Clinical scenarios related to poor-quality skin, postfasciectomy scarring, boutonnière deformity, closed capsulotomy, and blood thinner use were also presented for panelist consideration. Panelists provided responses to clinical scenarios using a 5-point Likert scale or a yes/no response. Consensus was defined as ≥66.7% panelist agreement or disagreement. Results Twenty panelists completed round 1; 19 of the 20 panelists completed rounds 2 and 3. Panelists achieved a high level of consensus for using CCH for the treatment of patients with palpable cords and varying severity contractures representing one- or two-finger MP joint contractures, most one- or two-finger PIP joint contractures, and most combined MP and PIP joint contractures. Consensus for the treatment of PIP joint contractures was mostly achieved, but clinical scenarios related to recurrent PIP contracture with poor-quality skin and/or significant postfasciectomy scarring, boutonnière deformity, PIP contractures >70°, closed capsulotomy, and blood thinner use were modified, and then most (95.3%) statements reached consensus for agreement in round 2. In round 3, open-ended responses indicated that panelists considered CCH appropriate for most patients with Dupuytren disease. Conclusions Consensus-based findings among expert hand surgeons with substantial CCH experience indicated that CCH has a wide-ranging application for the treatment of Dupuytren disease in patients with varying degrees of disease severity and functional impairment. Type of study/level of evidence Therapeutic V.
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Räisänen MP, Leppänen OV, Soikkeli J, Reito A, Malmivaara A, Buchbinder R, Kautiainen H, Kaivorinne A, Stjernberg-Salmela S, Lappalainen M, Luokkala T, Pönkkö A, Taskinen HS, Pääkkönen M, Jaatinen K, Juurakko J, Karjalainen VL, Karjalainen T. Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture : A Randomized Controlled Trial. Ann Intern Med 2024; 177:280-290. [PMID: 38346307 DOI: 10.7326/m23-1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Surgery, needle fasciotomy, and collagenase injection are used to treat Dupuytren contracture. The treatment decision requires balancing initial morbidity and costs of surgery against its potential long-term benefits over needle fasciotomy and collagenase. OBJECTIVE To compare the effectiveness of surgery, needle fasciotomy, and collagenase injection at 3 months and 2 years (secondary time points of the trial). DESIGN A multicenter, randomized, outcome assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT03192020). SETTING 6 public hospitals in Finland. PARTICIPANTS 302 persons with treatment-naive Dupuytren contracture (contracture angle <135°). INTERVENTION Surgery (n = 101), needle fasciotomy (n = 101), or collagenase (n = 100). MEASUREMENTS The primary outcome was the success rate, defined as greater than 50% contracture release and patients reaching the patient acceptable symptom state. Secondary outcomes included hand function, pain, quality of life, patient satisfaction, residual contracture angle, finger flexion, risk for retreatment, and serious adverse events. RESULTS A total of 292 (97%) and 284 (94%) participants completed the 3-month and 2-year follow-ups. Success rates were similar at 3 months: 71% (95% CI, 62% to 80%) for surgery, 73% (CI, 64% to 82%) for needle fasciotomy, and 73% (CI, 64% to 82%) for collagenase. At 2 years, surgery had superior success rates compared with both needle fasciotomy (78% vs. 50%; adjusted risk difference [aRD], 0.30 [CI, 0.17 to 0.43]) and collagenase (78% vs. 65%; aRD, 0.13 [CI, 0.01 to 0.26]). Secondary analyses paralleled with the primary analysis. LIMITATION Participants were not blinded. CONCLUSION Initial outcomes are similar between the treatments, but at 2 years success rates were maintained in the surgery group but were lower with both needle fasciotomy and collagenase despite retreatments. PRIMARY FUNDING SOURCE Research Council of Finland.
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Affiliation(s)
- Mikko Petteri Räisänen
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, and Tampere University, Tampere, Finland (M.P.R.)
| | - Olli V Leppänen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Janne Soikkeli
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Aleksi Reito
- Department of Orthopedics, Tampere University Hospital, Tampere, Finland (A.R.)
| | - Antti Malmivaara
- Finnish Institute for Health and Welfare and Orton Orthopedic Hospital, Helsinki, Finland (A.M.)
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (R.B.)
| | | | - Antti Kaivorinne
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Susanna Stjernberg-Salmela
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, Finland (S.S.)
| | | | - Toni Luokkala
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Annele Pönkkö
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Hanna-Stiina Taskinen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Markus Pääkkönen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Kati Jaatinen
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Joona Juurakko
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | | | - Teemu Karjalainen
- Department of Hand Surgery and Microsurgery, Tampere University Hospital, Tampere, Finland, and Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (T.K.)
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Stirling PH, McEachan JE, Rodrigues JN, Geoghegan L, Harrison CJ. Modified Scoring of the QuickDASH Can Achieve Previously-unattained Interval-level Measurement in Dupuytren Disease and Carpal Tunnel Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5372. [PMID: 38333027 PMCID: PMC10852374 DOI: 10.1097/gox.0000000000005372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/11/2023] [Indexed: 02/10/2024]
Abstract
Background Rasch measurement theory can be used to identify scales within questionnaires and to map responses to more precise continuous scales. The aim of this article was to use RMT to refine the scoring of the QuickDASH in patients with Dupuytren disease and carpal tunnel syndrome (CTS). Methods Data were collected between 2013 and 2019 from a single center in the UK. Preoperative QuickDASH responses from patients diagnosed with Dupuytren disease and CTS were used. RMT was used to reduce the number of items in the QuickDASH and examine the reliability and validity of each subscale. Results The preoperative QuickDASH responses of 750 patients with Dupuytren disease and 1916 patients with CTS were used. The median age of participants was 61 years, and 46% were men. Exploratory factor analysis suggested two distinct subscales within the QuickDASH: task items 1-6 and symptom items 9-11. These items were fitted to the Rasch model, and disordered response thresholds were collapsed. In Dupuytren disease, the two worst responses or each item were disordered. After collapsing these options, good Rasch model fit was demonstrated. CTS responses fitted without modification. Item targeting was more appropriate for CTS than Dupuytren disease. Conclusions This study proposes a modification to the scoring system for the QuickDASH that provides high-quality, continuous, and condition-specific scales for the QuickDASH. The identification of distinct subscales within the QuickDASH can be used to identify distinct improvements in hand function and/or symptoms in previous, current, and future work.
