Patients' perspectives of collagenase injection or needle fasciotomy and rehabilitation for Dupuytren disease, including hand function and occupational performance.

PURPOSE: To describe patients' perspectives of collagenase injection or needle fasciotomy for Dupuytren disease (DD) including hand therapy, and their view of hand function and occupational performance. MATERIALS AND METHODS: Interviews were performed with twelve patients who had undergone non-surgical treatment and rehabilitation for DD. Data was analysed using a problem-driven content analysis using the model of Patient Evaluation Process as a theoretical framework. RESULTS: The participants' previous experiences influenced their expectations of the upcoming treatment and they needed information to be prepared for treatment. Treatment and rehabilitation had a positive impact on daily life and were regarded as effective and simple with quick recovery. However, there could be remaining issues with tenderness or stiffness. The participants expressed their belief in rehabilitation and how their own efforts could contribute to an improved result. Despite concerns about future recurrence participants described increased knowledge and sense of control regarding future needs. CONCLUSION: Undergoing a non-surgical treatment and rehabilitation process for DD was regarded as quick and easy and can meet the need for improved hand function and occupational performance. Taking responsibility for one's own rehabilitation was considered to influence the outcome positively. The theoretical framework optimally supported the exploration of participants' perspective.Implications for rehabilitationTreatment of Dupuytren Disease (DD) with needle/collagenase combined with hand therapy was experienced as giving fast improvement in hand function and occupational performance.An individualized care process which satisfies the need for knowledge about the disease, prognosis, treatment options and rehabilitation can give individuals suffering from DD a sense of security.The need for active participation in the DD care process can vary and it is crucial to listen to individuals' opinions and needs.Individuals can take considerable responsibility for rehabilitation after non-surgical treatment for DD and regard it as important for the outcome.

Going beyond Activity and Participation: Development of the DIF-CHUM-A patient-reported outcome measure for individuals with Dupuytren's contracture.

STUDY DESIGN: This is a cross-sectional clinical measurement. INTRODUCTION: There are currently no Dupuytren's contracture (DC)-specific, patient-reported outcomes (PROs) that can provide a thorough clinical portrait of the patients' perceptions with regard to the execution of regular activities. PURPOSE OF THE STUDY: The purpose of this study was to present the development of the Dupuytren's contracture Impact on Function-Centre Hospitalier de l'Université de Montréal (DIF-CHUM), a DC-specific PRO. METHODS: The development process involved consultation of 45 individuals with DC and 7 health professionals, existing literature, and DC-specific PRO. RESULTS: The DIF-CHUM is composed of 2 sections: section 1, Activity and Participation includes 8 items per hand, scored on Difficulty and Change scales; section 2, General Impact includes up to 18 items, scored on Difficulty, Importance, Change and Satisfaction scales. Preliminary evidence suggests that the DIF-CHUM demonstrates good content validity. DISCUSSION: The DIF-CHUM is designed to be a patient-centered measure of Activity and Participation and Functional Competence for individuals with DC that will provide hand therapists with a unique perspective of the impact of DC on patients' lives. CONCLUSION: Further validation of the DIF-CHUM, including its scoring, is under way.

Outcome of Recurrent Surgery in Dupuytren's Disease: Comparison with Initial Treatment.

BACKGROUND: There are multiple studies about the effectiveness of primary treatment in Dupuytren's disease. However, such studies concerning treatment effectiveness of recurrent disease are scarce. Therefore, the primary aim of this study was to compare treatment effectiveness of initial and repeated surgery in patients with Dupuytren's disease. METHODS: Patients who underwent both initial and repeated treatment were selected from a prospectively maintained database. Outcome measurements consisted of finger goniometry, the Michigan Hand Outcomes Questionnaire, and complications. Treatment effectiveness was defined as improvement in extension deficit and patient-reported hand function. In addition, measurements at intake of both treatments were compared. Subgroup analyses were performed to evaluate influence of type of surgery of initial treatment on outcomes of repeated treatment. RESULTS: One hundred fourteen patients were included in the analyses. Improvement in extension deficit and Michigan Hand Outcomes Questionnaire outcomes was equal for initial and repeated treatments. Extension deficit and Michigan Hand Outcomes Questionnaire scores were worse at intake of repeated treatment compared to these outcomes at intake of initial treatment. In addition, patients who initially underwent needle fasciotomy achieved a better contracture reduction after repeated treatment. CONCLUSIONS: This study demonstrates that treatment of recurrent Dupuytren's disease is as effective as initial treatment, despite larger extension deficit and worse self-assessed hand function before undergoing repeated treatment. Complication rates were similar for initial and repeated treatments. Furthermore, needle fasciotomy for initial treatment results in better outcomes of repeated treatment compared to patients who initially underwent limited fasciectomy. These findings can be used for a more evidence-based preoperative counseling with patients with recurrent Dupuytren's disease. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Hand Function Deficiency in Patients with Dupuytren's Disease and Course of Recovery after Palmar Fasciectomy.

