The relative responsiveness of patient-rated outcome measures in evaluating clinical change after Dupuytren's surgery: A literature review and prospective observational pilot study

Abstract

Introduction Patient-rated outcome measures (PROMs) to measure upper limb activity and participation exist but there is little evidence to support their responsiveness in Dupuytren's surgery. Methods A literature review was conducted to evaluate the relative responsiveness of PROMs used in patients treated surgically for Dupuytren's contracture. A prospective observational pilot study was performed to test feasibility and clarify procedures in advance of a larger study to compare the relative responsiveness of different PROMs. The Quick Disabilities of the Arm, Shoulder and Hand ( QuickDASH), the Patient Outcomes of Surgery-Hand/Arm (POS-Hand/Arm) and the Patient Evaluation Measure (PEM) were administered to eight patients before and 12 weeks after a fasciectomy. Results The literature review identified seven studies using PROMs before and after surgery for a Dupuytren's contracture. The PROMs were the Michigan Hand Questionnaire (MHQ), the DASH and the QuickDASH. All three had moderate-to-large effect sizes and standardized response means with the MHQ showing higher responsiveness than the DASH. In the pilot study the PEM demonstrated a higher responsiveness than the POS-Hand/Arm followed by the QuickDASH. No evidence was found to support responsiveness in terms of what is clinically relevant in relation to a patient-rated external criterion. Discussion The literature review and pilot study findings justify the need and feasibility to conduct a larger study to investigate the relative responsiveness of PROMs in patients undergoing Dupuytren's surgery.