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Affiliation(s)
- Paul H.C. Stirling
- From the Queen Margaret Hospital, Dunfermline, Scotland, UK
- Fife Virtual Hand Clinic, Dunfermline, Scotland, UK
| | - Jane E. McEachan
- From the Queen Margaret Hospital, Dunfermline, Scotland, UK
- Fife Virtual Hand Clinic, Dunfermline, Scotland, UK
| | - Jeremy N. Rodrigues
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Luke Geoghegan
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Conrad J. Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Lauritzson A, Eckerdal D, Atroshi I. Responsiveness of the patient-specific Canadian occupational performance measure and a fixed-items activity limitations measure in patients with dupuytren disease. J Patient Rep Outcomes 2023; 7:38. [PMID: 37052819 PMCID: PMC10102265 DOI: 10.1186/s41687-023-00579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Patients with Dupuytren disease experience various activity limitations. Treatment aims to reduce finger joint contractures to improve hand function and activity performance. For assessing improvement different patient-centered measures have been used. The Canadian Occupational Performance Measure (COPM) was developed as an interview-based outcome measure to detect changes over time in patients' perception of their performance and satisfaction in self-identified activity issues. The 11-item disabilities of the arm, shoulder and hand (QuickDASH) scale consists of fixed items that ask patients to rate the difficulty in performing specific daily activities. Few studies have compared the responsiveness of these two types of patient-reported measures in Dupuytren disease. PATIENTS AND METHODS We included 30 patients with Dupuytren disease enrolled in a prospective cohort study of collagenase injection. We used the COPM (score range 1-10), the QuickDASH (score range 0-100) and measurement of finger joint contracture before and 5 weeks after treatment. RESULTS Using the COPM the patients identified 107 activity problems (55 in self-care, 19 in productivity and 33 in leisure). The two most common activity problems were to wash self (21 patients) and to don gloves (19 patients). A clinically important improvement with 3 points or greater from baseline to 5 weeks was seen for performance in 77 activities (72%). The median COPM performance score improved from 4.4 at baseline to 9.0 at 5 weeks and the median QuickDASH score improved from 13.6 to 2.5. Responsiveness (Cohen's d) for the COPM performance was 2.6 (95% CI 1.9-3.3) and for the QuickDASH 0.6 (95% CI 0.1-1.1). CONCLUSION The COPM had about 6-fold larger responsiveness than the QuickDASH, which supports use of an individualized measure when assessing treatment effects in Dupuytren disease.
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Affiliation(s)
- Anna Lauritzson
- Department of Rehabilitation, Hässleholm Hospital, Hässleholm, Sweden
| | - David Eckerdal
- Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, Hässleholm, Sweden.
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, 223 62, Sweden.
| | - Isam Atroshi
- Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, 223 62, Sweden
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QuickDASH questionnaire items behave as 2 distinct subscales rather than one scale in Dupuytren's disease. J Hand Ther 2021; 36:228-233. [PMID: 34972605 DOI: 10.1016/j.jht.2021.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cohort BACKGROUND: Exploratory Factor Analysis (EFA) and structural equation modelling (SEM) assess relationships between questionnaire items and the constructs ("factors") measured by a questionnaire. The QuickDASH has not been subjected to these analyses in Dupuytren's disease. PURPOSE To undertake EFA and SEM to identify the factors measured by the QuickDASH in patients with Dupuytren's disease. METHODS We identified 750 cases of surgery for Dupuytren's disease at a single center with preoperative QuickDASH scores. We performed EFA on QuickDASH responses in R, using established methodology. Based on the EFA results, we conducted SEM in a training sample of 200 participants. A test SEM analysis was performed in a second, independent sample of 200 participants. RESULTS EFA suggested a 2-factor model. Items 1-6 measured one factor (we interpreted this as "hand function"), whereas items 9-11 measured a different factor ("hand symptoms"). Items 7 and 8 (social and work activities) did not reflect either of these factors well, and may be influenced by other variables. A structural equation model based on the EFA results, with 2 first-order factors, demonstrated excellent fit in our first SEM sample. This was confirmed with a second independent sample in a test analysis. CONCLUSIONS The QuickDASH PROM may measure 2 distinct factors in patients with Dupuytren's disease. This aligns with previous analyses of the full-length DASH PROM. Separation of the QuickDASH PROM into 2 sub-scales with distinct scores to measure "hand function" and "hand symptoms" may improve its structural validity in patients with Dupuytren's disease.
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van Kooij YE, Poelstra R, Porsius JT, Slijper HP, Warwick D, Selles RW. Content validity and responsiveness of the Patient-Specific Functional Scale in patients with Dupuytren's disease. J Hand Ther 2021; 34:446-452. [PMID: 32307236 DOI: 10.1016/j.jht.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 02/19/2020] [Accepted: 03/16/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patient-reported outcome measures have become the standard tool for reflecting the patient's perspective on their treatment outcome for a wide variety of hand conditions. The Patient-Specific Functional Scale (PSFS), is an individualized questionnaire that enables patients to specify those activities with which they have difficulty in daily life. PURPOSE OF THE STUDY This study aims to determine the content validity and responsiveness of the PSFS compared with the Michigan Hand Questionnaire (MHQ) in patients with Dupuytren's disease. STUDY DESIGN Multicentre inception cohort. METHODS Patients with Dupuytren's disease being treated with percutaneous needle aponeurotomy, limited fasciectomy, or skin graft were selected from a database with routine outcome measurements in usual care. To assess content validity of the PSFS, the activities specified by patients were classified into the International Classification of Function core set for hand conditions. The standardized response mean is calculated for the pre- and post-change scores of the PSFS to evaluate responsiveness. RESULTS Three hundred and eight patients were analyzed before and three months after treatment. Content validity of the PSFS was appropriate because 95% of all items could be classified into the International Classification of Function activities and participation domain. The standardized response mean of the PSFS was 1.0 (95% confidence interval, 0.86-1.2), which was substantially larger than the standardized response mean of the MHQ score 0.58 (95% confidence interval, 0.42-0.74). DISCUSSION The PSFS is a content-valid questionnaire which may be more responsive to change than a fixed-item instrument such as the MHQ in patients with Dupuytren's disease. CONCLUSIONS The PSFS is a valuable tool to set therapy goals and evaluate the progress over time in patients with Dupuytren's disease.
