Abstract
BackgroundRheumatic diseases commonly affect joints and other structures in the hand. Surgery is a traditional way to treat hand problems in inflammatory rheumatic diseases with the purposes of pain relief, restore function and prevent progression. There are numerous measures to choose from, and a combination of outcome measures is recommended. This study evaluated if instruments commonly used in rheumatologic clinical practice are suitable to measure outcome of hand surgery and to identify time points relevant for follow-up.MethodsThirty-one patients (median age 56 years, median disease duration 15 years) with inflammatory rheumatic disease and need for post-surgical occupational therapy intervention formed this pilot study group.Hand function was assessed regarding grip strength (Grippit), pain (VAS), range of motion (ROM) (Signals of Functional Impairment (SOFI)) and grip ability (Grip Ability Test (GAT)). Activities of daily life (ADL) were assessed by means of Disabilities of the Arm, Shoulder and Hand Outcome (DASH) and Canadian Occupational Performance Measure (COPM). The instruments were evaluated by responsiveness and feasibility; follow-up points were 0, 3, 6 and 12 months.ResultsAll instruments showed significant change at one or more follow-up points. Satisfaction with activities (COPM) showed the best responsiveness (SMR>0.8), while ROM measured with SOFI had low responsiveness at most follow-up time points. The responsiveness of the instruments was stable between 6 and 12 month follow-up which imply that 6 month is an appropriate time for evaluating short-term effect of hand surgery in rheumatic diseases.ConclusionWe suggest a core set of instruments measuring pain, grip strength, grip ability, perceived symptoms and self-defined daily activities. This study has shown that VAS pain, the Grippit instrument, GAT, DASH symptom scale and COPM are suitable outcome instruments for hand surgery, while SOFI may be a more insensitive test. However, the feasibility of this protocol in clinical practice awaits prospective studies.
Highlights
Rheumatic diseases commonly affect joints and other structures in the hand
This study has shown that VAS pain, the Grippit instrument, Grip Ability Test (GAT), DASH symptom scale and Canadian Occupational Performance Measure (COPM) are suitable outcome instruments for hand surgery, while Signals of Functional Impairment (SOFI) may be a more insensitive test
Considering the high standardized mean response (SMR) values of several of the instruments and their stability at 6 and 12-month follow-up, and in view of the dropping of some patients at the 12-month follow-up, we propose that an acceptable time to follow up short-term effect from hand surgery in rheumatic diseases is at 6 months
Summary
Rheumatic diseases commonly affect joints and other structures in the hand. Surgery is a traditional way to treat hand problems in inflammatory rheumatic diseases with the purposes of pain relief, restore function and prevent progression. This study evaluated if instruments commonly used in rheumatologic clinical practice are suitable to measure outcome of hand surgery and to identify time points relevant for follow-up. Rheumatic diseases commonly affect joints and other structures in the hand. Hand surgery has mainly been evaluated by objective measures such as range of motion (ROM), prosthesis survival and grip strength and subjectively such as pain, function and disability [3,4,5,6,7,8]. Hand function assessments on the body functions and structures level include measures of ROM, grip ability, grip strength, pain and sensation, while self-reported questionnaires, interviews and observations are used to highlight activity limitations
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