Cochin Hand Function Scale Research Articles

Splint for Base-of-Thumb Osteoarthritis

Some guidelines recommend splinting for base-of-thumb osteoarthritis, despite lack of evidence of efficacy. To assess the efficacy and acceptability of a splint for base-of-thumb osteoarthritis. Multicenter, randomized trial. Randomization was computer-generated, and allocation was concealed by faxing centralized treatment assignment to investigators at the time of enrollment. Patients and investigators were not blinded to assignment, and patients self-reported outcomes. 2 tertiary care hospitals in France. 112 patients (101 women) with base-of-thumb osteoarthritis. Custom-made neoprene splint (n = 57) or usual care (n = 55). Primary outcome was change in pain level assessed on a visual analogue scale (VAS) (range, 0 to 100 mm) from baseline to 1 month. Secondary outcomes were change in measures of hand disability at 1 month and change in pain level and measures of disability at 12 months. Tolerance and adherence with the splint were recorded. At 1 month, no difference in change occurred in pain level from baseline in the intervention and control groups (adjusted mean change, -10.1 vs. -10.7; between-group difference, 0.6 [95% CI, -7.9 to 9.1]; P = 0.89). Disability was assessed by the Cochin Hand Function Scale score (range, 0 to 90) or patient-perceived disability (VAS, 0 to 100 mm). At 12 months, change in pain from baseline was greater in the intervention group than in the control group (adjusted mean change, -22.2 vs. -7.9; between-group difference, -14.3 [CI, -23.4 to -5.2]; P = 0.002). The Cochin Hand Function Scale score was -1.9 versus 4.3 (between-group difference, -6.3 [CI, -10.9 to -1.7]; P = 0.008) and patient-perceived disability was -11.6 versus 1.5 (between-group difference, -13.1 [CI, -21.8 to -4.4]; P = 0.003). At 12 months, 86% of the intervention group had worn the splint for more than 5 nights a week, and no adverse effects were observed. Patients, health care providers, and outcome assessors were not blinded. For patients with base-of-thumb osteoarthritis, wearing a splint had no effect on pain at 1 month but improved pain and disability at 12 months. Programme Hospitalier de Recherche Clinique National.

Impact of digital ulcers on disability and health-related quality of life in systemic sclerosis

Objective:To assess the impact of digital ulcers (DUs) on disability and health-related quality of life (HRQoL) in systemic sclerosis (SSc).Methods:Two hundred and thirteen patients with SSc were evaluated at four...

Long-term use of a splint at night reduces pain and disability in people with osteoarthritis at the base of the thumb

Does use of a splint at night improve pain and disability in people with osteoarthritis at the base of the thumb (OABT)? Randomised, controlled trial with concealed allocation. Two tertiary hospitals in France. Patients were recruited from tertiary clinics or private practices. Inclusion criteria were pain at the base of the thumb 30 mm or greater on a visual analogue scale (VAS) from 0 (no pain) to 100 mm, age 45–75 years, radiographic evidence of OABT, and either trapeziometacarpal joint enlargement or closure of the first web. Post-traumatic osteoarthritis, inflammatory and crystal arthritis, neurological conditions, trauma, surgery and collagen diseases were exclusion criteria. Randomisation of 112 participants allotted 57 to the intervention group and 55 to a control group. Both groups received usual care, at the discretion of the general practitioner or rheumatologist. In addition, a rigid splint was custom made for participants in the intervention group by an occupational therapist. It covered the base of the thumb and the thenar eminence but not the wrist. These participants were advised to wear it at night for one year, and encouraged to contact the therapist if they felt the splint needed adjustment, if pain increased while wearing the splint, or if they had adverse effects, eg, skin erosion. The primary outcome was the change in pain on the VAS at one month. Secondary outcome measures were disability at one month, and pain and disability at twelve months. Disability was measured with Cochin Hand Functional Scale from 0 (low disability) to 90, and on another VAS (100 mm = high perceived disability). Participants also rated their perceived global improvement and underwent clinical and radiological measures: pinch strength, pain during pinch, thumb mobility, closure of the first web, and blinded assessment of radiological progression of osteoarthritis. 98 (87%) participants completed the study. No significant between-group differences in any outcomes were observed at one month. At 12 months, however, the intervention group showed significantly greater reductions in pain (by 14 mm, 95% CI 5 to 23), in Cochin scores (by 6 points, 95% CI 2 to 11), and in perceived disability (by 13 mm, 95% CI 4 to 22). The groups did not significantly differ on the remaining secondary outcomes. For patients with OABT, night splinting had no effect on pain and disability at 1 month but both improved at 12 months.