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Affiliation(s)
- Yara E van Kooij
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands; Center for Hand Therapy, Handtherapie Nederland, Utrecht, the Netherlands.
| | - Ralph Poelstra
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands; Hand and Wrist Centre, Xpert Clinic, Hilversum, the Netherlands
| | - Jarry T Porsius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Harm P Slijper
- Hand and Wrist Centre, Xpert Clinic, Hilversum, the Netherlands
| | | | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Boe C, Blazar P, Iannuzzi N. Dupuytren Contractures: An Update of Recent Literature. J Hand Surg Am 2021; 46:896-906. [PMID: 34452797 DOI: 10.1016/j.jhsa.2021.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 05/28/2021] [Accepted: 07/02/2021] [Indexed: 02/02/2023]
Abstract
Dupuytren disease is a fibroproliferative disorder that affects the palmar fascia of the hand and results in varying degrees of nodule and cord formation. Over time, patients may develop progressive contractures, impairing their ability to type, to perform with fine instruments, or to participate in social activities such as shaking hands. Treatment options for Dupuytren contractures include needle aponeurotomy (NA), injection of collagenase Clostridium histolyticum (CCH) with manipulation of the digits, and surgical fasciectomy. Over the past decade, the use of CCH has increased. Recent studies have provided additional data regarding the pathophysiology, indications, outcomes, and costs associated with the treatment for Dupuytren contractures, and this review highlights these advances.
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Affiliation(s)
- Chelsea Boe
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA
| | - Philip Blazar
- Section of Hand and Upper Extremity Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nicholas Iannuzzi
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA.
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Forget NJ, Higgins J, Rivard M, Harris PG. Going beyond Activity and Participation: Development of the DIF-CHUM-A patient-reported outcome measure for individuals with Dupuytren's contracture. J Hand Ther 2021; 33:305-313. [PMID: 31492480 DOI: 10.1016/j.jht.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a cross-sectional clinical measurement. INTRODUCTION There are currently no Dupuytren's contracture (DC)-specific, patient-reported outcomes (PROs) that can provide a thorough clinical portrait of the patients' perceptions with regard to the execution of regular activities. PURPOSE OF THE STUDY The purpose of this study was to present the development of the Dupuytren's contracture Impact on Function-Centre Hospitalier de l'Université de Montréal (DIF-CHUM), a DC-specific PRO. METHODS The development process involved consultation of 45 individuals with DC and 7 health professionals, existing literature, and DC-specific PRO. RESULTS The DIF-CHUM is composed of 2 sections: section 1, Activity and Participation includes 8 items per hand, scored on Difficulty and Change scales; section 2, General Impact includes up to 18 items, scored on Difficulty, Importance, Change and Satisfaction scales. Preliminary evidence suggests that the DIF-CHUM demonstrates good content validity. DISCUSSION The DIF-CHUM is designed to be a patient-centered measure of Activity and Participation and Functional Competence for individuals with DC that will provide hand therapists with a unique perspective of the impact of DC on patients' lives. CONCLUSION Further validation of the DIF-CHUM, including its scoring, is under way.
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Affiliation(s)
- Nancy J Forget
- Public Health PhD Program, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
| | - Johanne Higgins
- School of Rehabilitation, University of Montreal, Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Michèle Rivard
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Public Health Research Institute, University of Montreal, Montreal, Quebec, Canada
| | - Patrick G Harris
- Plastic Surgery Service, Department of Surgery, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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Lanfranchi E, Fairplay T, Arcuri P, Lando M, Marinelli F, Pillastrini P, Vanti C. The Italian version of the Unité Rhumatologique des Affections de la Main (URAM) for Dupuytren's disease: The URAM-I(10). HAND THERAPY 2021; 26:91-101. [PMID: 37904881 PMCID: PMC10584047 DOI: 10.1177/17589983211034532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/05/2021] [Indexed: 11/01/2023]
Abstract
Introduction Several general hand functional assessment tools for Dupuytren's disease have been reported, but none of the patient-reported-outcome measures specific to Dupuytren's disease-associated disabilities are available in the Italian language. The purpose of this study was to culturally adapt the Unité Rhumatologique des Affections de la Main (URAM) into Italian (URAM-I) and determine its measurement properties. Methods Cross-cultural adaptation was performed according to the current guidelines. Construct validity (convergent and divergent validity) was measured by comparing the URAM-I with the Pain-Rated Wrist/Hand Evaluation (PRWHE-I), Short-Form 36 (SF-36-I) scale and finger range of motion, respectively. Factor analysis was used to investigate the URAM-I's internal structure. Reliability was assessed by internal consistency (Cronbach's alpha) and test-retest reliability by Intra-Class Correlation Coefficient (ICC). Results This study included 96 patients (males = 85%, age = 66.8 ± 9.3). Due to the cultural adaptation, we divided the original item #1 into two separate items, thus generating the URAM-I(10). Convergent validity analysis showed a strong positive (r = 0.67), significant (p < 0.01) Pearson's correlation with the PRWHE-I. Divergent validity analysis showed a weak, negative (r < 0.3) and not significant correlation with the SF-36-I subscales, except for the physical pain subscale (r = -0.21, p < 0.05). Factor analysis revealed a 2-factor, 4-item solution that explained 76% of the total variance. The URAM-I(10) demonstrated high internal consistency (α = 0.94) and high test-retest reliability (ICC = 0.97). Conclusion The URAM-I(10) demonstrates moderate construct validity, high internal consistency and test-retest reliability, and showed a 2-factor internal structure. Its evaluative use can be suggested for the Italian Dupuytren's population.