PURPOSE OF THE STUDY To evaluate hand function deficiency in patients with Dupuytren's disease (DD) in addition to assessing the improvement of function after palmar fasciectomy by using different hand-related questionnaires. MATERIAL AND METHODS A total of 121 hands (95 patients) underwent surgery. Disease severity was designated using Tubiana's Staging System. The Tendency of changes of Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), Patient Evaluation Measure (PEM), and Hand Function Score (HFS) scores of patients with DD undergoing palmar fasciectomy were assessed prior to, 3 months after, and 1 year after the operation. Moreover, total loss of extension (TLoE) was evaluated using a goniometer in the same time intervals. Repeated measure ANOVA Friedman's test were used. Responsiveness to clinical change was calculated by using standardized response means (SRMs). RESULTS The results showed statistically significant improvement of the originally obtained questionnaire results after 3 months for DASH and HFS and 12 months for all forms; only the PEM and DASH score significantly changed between 3 and 12 months. TLoE before surgery was 144.1 o ±99.6 o ; 3-month and 1-year after surgery: 14.3 o ±58.0 o and 19.3 o ±34.7 o respectively. SRMs for 1 year after surgery was large for PEM (1.11) and medium for DASH (0.7) and HFS (0.79). CONCLUSIONS DASH, PEM, and HFS are valuable tools to monitor the hand function of patients with DD after surgery. Key words:hand function, Dupuytren's disease, palmar fasciectomy.

Patients' needs during a surgical intervention process for Dupuytren's disease.

PURPOSE: To explore and describe clients' needs during a surgical intervention process for Dupuytren's disease. MATERIALS AND METHODS: Design: Interview study with 21 men undergoing surgical intervention for Dupuytren's disease. Qualitative content analysis was performed with the model of Patient Evaluation Process as a theoretical framework. RESULTS: The primary reason for seeking medical care was to receive an intervention to improve hand function. The need for knowledge was evident during the care process, and was connected to involvement in decision-making. During surgery and rehabilitation, participants needed support with pain relief, a sense of security, support for self-care, or sick leave. There was also a need for participation in the evaluation and improvement of care. Clients' life situations contributed to the occurrence of needs or were a resource for handling them. Depending on patient character, clients handled their perceived needs differently. CONCLUSIONS: Clients' needs during a surgical intervention process include needs for improvement of hand function, knowledge, and support during treatment, and participation in evaluation. Clients' needs change during the care process and can be influenced by their life situation or their character. The identified needs ought to be included in quality assessments from the carers' perspective, to ensure that important needs of the clients are met by the surgical intervention process. Communication and interaction between client and health care provider is a key aspect of fulfilling clients' needs. Implications for rehabilitation Patients have need for knowledge throughout the care process: about the disease, risk factors, treatment options, practical and medical information related to the treatment and recovery, and about the care process as a whole. Need for knowledge is closely connected to patients' experience of being involved in decision making. Patients need support with both general human and specific medical issues during surgery and rehabilitation. Patients' needs change during the care process and can be influenced by the patient's life situation or character. From the carers' perspective, the identified needs ought to be included in quality assessments to ensure that important needs of the clients are met by the surgical intervention process.

Short-term efficacy and safety of collagenase injection for Dupuytren's contracture: Therapy protocol for successful outcomes in a clinical setting.

PURPOSE: To assess the short-term efficacy and safety of collagenase injection for Dupuytren's contracture and of our post-injection therapy protocol alternative the instruction of phase III studies at clinical setting. METHODS: The retrospective study included 23 fingers of 21 hands of 18 patients for primary metacarpophalangeal (MP) joints and 11 fingers of 10 hands of 10 patients for primary proximal interphalangeal (PIP) joints with Dupuytren's contracture who were treated with 0.58 mg collagenase Clostridium histolyticum (CCH) injections at our hospital consecutively from September 2015 to October 2017. The mean age of the patients was 73.0 years (range, 57-88) for primary MP joints and 70.7 years (61-81) for primary PIP joints. Following standard CCH injection and manipulation on the next day, certified hand surgeons evaluated and treated each patient based on a defined 4-week therapy protocol that consisted of performing finger exercises during the day and wearing static extension splint at night for all cases, and of wearing Capener dynamic splint intervention to address severely contracted PIP joints. We measured the degree of contracture at baseline, immediately, 4 weeks, and 12 weeks after the last manipulation. RESULTS: More improvement of contracture was seen in the MP joints than in the PIP joints. For the five fingers severely contracted and treated with Capener splint intervention, the mean passive PIP joint contracture was 62.0° at baseline, 21.0° immediately, further improved to 6.0° by 4 weeks, and maintained 8.0° by 12 weeks after the last manipulation. The adverse events were mild-to-moderate local reactions in the injected hand. CONCLUSIONS: The clinical efficacy and safety of CCH were confirmed in a clinical setting similar to phase III studies. The improvement of 4-week-intervention was maintained at 12 weeks after the last manipulation. Severely contracted PIP joints could benefit from Capener splint intervention.

Range of motion, postoperative rehabilitation and patient satisfaction in MCP and PIP joints affected by Dupuytren Tubiana stage 1-3: collagenase enzymatic fasciotomy or limited fasciectomy? A clinical study in 52 patients.

