Abstract
BackgroundBasal thumb joint osteoarthritis (OA) is a common painful condition of the hand often treated surgically if non-operative care does not provide sufficient pain relief. Many instruments are available to measure pain for this condition including single item and multidimensional measures. To inform our choice of instrument for the purpose of evaluating the value of surgery for people with thumb OA, the aim of this study was to compare the longitudinal validity and signal to noise ratio of a single item numeric rating scale (NRS) for pain and the Patient-rated Wrist and Hand Evaluation (PRWHE) pain subscale, and to assess if recall period affects longitudinal validity of the NRS pain and reported pain levels.MethodsWe invited 52 patients referred for surgical treatment of basal thumb joint OA to participate in this study. All wore a splint for six weeks followed by surgery. Pain during the past day, week, and month and the PRWHE were collected at baseline, operation day, and 3, 6, 9 and 12 months after surgery. Responsiveness was assessed with two methods: 1) using participant-reported global improvement and PRWHE function subscale as external anchors (longitudinal validity) and 2) comparing Standardized Response Means (SRM).ResultsThe Spearman’s ρ between PRWHE pain and participant-reported global improvement was better (0.71) compared with NRS past day (0.55), past week (0.62), or past month (0.59). Similar findings were found with PRWHE function as anchor (Pearson’s r for PRWHE pain 0.78; NRS past day 0.68; past week 0.73; past month 0.69). The SRM of PRWHE pain subscale (2.8) and NRS past week (2.9) outperformed pain past day (2.3) and month (2.4). Mean pain was 0.3 points (on a 0 to 10 scale) worse during past week when compared with past day and 0.3 worse during past month than during past week.ConclusionsAll studied pain measures captured the change in pain over time. For clinical trials, we recommend PRWHE pain subscale or NRS past week due to their better signal noise ratio.Trial registrationRetrospectively registered.
Highlights
Basal thumb joint osteoarthritis (OA) is a common painful condition of the hand often treated surgically if non-operative care does not provide sufficient pain relief
The aim of this study was to determine 1) if change in Patient-rated Wrist and Hand Evaluation (PRWHE) pain subscale correlates better than a single item pain numeric rating scale (NRS) with participant-reported global improvement or hand function following treatment; 2) if the PRWHE pain subscale has a better signal to noise ratio than the single item pain NRS; and 3) if the recall period affects the longitudinal validity of single item NRS or 4) self-reported mean pain levels of a single item NRS pain in an observational cohort of participants who underwent sequential splinting surgical intervention for basal thumb joint OA
PRWHE pain subscale and NRS past week had best signal to noise ratio translating into greater precision of treatment estimates in clinical trials making them best options for research use
Summary
Basal thumb joint osteoarthritis (OA) is a common painful condition of the hand often treated surgically if non-operative care does not provide sufficient pain relief. Anti-inflammatory drugs, intra-articular glucocorticoid injections and various orthoses can be used for pain relief These treatments, may not mitigate symptoms sufficiently, and in those cases surgery – most commonly removal of the trapezoid bone (trapeziectomy) – is used to relieve pain. Single item instruments can only measure one dimension of pain, such as its intensity, and they cannot capture different aspects of the pain experience such as its fluctuation, frequency and quality [9]. Another potential issue with pain questions is the recall period, which is often defined as current pain, pain during the past 24 h, or past week
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