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Affiliation(s)
- E Lanfranchi
- Studio Fairplay - Arcuri - Functional Rehabilitation of the Upper Extremity, Private Practice, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - T Fairplay
- Studio Fairplay - Arcuri - Functional Rehabilitation of the Upper Extremity, Private Practice, Bologna, Italy
- Department of Hand Surgery and Hand Rehabilitation, Modena Polyclinic Hospital, Modena, Italy
| | - P Arcuri
- Studio Fairplay - Arcuri - Functional Rehabilitation of the Upper Extremity, Private Practice, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Lando
- Department of Hand Surgery and Hand Rehabilitation, Modena Polyclinic Hospital, Modena, Italy
| | - F Marinelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - P Pillastrini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - C Vanti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Stirling PHC, Jenkins PJ, Clement ND, Duckworth AD, McEachan JE. Self-Perceived Hand Normality Before and After Surgical Treatment of Dupuytren Contracture. J Hand Surg Am 2021; 46:403-408. [PMID: 33744014 DOI: 10.1016/j.jhsa.2021.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/10/2020] [Accepted: 01/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe patients' self-reported hand normality before and after surgery for Dupuytren contracture and to determine whether this metric could be used as an adjunct to determine the success of surgery. METHODS Preoperative and 1-year postoperative Quick-Disabilities of the Arm, Shoulder, and Hand and EuroQol 5-Dimensions 5-level scores were collected prospectively over 5 years. Patients were asked "How normal is your hand?" Scores were recorded on a 100-point visual analog scale. Outcomes were available for 296 patients (77%). RESULTS Median hand normality score improved significantly from 50 to 86 after surgery. Effect size of the change in normality was 1.2 SDs. The change in normality score correlated significantly with the Quick-Disabilities of the Arm, Shoulder, and Hand score. No significant floor or ceiling effects were observed. CONCLUSIONS This study introduced the concept of self-perceived hand normality in Dupuytren disease. Hand normality improved after surgery for Dupuytren disease, and this score performed favorably compared with preexisting outcome measures, which suggests it may be a useful adjunct to gauge the success of surgery. CLINICAL RELEVANCE This study introduces the concept of self-perceived hand normality in patients undergoing surgery for Dupuytren disease and quantifies improvement observed after surgery.
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Bradet-Levesque I, Audet J, Roy JS, Flamand VH. Measuring functional outcome in Dupuytren's disease: A systematic review of patient-reported outcome measures. J Hand Ther 2021; 35:613-627. [PMID: 34334275 DOI: 10.1016/j.jht.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/16/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Functional impairments related to Dupuytren's disease (DD) can be assessed using patient-reported outcome measures (PROMs). A systematic review was published in 2013 on outcome measures for assessing treatment in individuals with DD; however, several articles have since been published on this matter. PURPOSE To conduct a systematic review to analyze the quality and content of the evidence on the psychometric properties of PROMs used in individuals with DD. STUDY DESIGN Systematic review. METHODS CINAHL, EBM reviews, Embase, Medline, and Web of Science were searched to identify studies evaluating the psychometric properties of PROMs used with individuals with DD. All studies retained were appraised by two independent assessors using two validated critical appraisal tools. RESULTS Fifteen articles on the psychometric properties of 10 PROMs were included. Construct validity and responsiveness were the most studied. Eighty percent of the studies were of good to very good methodological quality according to MacDermid's Critical appraisal checklist for psychometric articles, whereas 67% of the studies comported risks of bias according to the COSMIN checklist. Of the 10 PROMs, three were specifically developed for DD but remain mostly under-studied for their psychometric properties (≤ 2 studies for the SDSS and DIF-CHUM). The QuickDASH, MHQ, BriefMHQ, and URAM present moderate to good convergent validity. Test-retest reliability was found to be good for the MHQ, briefMHQ, URAM, SDSS, SF-36, and the multi-attribute of the HUI-3. The MHQ and BriefMHQ are highly responsive. CONCLUSION There is a need for more psychometric studies on the PROMs used with individuals with DD. However, to date, the results included in this systematic review support that the MHQ and briefMHQ are the PROMs with the most acceptable psychometric properties.
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Affiliation(s)
- Isabelle Bradet-Levesque
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Cirris, Québec, Québec, Canada
| | - Jessika Audet
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Cirris, Québec, Québec, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Cirris, Québec, Québec, Canada
| | - Véronique H Flamand
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Cirris, Québec, Québec, Canada.
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David M, Smith G, Pinder R, Craigen M, Waldram M, Mishra A, Dickson D, Wu F, Brewster M. Outcomes and Early Recurrence Following Enzymatic (Collagenase) Treatment of Moderate and Severe Dupuytren Contractures. J Hand Surg Am 2020; 45:1187.e1-1187.e11. [PMID: 32861504 DOI: 10.1016/j.jhsa.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 05/09/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE We offer collagenase Clostridium histolyticum (CCH) injections to all patients with a Dupuytren contracture and a palpable cord. We assessed whether more severe contractures respond less well or recur more frequently. METHODS From a database of 502 CCH injections, 386 (77%) had a complete dataset with minimum 1-year face-to-face follow-up. Contracture severity was assessed using the Tubiana system: grade 1 (27%), grade 2 (49%), grade 3 (19%), and grade 4 (5%). Patients received a single intralesional injection of 0.58 mg CCH followed by manipulation. Finger position was measured at 6 to 12 weeks, 6 months, and 1 year. Failure to break the cord, skin tears, and any adverse events were noted. Recurrence was defined as a failure to maintain any prior correction to within 20°. RESULTS There were 17 failures (4%) and 6 allergic reactions (1%). We found 31% corrected completely, with approximately half remaining corrected at 1 year. We achieved 43° (95% confidence interval, 40°-46°) correction of combined deformity, with 11° (95% confidence interval, 9°-13°) correction attrition over 1 year. Sixteen percent of treated digits experienced a recurrence with no difference between Tubiana grades, and one-third chose further treatment. Following treatment, Tubiana grade 1 contractures improved by 78% in comparison with higher grade contractures (55%-67% relative correction). By 1 year, all grades had a similar mean 46% relative correction. A complete correction was seen in 61% of grade 1 contractures, with more severe contractures less likely to correct completely (9%-24%). A 31% skin tear rate had no impact on outcome, recurrence, or long-term morbidity. CONCLUSIONS CCH may treat any Dupuytren cord regardless of severity. Although contracture may recur, few patients pursue further treatment within 1 year. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Michael David
- Birmingham Hand Centre, The Royal Orthopaedic Hospital, Northfields, Birmingham, West Midlands, United Kingdom.