A modified hand anatomic index to assesss hand deformity in scleroderma

We recently described a hand anatomic index (HAI, a simple and reliable quantitative measure of hand deformity) in scleroderma and showed that it clearly distinguished patients with increasing hand deformity and separated patients with diVuse scleroderma from those with limited scleroderma [1]. Furthermore, the HAI correlated signiWcantly with measures of functional impairment. We now wish to report a modiWed HAI (mHAI) which appears to be more informative than the original HAI. This new mHAI additionally incorporates a measure of the severity of the Xexion deformity of the third digit into the original HAI. The new index is derived from the equation (maximal lateral hand height/extended hand span) £ (distance of volar arch of third digit (from distal wrist crease to tip of Wnger)/direct volar distance of third digit) £ 10. It can be quickly and simply measured in the clinic setting and a normal range has been determined. The mHAI was measured in 19 scleroderma patients registered on the South Australian Scleroderma Register [2] and compared with a qualitative measure of structural hand deformity (as assessed by two independent rheumatologists [1]) and with the validated Cochin Hand Functional Scale (CHFS), an 18 point questionnaire that accurately reXects hand function and has good construct validity [3]. The mHAI was signiWcantly elevated in patients with scleroderma, separated patients with limited disease from diVuse disease (Fig. 1) and correlated signiWcantly with the measure of structural hand deformity (r = 0.94, P = 0.00001) and with the CHFS (r = 0.69, P = 0.003). The mHAI with stronger correlation coeYcients appears to be more informative than the original HAI. We conclude that the measurement of the mHAI in scleroderma produces a reliable and objective measure reXecting the degree of hand deformity and functional impairment, and might provide a valid clinical outcome

Patient preference disability questionnaire in systemic sclerosis: A cross‐sectional survey

To assess patient priorities concerning disability in systemic sclerosis (SSc). A total of 150 SSc patients (22 men) fulfilling the American College of Rheumatology and/or LeRoy and Medsger criteria for SSc were evaluated by the McMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), Karnofsky performance status (KPS), Cochin Hand Function Scale, Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale, Mouth Handicap in SSc (MHISS) scale, and global perception regarding their health status. Correlations between scores were analyzed using Spearman's coefficient. Logistic regression analysis was used to determine factors associated with patients' global perception of their health. Of the patients investigated, 81 (54%) had limited cutaneous SSc, 65 (43.3%) diffuse SSc, and 4 (2.7%) limited SSc. The 3 disability domains most often cited were walking (82 patients [54.6%]), housekeeping (67 patients [44.6%]), and sport activities (59 patients [39.3%]). The MACTAR score correlated moderately with KPS (r = 0.58) but only weakly with the HAQ score (r = 0.38). In multivariate analysis, 2 factors were associated with patients' negative global perception of their health status: KPS (odds ratio [OR] 1.07, 95% confidence interval [95% CI] 1.00-1.15) and MHISS score (OR 0.93, 95% CI 0.88-0.99). For assessing SSc patient priorities concerning disability, the MACTAR has acceptable construct validity. Its weak correlation with the HAQ suggests that it adds useful information on disability.

