AB0665 Turkish validation of the ‘Cochin (Duruoz) hand function scale’ in patients with systemic sclerosis

Abstract

BackgroundHand impairment is the main challenge for patients with systemic sclerosis (SSc) and may arise from inflammatory arthritis, joint contractures, tendon friction rubs (TFRs), Raynaud’s phenomenon (RP), digital ulcers (DU), puffy hands, skin sclerosis, acro-osteolysis, or calcinosis. There is not yet a tool which can objectively measure hand functions in scleroderma patients both in daily practice and for research purposes.ObjectivesTo adapt and validate the Turkish version of Cochin (Duruoz) hand function scale (CHFS) and contribute to the development of outcome measures with good metric properties assessing hand disability in SSc (1).MethodsNinety one consecutive patients who fulfilled the 2013 ACR/EULAR SSc classification criteria for SSc were enrolled in the study. Disease related involvements and physical examination findings of the patients were recorded. Participants filled out the self-administered questionnaire of the Turkish version of the CHFS. Modified Rodnan skin scores of the patients were calculated, bilateral hand extension and fingertip-palm distances were measured, grip strength was evaluated with hydrolic hand dynamometer. We evaluated convergent validity by testing the correlation between CHFS and related components of Short Form 36 version 2 (SF-36v2) and Scleroderma Health Assessment Questionnaire (sHAQ). Discriminant validity was evaluated by stratifying patients according to hand related involvements and disease subtypes. Thirty of the patients re-filled the CHFS questionnaire two weeks after the first visit.ResultsDemographic data and disease characteristics of the patients shown in Table 1. For the convergent validity, the CHFS significantly correlated with the sHAQ, Raynaud visual analog scale (VAS), digital ulser VAS, overall disease severity VAS, hand grip, hand extension measurements and fingertip-palm distances (Table 2). The instruments could discriminate between disease subtypes (10[0-24] / 2[0-19], p=0,038) and between the patients with and without contractures (11[0-24] / 2[0-9], p=0,023) for the discriminant validity. We demonstrated high reproducibility for CHFS (ICC = 0,894, 95% confidence interval = 0,779-0,949).Table 1.Demographic data and disease characteristics of the patientsAge (years)55.4±10.7Total mRSS6 ±5.1Sex (female)79 (%86.8)Right hand total mRSS2.2±1.7Diseasesubtype (diffuse)25(%27.5)Left hand total mRSS2.2±1.7PAH6 (%6.7)Right hand fingertip-palm distance (cm)1.3±1ILD41 (%45.6)Left hand fingertip-palm distance (cm)1.2±1.2ANA positivity88 (%96.7)Right hand extension (cm)17.7±2.5Arthritis1 (%1.1)Left hand extension (cm)18±2.3Sclerodactly79 (%86.8)Right hand hydrolic dynomometer pressure (kg)21.7±8.6Contracture26 (%28.6)Left hand hydrolic dynomometer pressure (kg)20.4±7.6Amputation12 (%13.2)SF 36 physical function51.7 ±24Active digitalulcer3 (%3.2)SF 36 role limitations due to physical health52±42Digitalulcerscar23 (%25.3)SF 36 role limitations due to emotional problems57.3±33.4Calcinosis10 (%11)SF 36 energy/fatigue46±23.3CHFS score3 [0-13]SF 36 emotional well-being60.4±21.2Raynaud’s phenomenon VAS0.8±0.9SF 36 social functioning70±26Digital ulcer VAS0.5±0.9SF 36 pain64±30Overall disease severity VAS0.9±0.9SF 36 general health44.3±21.7PAH: Pulmoner arterial hypertension, ILD: Interstitial lung disease, ANA: Anti nuclear antibody, CHFS: Cochin hand function scale, mRSS: Modified Rodnan skin score, VAS: visual analog scale, SF36: short form 36ConclusionThe Turkish version of the CHFS met the requirements of validity and reproducibility. With this study, we validated a scale which will contribute to the development of outcome measures with good metric properties assessing hand disability, disease evolution and treatment efficacy in our SSc patients.