| | - Gemma Smith
- Birmingham Hand Centre, The Royal Orthopaedic Hospital, Northfields, Birmingham, West Midlands, United Kingdom
| | - Richard Pinder
- Birmingham Hand Centre, The Royal Orthopaedic Hospital, Northfields, Birmingham, West Midlands, United Kingdom
| | - Michael Craigen
- Birmingham Hand Centre, The Royal Orthopaedic Hospital, Northfields, Birmingham, West Midlands, United Kingdom
| | - Michael Waldram
- Birmingham Hand Centre, The Royal Orthopaedic Hospital, Northfields, Birmingham, West Midlands, United Kingdom
| | - Anuj Mishra
- Birmingham Hand Centre, The Royal Orthopaedic Hospital, Northfields, Birmingham, West Midlands, United Kingdom
| | - David Dickson
- Birmingham Hand Centre, The Royal Orthopaedic Hospital, Northfields, Birmingham, West Midlands, United Kingdom
| | - Feiran Wu
- Birmingham Hand Centre, The Royal Orthopaedic Hospital, Northfields, Birmingham, West Midlands, United Kingdom
| | - Mark Brewster
- Birmingham Hand Centre, The Royal Orthopaedic Hospital, Northfields, Birmingham, West Midlands, United Kingdom
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Hensler S, Wehrli M, Herren D, Marks M. Measurement properties of the German Unité Rhumatologique des Affections de la Main (URAM) scale in patients treated for Dupuytren's disease. HAND SURGERY & REHABILITATION 2020; 39:568-574. [DOI: 10.1016/j.hansur.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
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Salari N, Heydari M, Hassanabadi M, Kazeminia M, Farshchian N, Niaparast M, Solaymaninasab Y, Mohammadi M, Shohaimi S, Daneshkhah A. The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis. J Orthop Surg Res 2020; 15:495. [PMID: 33115483 PMCID: PMC7594412 DOI: 10.1186/s13018-020-01999-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background The Dupuytren disease is a benign fibroproliferative disorder that leads to the formation of the collagen knots and fibres in the palmar fascia. The previous studies reveal different levels of Dupuytren’s prevalence worldwide; hence, this study uses meta-analysis to approximate the prevalence of Dupuytren globally. Methods In this study, systematic review and meta-analysis have been conducted on the previous studies focused on the prevalence of the Dupuytren disease. The search keywords were Prevalence, Prevalent, Epidemiology, Dupuytren Contracture, Dupuytren and Incidence. Subsequently, SID, MagIran, ScienceDirect, Embase, Scopus, PubMed and Web of Science databases and Google Scholar search engine were searched without a lower time limit and until June 2020. In order to analyse reliable studies, the stochastic effects model was used and the I2 index was applied to test the heterogeneity of the selected studies. Data analysis was performed within the Comprehensive Meta-Analysis Software version 2.0. Results By evaluating 85 studies (10 in Asia, 56 in Europe, 2 in Africa and 17 studies in America) with a total sample size of 6628506 individuals, the prevalence of Dupuytren disease in the world is found as 8.2% (95% CI 5.7–11.7%). The highest prevalence rate is reported in Africa with 17.2% (95% CI 13–22.3%). According to the subgroup analysis, in terms of underlying diseases, the highest prevalence was obtained in patients with type 1 diabetes with 34.1% (95% CI 25–44.6%). The results of meta-regression revealed a decreasing trend in the prevalence of Dupuytren disease by increasing the sample size and the research year (P < 0.05). Conclusion The results of this study show that the prevalence of Dupuytren disease is particularly higher in alcoholic patients with diabetes. Therefore, the officials of the World Health Organization should design measures for the prevention and treatment of this disease.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Hassanabadi
- Lecturer in International Business & Strategy, Faculty of Business & Law, University of Northampton, Northampton, UK
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nikzad Farshchian
- Department of Otolaryngology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Yousef Solaymaninasab
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Alireza Daneshkhah
- School of Computing, Electronics and Maths, Coventry University, London, UK
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Comparison of Treatment Outcomes after Collagenase Injection and Percutaneous Needle Fasciotomy for Dupuytren's Contracture: Objective and Subjective Comparisons with a 3-Year Follow-Up. Plast Reconstr Surg 2020; 145:1464-1474. [PMID: 32459776 DOI: 10.1097/prs.0000000000006828] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study compared the effectiveness of injectable collagenase clostridium histolyticum and percutaneous needle fasciotomy in the treatment of Dupuytren's contracture. METHODS Patients with a total passive extension deficit of 30 degrees or more in a single digital ray were enrolled and assigned randomly to receive either collagenase clostridium histolyticum injections or percutaneous needle fasciotomy. Preoperative severity of proximal interphalangeal joint contracture for Dupuytren's disease was classified according to the British Society for Surgery of the Hand as less than 30 degrees (stage I) or 30 degrees or more (stage II). RESULTS Of the 70 patients enrolled, 36 patients with 46 joints received collagenase clostridium histolyticum injections and 34 patients with 48 joints received percutaneous needle fasciotomy. At day 30, successful corrections were obtained in only 50 percent of the injection group and 67 percent of the fasciotomy group for stage II proximal interphalangeal joints. Recurrences were frequent among patients with stage II joint contractures. The mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score at day 30 was significantly higher in the injection group compared with the fasciotomy group (7.5 versus 4.2, respectively). In the injection group, adverse events were reported for all patients. In the fasciotomy group, complications were reported for 15 percent of patients. CONCLUSIONS The collagenase clostridium histolyticum and percutaneous needle fasciotomy groups had similar outcomes for Dupuytren's contracture with 3 years' follow-up. Recurrences were frequent among patients with stage II proximal interphalangeal joint contractures. The Unité Rhumatologique des Affections de la Main scale and Quick Disabilities of the Arm, Shoulder and Hand questionnaire score decreased significantly for both groups at final follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Poelstra R, van Kooij YE, van der Oest MJW, Slijper HP, Hovius SER, Selles RW. Patient's satisfaction beyond hand function in Dupuytren's disease: analysis of 1106 patients. J Hand Surg Eur Vol 2020; 45:280-285. [PMID: 31779520 DOI: 10.1177/1753193419890284] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigates the outcomes of 1106 patients with Dupuytren's disease treated with limited fasciectomy or percutaneous needle fasciotomy over 16 years according to the different domains of patient-reported hand function. These patients completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery. Scores for the various outcome parameters were calculated and linear regression analyses were used to examine associations between the changes in digital extension deficit and change in Michigan Hand Outcomes Questionnaire (sub)scores. We found the largest effects of surgical treatment in the decreases in extension deficit, the appearance of the hand, and the satisfaction with the hand function. However, associations between different domains of evaluation were weak. We conclude that improvement of digital extension deficits is not parallel to varying aspects of patient satisfaction. The findings underline the importance of assessing domains relating to patient satisfaction other than objective hand function measures in Dupuytren's disease. Level of evidence: IV.