398 SPLINT FOR BASE OF THUMB OSTEOARTHRITIS: A 12 MONTH RANDOMIZED CONTROLLED STUDY

Purpose: Splints for base of the thumb osteoarthritis (OA) are recommended in international guidelines but evidence for their efficacy in randomized trials are missing. The objective was to assess the efficacy and acceptability of splints for base of the thumb OA. Methods: Study design: Randomized controlled trial Setting: Two tertiary care hospitals in France Patients: 109 (94 women) patients with base of thumb carpometacarpal joint OA Intervention: 56 patients received custom-made neoprene splint and usual care (intervention) and 53 usual care (control) Outcome measures: Primary outcome was pain assessed on Visual Analog Scale (VAS, range 0-100) at 12 month follow-up. Secondary outcome measures were pain at 1 and 6 month, disability assessed by the Cochin Hand Function Scale (CHFS, range 0-90) and pinch strength at 1, 6, and 12 month. Intentionto-treat analyses were performed. Results: Pain at 12 month follow-up had significantly decreased in both groups (from 45.5±20.0mm to 23.6±22.8mm in intervention group, p= 0.0001, and from 47.7±20.0 to 39.2±24.2, p=0.02 in control group), and an inter-group difference was observed (-22.1±25.7 in intervention, and -8.8±25.2 in control group, p=0.006). Pain inter-group difference was also observed at 6 month but not at 1 month. Disability at 12 month was not significantly decreased in the intervention group (-2.0±12.9, p=0.19) but was significantly increased in the control group (3.4±11.3, p=0.04), and an inter-group difference was observed (p=0.03). Pinch strength was not modified in intervention and control group. In the intervention group, 86% of patients wore their splint at least 5 nights a week at 12 month and no adverse effect was observed. Conclusions: Our results suggest that splints are useful, safe, and acceptable for patients with thumb carpometacarpal joint OA.

Development and validation of a scale for mouth handicap in systemic sclerosis: the Mouth Handicap in Systemic Sclerosis scale

Objective:To develop and assess the reliability and construct validity of a scale assessing disability involving the mouth in systemic sclerosis (SSc).Methods:We generated a 34-item provisional scale from mailed responses of...

Assessing disability and quality of life in systemic sclerosis: Construct validities of the Cochin Hand Function Scale, Health Assessment Questionnaire (HAQ), Systemic Sclerosis HAQ, and Medical Outcomes Study 36‐Item Short Form Health Survey

To assess the construct validity of the Cochin Hand Function Scale (CHFS) and the relevance of using aggregate scores for the scleroderma Health Assessment Questionnaire (sHAQ) and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) in systemic sclerosis (SSc). We evaluated 50 patients with SSc (mean +/- SD age and disease duration 54 +/- 12 years and 9 +/- 8 years, respectively), of which 26 had limited cutaneous SSc (lcSSc) and 23 diffuse SSc (dSSc). Quality of life was assessed by the SF-36, global disability by the Health Assessment Questionnaire (HAQ) and sHAQ, and hand disability by the CHFS. Construct validity was assessed by convergent and divergent validity (Spearman's rank correlation coefficient) and factor analysis. The CHFS had good construct validity and its total score explained 75% of the variance of the HAQ. The HAQ had better construct validity than the aggregate sHAQ and their scores correlated well (r = 0.88). The aggregate sHAQ was no better than the HAQ in discriminating between lcSSc and dSSc. SF-36 physical and mental components had acceptable convergent and divergent validity. Factor analysis of the 8 subscales extracted 3 factors explaining 72% of the variance, which differed from the a priori stratification with physical and mental subscales extracted in the same factor. In patients with SSc, the CHFS has good construct validity, the HAQ should be preferred over the aggregate sHAQ for assessing physical functioning, and use of SF-36 physical and mental components aggregate scores is questionable.

Quantitative and qualitative assessment of hand function and deformity in systemic sclerosis

Dear Sir, We recently described a hand anatomic index (HAI—a simple and reliable quantitative measure of hand deformity) in scleroderma and showed that it clearly distinguished patients with increasing hand deformity and separated patients with diVuse scleroderma from those with limited scleroderma [1]. Furthermore the HAI correlated signiWcantly with measures of functional impairment and it was estimated that the HAI accounted for approximately 25% of the total global disability [as measured by the health assessment questionnaire (HAQ)]. We now report that the comparison of the HAI with the Cochin Hand Functional Scale (CHFS) an 18 point questionnaire that has recently been shown to accurately reXect hand function in scleroderma and has good construct validity [2, 3]. Using the same 25 patients with scleroderma as in our original description [1, 4] we have now compared the HAI with the CHFS, a HAQ and the pre hensile hand grip ability test (GAT) [5]. Of particular interest was the signiWcant correlation between HAI and CHFS (P = 0.0008, Fig. 1). This correlation was maintained in both the diVuse and limited sub group (Table 1). We conclude that in the assessment of hand function in scleroderma, a simple quantitative measure such as the HAI complements a qualitative measure such as the CHFS. In addition both indices may be well suited in providing a useful outcome measure in scleroderma and in monitoring response to therapeutic interventions. Yours sincerely AJ Roberts-Thomson, Occupational Therapist and PJ Roberts-Thomson, Chairman Department of Immunology Allergy and Arthritis, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia A. J. Roberts-Thomson · P. J. Roberts-Thomson (&) Department of Immunology Allergy and Arthritis, Flinders Medical Centre, Bedford Park, SA 5042, Australia e-mail: peter.roberts-thomson@Xinders.edu Fig. 1 Correlation of the hand anatomic index with the Cochin hand functional scale (P = 0.0008) 0 1 2 3 4 5

Disability induced by hand osteoarthritis: are patients with more symptoms at digits 2–5 interphalangeal joints different from those with more symptoms at the base of the thumb?

