RESUMO
The perspective of the patient in measuring the outcome of their hand treatment is of key importance. We developed a hand-specific patient-reported outcome measure to provide a means to measure outcomes and experiences of care from the patient perspective, that is, HAND-Q. METHODS: Data were collected from people with a broad range of hand conditions in hand clinics in six countries between April 2018 and January 2021. Rasch measurement theory analysis was used to perform item reduction and to examine reliability and validity of each HAND-Q scale. RESULTS: A sample of 1277 patients was recruited. Participants ranged in age from 16 to 89 years, 54% were women, and a broad range of congenital and acquired hand conditions were represented. Rasch measurement theory analysis led to the refinement of 14 independently functioning scales that measure hand appearance, health-related quality of life, experience of care, and treatment outcome. Each scale evidenced reliability and validity. Examination of differential item functioning by age, gender, language, and type of hand condition (ie, nontraumatic versus traumatic) confirmed that a common scoring algorithm for each scale could be implemented. CONCLUSIONS: The HAND-Q was developed following robust psychometric methods to provide a comprehensive modular independently functioning set of scales. HAND-Q scales can be used to assess and compare evidence-based outcomes in patients with any type of hand condition.
RESUMO
Purpose: The purpose of this randomized prospective cohort study was to assess the acceptability of administering patient-reported outcome measures (PROMs) in the waiting room of hand clinics. Methods: Participants were randomly assigned to receive the Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, or Michigan Hand Questionnaire (MHQ). Acceptability was measured in terms of data quality, participation, and retention rates. Data quality was determined by the number of incomplete questionnaires, unanswered questions, and unscorable questionnaires. Most frequently unanswered questions were identified. The participant-reported time taken to complete the questionnaires was collected. Results: A total of 491 participants enrolled in this study. A participation rate of 85% with a retention rate of 94% indicated that patients found the administration of PROMs in the waiting room of the clinic to be acceptable. The proportion of missing data for each questionnaire was 4.2% for PRWHE, 3.9% for DASH and 6.3% for MHQ. Whether a questionnaire could be used to generate a score was determined by the scoring rules of each instrument. The proportion of questionnaires that were not completed sufficiently for a score to be generated was 0% for PRWHE, 9% for DASH, and 4% for MHQ. No association was found between whether a questionnaire could generate a score and participants' sex, age, or the nature of the condition. Over 80% of participants reported taking 10 minutes or less to complete the questionnaire. Conclusions: This study shows that hand clinic patients will complete PROMs while waiting for the clinical review. The PRWHE and MHQ groups demonstrated good usability, because less than 5% were unable to produce a score. The usability of the DASH group was lower, because 9% were unable to be scored. This indicates that PRWHE and MHQ are more suitable than DASH to application in a hand clinic setting. Type of study/level of evidence: Therapeutic III.
RESUMO
The authors present a case of spontaneous delayed periprosthetic breast haematoma in a woman taking Rivaroxaban.