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Affiliation(s)
- Ralph Poelstra
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Hand and Wrist Centre, Xpert Clinic, Hilversum, The Netherlands
| | - Yara E van Kooij
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Center for Hand Therapy, Handtherapie Nederland, Utrecht, The Netherlands
| | - Mark J W van der Oest
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Hand and Wrist Centre, Xpert Clinic, Hilversum, The Netherlands
| | - Harm P Slijper
- Hand and Wrist Centre, Xpert Clinic, Hilversum, The Netherlands
| | - Steven E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Hand and Wrist Centre, Xpert Clinic, Hilversum, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Lyman SL, Burket Kotsov J, Hidaka C, Tran Q, Roselaar N, Nakamura N, Hotchkiss R. Novel patient-specific visual analogue survey (PVS) is validated in patients treated with collagenase injection for Dupuytren's disease. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Nowadays, the use of patient-reported outcome measures to monitor a treatment effect in daily practice or to quantify study outcomes is indispensable. In hand surgery, there is a wide variety available. This article provides an overview about the most common hand-specific, upper-extremity specific and general quality of life patient-reported outcome measurement instruments with adequate psychometric properties. A checklist and a decision tree are provided for choosing the appropriate instrument when evaluating patients with hand conditions.
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Affiliation(s)
- Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
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Aglen T, Matre KH, Lind C, Selles RW, Aßmus J, Taule T. Hand therapy or not following collagenase treatment for Dupuytren's contracture? Protocol for a randomised controlled trial. BMC Musculoskelet Disord 2019; 20:387. [PMID: 31455312 PMCID: PMC6712875 DOI: 10.1186/s12891-019-2712-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background Dupuytren’s contracture (DC) is a fibrotic hand condition in which one or more fingers develop progressive flexion deformities. Quality of life is diminished due to disabling limitations in performing everyday activities. For DC patients treated with collagenase, referral for subsequent hand therapy is inconsistent. It is unknown whether subsequent hand therapy is beneficial compared to no therapy. The purpose of this study is to determine whether hand therapy improves DC patients’ performance of and satisfaction with performing everyday activities one year after collagenase treatment. Methods We will conduct a randomised controlled trial with two treatment groups (hand therapy vs. control) of DC patients who have received collagenase treatment. DC patients with contracted metacarpophalangeal joint(s) (MCPJ) (hand therapy, n = 40; control, n = 40) and those with proximal interphalangeal joint(s) (PIPJ) involvement (hand therapy, n = 40; control, n = 40) comprise two subgroups, and we will study if the treatment effect will be different between both groups (n = 160). Patients with a previous injury or treatment for DC in the treatment finger are excluded. Hand therapy includes oedema and scar management, splinting, movement exercises, and practice of everyday activities. The main outcome variable is patients’ performance of and satisfaction with performing everyday activities, as assessed with the Canadian Occupational Performance Measure. Secondary outcomes are DC-specific activity problems, as assessed with the Unité Rhumatologique des Affections de la Main scale, and active/passive flexion/extension of treated joints and grip force using standard measuring tools, and self-reported pain level. Demographic and clinical variables, degree of scarring, cold hypersensitivity, number of occupational sick-leave days are collected. Self-reported global impression of change will be used to assess patient satisfaction with change in hand function. Assessments are done pre-injection and 6 weeks, 4 months, and 1 year later. Standard univariate and multivariate statistical analyses will be used to evaluate group differences. Discussion This study aims to assess whether hand therapy is beneficial for activity-related, biomechanical, and clinical outcomes in DC patients after collagenase treatment. The results will provide an objective basis for determining whether hand therapy should be conducted after collagenase treatment. Trial registration This study has been registered at ClinicalTrials.gov as NCT03580213 (April 5, 2018).
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Affiliation(s)
- Terese Aglen
- Department of Occupational Therapy, Orthopaedic Clinic, Haukeland University Hospital (HUH), Bergen, Norway.
| | - Karin Hoegh Matre
- Department of Occupational Therapy, Orthopaedic Clinic, Haukeland University Hospital (HUH), Bergen, Norway
| | - Cecilie Lind
- Department for Plastic-, Hand-, Reconstructive surgery and National burn unit, Surgery Clinic, Haukeland University Hospital (HUH), Bergen, Norway
| | - Ruud W Selles
- Department of Rehabilitation Medicine and department of Plastic and Reconstructive Surgery Hand Surgery, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - Jörg Aßmus
- Centre for Clinical Research, HUH, Bergen, Norway
| | - Tina Taule
- Department of Occupational Therapy, Orthopaedic Clinic, Haukeland University Hospital (HUH), Bergen, Norway
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Nordenskjöld J, Lauritzson A, Waldén M, Kopylov P, Atroshi I. Surgical fasciectomy versus collagenase injection in treating recurrent Dupuytren disease: study protocol of a randomised controlled trial. BMJ Open 2019; 9:e024424. [PMID: 30808670 PMCID: PMC6398619 DOI: 10.1136/bmjopen-2018-024424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION There is no definitive cure for Dupuytren disease (DD), and recurrence of finger contractures after treatment is common. Surgical fasciectomy is considered the standard treatment method for recurrence, although associated with a high incidence of complications. Collagenase injection, a non-surgical treatment option, has been shown to be a safe and effective method; however, most studies regarding collagenase have involved first-time treatment. Collagenase efficacy in patients with recurrent DD beyond the immediate effect has not yet been determined. The aim of our study is to compare surgical fasciectomy and collagenase injection in treating recurrent DD. METHODS AND ANALYSIS The study is a single-centre randomised controlled trial. Inclusion criteria are recurrence of DD in one or more fingers after previous treatment with fasciectomy or collagenase injection, a passive extension deficit ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint, and a palpable cord causing the recurrent contracture. A total of 56 patients will be randomised to either surgical fasciectomy or collagenase injection. A hand therapist blinded to patients' group allocation will measure range of motion at baseline, 3 months, 12 months, 24 months and 60 months. The primary outcomes are the total active extension deficit (MCP plus PIP) at 3 months and the proportion of patients with contracture worsening ≥20° in the treated finger joint at 2 years compared with 3 months. The secondary outcomes include changes in total active motion, active and passive extension deficit from baseline up to 5 years, scores on patient-reported outcome measures, adverse events and costs of treatment. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Regional Ethical Review Board, Lund University, Sweden(2017/623). The trial will be conducted according to the Helsinki Declaration of 1975, revised in 2000. The results of the trial will be disseminated as published articles in peer-reviewed journals. TRIAL REGISTRATION NCT03406338; Pre-results.