Background: The contribution of osteoarthritis (OA) at the base of the thumb (BT) and digits 2–5 interphalangeal joints (IP) to disability in the hand has never been assessed. Objectives: To evaluate and compare disability in patients with clinical hand OA and more severe symptoms at BT or IP. Design: Observational, prospective, correlational. Setting: Rheumatology and rehabilitation departments in two tertiary care teaching hospitals. Participants: One hundred and sixteen patients (107 women, mean age 62±7 years) fulfilling the American College of Rheumatology criteria for OA in the hand, with more symptomatic BT (67 patients) or IP (49 patients). Main outcome measure: Disability assessment with Cochin hand functional scale (CHFS) was the primary outcome. Assessment of impairment by the visual analog scale of pain (VAS pain), Ritchie articular index (RAI), modified Kapandji index (mKI), Kallman radiological classification and handicap assessment with visual analog scale (VAS Hd) was the secondary outcome. Group comparisons were assessed by use of Student’s t-test for quantitative variables and Chi-square test for categorical variables. Results of the CHFS analysis were assessed by factorial analysis followed by Varimax rotation. Correlation between scores of disability, impairment, and handicap measures were calculated with use of Spearman rank correlation coefficient. Results: Demographic data, disease duration, and level of global pain were similar between the BT and IP groups. The BT and IP groups did not differ significantly according to disability and handicap level ( P=0.42 and P=0.94 for CHFS total score and VAS Hd, respectively). Factor analysis of the CHFS revealed similar results for the two groups of patients, especially for the first extracted factor. Disability scores correlated best with global hand pain ( r=0.65) in the BT group and with RAI scores ( r=0.71) in the IP group. Conclusions: Disability and perceived handicap levels are comparable in clinical hand OA patients with more symptomatic BT or IP. These two groups should not be considered different during trials assessing treatments for hand OA when the primary outcome measure assesses disability.

Reliability, validity, and sensitivity to change of the Cochin hand functional disability scale in hand osteoarthritis

Objective To assess the reliability, validity and sensitivity to change of the Cochin hand functional scale in hand osteoarthritis (OA).Background The Cochin hand functional disability scale has been validated in rheumatoid arthritis.Design Patients with hand OA according to Altman's criteria were included. Impairment outcome measures (VAS of pain, hand score of tenderness, clinical hand score of impairment, Kallman's radiographic scale), functional disability measures [Cochin scale, Revel's functional index (RFI), Dreiser's functional index (DFI)] and patients' perceived handicap (VAS) were recorded twice, at baseline and at a 6-month follow-up visit. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Construct (convergent and divergent) validity was investigated using the Spearman rank correlation coefficient and a factor analysis was performed. Sensitivity to change was assessed using the effect size (ES) and the standardized response mean (SRM), and the non-parametric Spearman rank correlation coefficient (r) was used to assess the correlation between quantitative variable changes and patient's overall opinion.Results89 patients (8 males, mean age 63 years) were included. Interobserver reliability was excellent (ICC=0.96). The Bland and Altman method showed no systematic trend. Correlations of the Cochin scale score with RFI (r=0.86), DFI (r=0.87), VAS of handicap (r=0.67), VAS of pain (r=0.54), tenderness (r=0.51), clinical impairment (r=0.32), and Kallman's radiographic scale (r=0.13) indicated a good construct validity. Factor analysis extracted four main factors, accounting for 65% of the total variance. 51 patients were evaluated at the 6-month visit. The Cochin scale score had worsened with SRM and ES values of −0.26 and −0.17 respectively. Changes in the score had one of the highest correlation (r=0.47) with the patient's overall opinion.Conclusion The Cochin hand functional disability scale which was first developed to assess the rheumatoid hand can be used to evaluate functional disability in hand OA.