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Affiliation(s)
- Jesper Nordenskjöld
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
| | - Anna Lauritzson
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
| | - Markus Waldén
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
| | - Philippe Kopylov
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
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Broekstra DC, van den Heuvel ER, Lanting R, Werker PMN. Measurement properties of the Dutch Unité Rhumatologique des Affections de la Main and its ability to measure change due to Dupuytren's disease progression compared with the Michigan Hand outcomes Questionnaire. J Hand Surg Eur Vol 2018; 43:855-863. [PMID: 29439589 PMCID: PMC6139982 DOI: 10.1177/1753193417752891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Data of a prospective longitudinal cohort study including 233 Dupuytren's patients was used to determine: (1) whether the Unité Rhumatologique des Affections de la Main scale and Michigan Hand outcomes Questionnaire can detect change in hand function due to Dupuytren's disease progression and to compare their abilities; (2) the concurrent validity, reliability, responsiveness and interpretability of the Dutch Unité Rhumatologique des Affections de la Main. The Unité Rhumatologique des Affections de la Main and Michigan Hand outcomes Questionnaire had comparable measurement properties, and were both able to distinguish participants with disease progression from those without progression (resp. U = 1252.5, p = 0.008, and U = 1086.0, p < 0.001), but only at a group level. Individual cases of progression could not be detected using these outcome measures, as indicated by the fact that the smallest detectable change was larger than the minimal important change, and area under the receiver operating curve (AUC) values of 0.75 for Michigan Hand outcomes Questionnaire and 0.67 for Unité Rhumatologique des Affections de la Main. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Dieuwke C. Broekstra
- University of Groningen, University
Medical Center Groningen, Department of Plastic Surgery, Groningen, The
Netherlands,Dieuwke C. Broekstra, Department of Plastic
Surgery BB81, University Medical Center Groningen, PO Box 30.001, 9700 RB
Groningen, The Netherlands.
| | - Edwin R. van den Heuvel
- Eindhoven University of Technology,
Department of Mathematics and Computer Science, Eindhoven, The Netherlands
| | - Rosanne Lanting
- University of Groningen, University
Medical Center Groningen, Department of Plastic Surgery, Groningen, The
Netherlands
| | - Paul M. N. Werker
- University of Groningen, University
Medical Center Groningen, Department of Plastic Surgery, Groningen, The
Netherlands
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24
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Abstract
Despite more than a hundred years of publications on Dupuytren disease, there has been a lack of consensus on definitions and outcomes until recently. Staging and classifications systems have an important historical context; however, more recently, outcomes rely on patient-reported outcomes, angular correction, and definitions of recurrence. This article reviews commonly used assessments, classifications, and staging systems for Dupuytren disease.
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25
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Wormald JCR, Rodrigues JN. Outcome measurement in plastic surgery. J Plast Reconstr Aesthet Surg 2017; 71:283-289. [PMID: 29233505 DOI: 10.1016/j.bjps.2017.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/11/2017] [Accepted: 11/09/2017] [Indexed: 01/14/2023]
Abstract
Outcome measurement in plastic surgery is often surgeon-centred, and clinician-derived. Greater emphasis is being placed on patient-reported outcomes (PROs), in which the patients' perspective is measured directly from them. Numerous patient-reported outcome measures (PROMs) have been developed in a range of fields, with a number of good quality PROMs in plastic surgery. They can be deployed to support diagnosis, disease severity determination, referral pathways, treatment decision-making, post-operative care and in determining cost-effectiveness. In order to understand the impact of disease and health interventions, appropriate PROMs are a logical choice in plastic surgery, where many conditions involve detriment of function or cosmesis. PROMS can be classified as disease-specific, domain-specific, dimension-specific, population-specific and generic. Choosing the correct outcome and measure can be nebulous. The two most important considerations are: is it suitable for the intended purpose? And how valid is it? Measurement that combines being patient-centred and aligning with clinicians' understanding is achievable, and can be studied scientifically. Rational design of new PROMs and considered choice of measures is critical in clinical practice and research. There are a number of tools that can be employed to assess the quality of PROMs that are outlined in this overview. Clinicians should consider the quality of measures both in their own practice and when critically appraising evidence. This overview of outcome measurement in plastic surgery provides a tool set enabling plastic surgeons to understand, implement and analyse outcome measures across clinical and academic practice.
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Affiliation(s)
- Justin C R Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK
| | - Jeremy N Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK.
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26
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Harrison E, Tan W, Mills N, Karantana A, Sprange K, Duley L, Elliott D, Blazeby J, Hollingworth W, Montgomery AA, Davis T. A feasibility study investigating the acceptability and design of a multicentre randomised controlled trial of needle fasciotomy versus limited fasciectomy for the treatment of Dupuytren's contractures of the fingers (HAND-1): study protocol for a randomised controlled trial. Trials 2017; 18:392. [PMID: 28841903 PMCID: PMC5574125 DOI: 10.1186/s13063-017-2127-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dupuytren's contractures are fibrous cords under the skin of the palm of the hand. The contractures are painless but cause one or more fingers to curl into the palm, resulting in loss of function. Standard treatment within the NHS is surgery to remove (fasciectomy) or divide (fasciotomy) the contractures, and the treatment offered is frequently determined by surgeon preference. This study aims to determine the feasibility of conducting a large, multicentre randomised controlled trial to assess the clinical and cost-effectiveness of needle fasciotomy versus limited fasciectomy for the treatment of Dupuytren's contracture. METHODS/DESIGN HAND-1 is a parallel, two-arm, multicentre, randomised feasibility trial. Eligible patients aged 18 years or over who have one or more fingers with a Dupuytren's contracture of more than 30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints, well-defined cord(s) causing contracture, and have not undergone previous surgery for Dupuytren's on the same hand will be randomised (1:1) to treatment with either needle fasciotomy or limited fasciectomy. Participants will be followed-up for up to 6 months post surgery. Feasibility outcomes include number of patients screened, consented and randomised, adherence with treatment, completion of follow-up and identification of an appropriate patient-reported outcome measure (PROM) to use as primary outcome for a main trial. Embedded qualitative research, incorporating a QuinteT Recruitment Intervention, will focus on understanding and optimising the recruitment process, and exploring patients' experiences of trial participation and the interventions. DISCUSSION This study will assess whether a large multicentre trial comparing the clinical and cost-effectiveness of needle fasciotomy and limited fasciectomy for the treatment of Dupuytren's contractures is feasible, and if so will provide data to inform its design and successful conduct. TRIAL REGISTRATION International Standard Registered Clinical/soCial sTudy Number: ISRCTN11164292 . Registered on 28 August 2015.
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Affiliation(s)
- Eleanor Harrison
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Wei Tan
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Nicola Mills
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Alexia Karantana
- Department of Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Kirsty Sprange
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Daisy Elliott
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jane Blazeby
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - William Hollingworth
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Tim Davis
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
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Rodrigues JN, Zhang W, Scammell BE, Davidson D, Fullilove S, Chakrabarti I, Russell PG, Davis TRC. Recovery, responsiveness and interpretability of patient-reported outcome measures after surgery for Dupuytren's disease. J Hand Surg Eur Vol 2017; 42:301-309. [PMID: 27872343 DOI: 10.1177/1753193416677712] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This prospective cohort study investigated the responsiveness and interpretability of the Disabilities of the Arm, Shoulder and Hand (DASH) and Unité Rhumatologique des Affections de la Main (URAM) outcome measures for assessing recovery after fasciectomy and dermofasciectomy for Dupuytren's disease. DASH outcome scores at 1 year were significantly better than at 6 weeks, suggesting that recovery is not complete by 6 weeks. Of the 101 patients recruited to the DASH cohort, 71 completed preoperative, 6 week and 1 year postoperative DASH scores; 68 of them completed preoperative and 1 year postoperative DASH scores and an external anchor question. In the URAM cohort, 30/44 completed the preoperative and the 1 year postoperative URAM scores and the anchor question. The DASH score exhibited moderate responsiveness but poor interpretability on receiver operating characteristic curve analysis, such that a minimal important change could not be estimated. The URAM score showed acceptable responsiveness, and an MIC of 10.5 on receiver operating characteristic analysis. LEVEL OF EVIDENCE II.
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Affiliation(s)
- J N Rodrigues
- 1 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - W Zhang
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B E Scammell
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D Davidson
- 3 St John's Hospital at Howden, Livingston, UK
| | | | | | - P G Russell
- 6 Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
| | - T R C Davis
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
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28
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Rodrigues J, Zhang W, Scammell B, Russell P, Chakrabarti I, Fullilove S, Davidson D, Davis T. Validity of the Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and the Quickdash when used in Dupuytren's disease. J Hand Surg Eur Vol 2016; 41:589-99. [PMID: 26307142 DOI: 10.1177/1753193415601350] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 07/17/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study investigated aspects of the validity and reliability of the 30-item Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and its relationship with the shorter 11-item QuickDASH in patients with Dupuytren's disease.Seven hundred and fifty-nine DASH questionnaires were studied, covering pre- and postoperative patients undergoing different treatments for Dupuytren's disease. Items related to pain rose early after treatment before returning to baseline, suggesting that studying pain is relevant during postoperative recovery. Across all 759 sets of responses, the QuickDASH agreed closely with the DASH. In exploratory factor analysis, the DASH was not unidimensional, questioning the validity of the DASH summary score in Dupuytren's disease.Further validation of existing PROMs for use in Dupuytren's disease is needed. These data suggest that pain is a relevant symptom to study during postoperative recovery following treatment for Dupuytren's disease. LEVEL OF EVIDENCE III.
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Affiliation(s)
- J Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | - W Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - B Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - P Russell
- Pulvertaft Hand Centre, Royal Derby Hospital, Uttoxeter New Road, Derby, UK
| | | | | | - D Davidson
- St John's Hospital at Howden, Livingston, UK
| | - T Davis
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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29
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Wade R, Igali L, Figus A. Skin involvement in Dupuytren's disease. J Hand Surg Eur Vol 2016; 41:600-8. [PMID: 26353945 DOI: 10.1177/1753193415601353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 07/17/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Whether the palmar skin has a role in the development, propagation or recurrence of Dupuytren's disease remains unclear. Clinical assessment for skin involvement is difficult and its correlation with histology uncertain. We prospectively biopsied the palmar skin of consecutive patients undergoing single digit fasciectomy (for primary Dupuytren's disease without clinically involved skin) and dermofasciectomy (for clinically involved skin or recurrence) in order to investigate this relationship. We found dermal fibromatosis in 22 of 44 patients (50%) undergoing fasciectomy and 41 of 59 patients (70%) undergoing dermofasciectomy. Dermal fibromatosis appeared to be associated with greater preoperative angular deformity, presence of palmar nodules and occupations involving manual labour. Dermal fibromatosis exists in the absence of clinical features of skin involvement and we hypothesize that the skin may have a greater role in the development and propagation of Dupuytren's disease than previously thought. LEVEL OF EVIDENCE III.
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Affiliation(s)
- R Wade
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - L Igali
- Norfolk and Waveney Cellular Pathology Network, Cotman Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - A Figus
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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30
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Warwick D, Worsley P, Graham D. Re: Akhavani MA, McMurtrie A, Webb M, Muir L. A review of the classification of Dupuytren's Disease. J Hand Surg Eur. 2015, 40: 155-65 and Rodrigues JN, Zhang W, Scammell BE, Davis TRC. What patients want from the treatment of Dupuytren's Disease--is the Unité Rhumatologique des Affections de la Main (URAM) scale relevant? J Hand Surg Eur. 2015, 40: 150-4. J Hand Surg Eur Vol 2015; 40:544. [PMID: 26002706 DOI: 10.1177/1753193415583625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D Warwick
- University Hospital Southampton, University of Southampton, UK
| | - P Worsley
- University Hospital Southampton, University of Southampton, UK
| | - D Graham
- University Hospital Southampton, University of Southampton, UK
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31
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Affiliation(s)
- T R C Davis
- Trauma and Orthopaedics, Nottingham University Hospitals, Nottingham, UK
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