INTRODUCTION: In Switzerland, collagenase Clostridium histolyticum therapy (CCH) for Dupuytren's disease was introduced in 2011. This study analyzes possible differences between CCH and limited fasciectomy (LF) in terms of range of motion, patient satisfaction and postoperative rehabilitation. MATERIALS AND METHODS: This retrospective study included 52 patients with Dupuytren's disease stage 1-3 according to Tubiana, treated with CCH or LF between January 2012 and December 2013. Complications were analyzed for each patient. The contracture of each treated joint measured on average at the 3 months and up to 2 years follow-up was compared with the preoperative values. The Michigan Hand score was evaluated at 2 years and the patients were asked to subjectively evaluate the outcome of the treatment and whether they would repeat it if necessary. Postoperative rehabilitation was also precisely quantified. RESULTS: 11 minor complications were reported for a complication rate of 29% in the CCH group. No major complications were reported in both groups. In the CCH group, mean MCP joint contracture was, respectively, 44° ± 20°, 9° ± 2° (gain of mobility compared to the preoperative situation 35°, P < 0.001), and 10° ± 3° (gain 34°, P < 0.001), respectively, before, at the 3 months' control and at the 2-year clinical control. In the LF group, mean MCP joint contracture was, respectively, 30° ± 21°, 2° ± 0.5° (gain 28°, P < 0.001), and 1° ± 0.5° (gain 29°, P < 0.001) for the same control periods. In the CCH group, mean PIP joint contracture was, respectively, 51° ± 21°, 18° ± 3° (gain of mobility compared to the preoperative situation 33°, P < 0.001), and 32° ± 4° (gain 19°, P < 0.001), respectively, before, at the 3 months' control and at the 2-year clinical control. In the LF group, mean PIP joint contracture was, respectively, 30° ± 20°, 2° ± 0.5° (gain of mobility compared to the preoperative situation 28°, P < 0.001), and 11° ± 4° (gain 19°, P < 0.001) for the same control periods. Outcomes were compared across the LF and CCH groups: surgery performed better than collagenase for PIP joint treatment at early (P < 0.001) and 2-year follow-up (P = 0.004) controls. However, patient satisfaction was higher in the CCH group: 92% were satisfied or very satisfied of the treatment compared to 71% in the LF group. All patients would reiterate the treatment in the CCH group if necessary compared to only 71% in the LF group. Rehabilitation was highly reduced in the CCH group compared to the LF group. CONCLUSION: In this study, surgery performed better than collagenase at early and 2-year follow-up in PIP joints and similar in MCP joints. While surgery seems to achieve better results, collagenase is considered in Switzerland as an off-the-shelf therapy that provides consistent results without scars, with shorter rehabilitation time, minor hand therapy, shorter splinting time, and applicability. LEVEL OF EVIDENCE AND STUDY TYPE: Level III.

Night Orthosis After Surgical Correction of Dupuytren Contractures: A Systematic Review.

PURPOSE: To determine the role of night orthosis use after surgical correction of Dupuytren contracture. METHODS: We searched MEDLINE, EMBASE, CINAHL, AMED, OTSeeker, and CENTRAL for articles published from inception of the databases to August 2015. Assessment was undertaken by 2 independent reviewers (O.A.S. and S.A.). Methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa instrument. RESULTS: Seven studies met the standard for inclusion in this review. A total of 659 patients across these 7 studies were included in the analysis, with follow-up ranging from 3 to 72 months. None of the included studies assessed recurrence. The analysis revealed no significant improvement in range of motion of hand joints for patients who received a static night orthosis after Dupuytren surgery compared with patients without an orthosis. Similarly, no differences were found in patient-reported functional status across the 2 groups. CONCLUSIONS: The current literature does not appear to support the use of static night orthosis in addition to hand therapy after surgical correction of Dupuytren contracture. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand: A Systematic Review.

Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.

Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. PURPOSE OF THE STUDY: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytren's disease. METHODS: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). RESULTS: The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. DISCUSSION: Safety and social issues of hand function and quality of life had an evident association with functional recovery. LEVEL OF EVIDENCE: IV.

Construct validity of the canadian occupational performance measure in participants with tendon injury and Dupuytren disease.

BACKGROUND: In patient-centered practice, instruments need to assess outcomes that are meaningful to patients with hand conditions. It is unclear which assessment tools address these subjective perspectives best. OBJECTIVE: The aim of this study was to establish the construct validity of the Canadian Occupational Performance Measure (COPM) in relation to the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) in people with hand conditions. It was hypothesized that COPM scores would correlate with DASH and MHQ total scores only to a moderate degree and that the COPM, DASH questionnaire, and MHQ would all correlate weakly with measures of hand impairments. DESIGN: This was a validation study. METHODS: The COPM, DASH questionnaire, and MHQ were scored, and then hand impairments were measured (pain [numerical rating scale], active range of motion [goniometer], grip strength [dynamometer], and pinch grip strength [pinch meter]). People who had received postsurgery rehabilitation for flexor tendon injuries, extensor tendon injuries, or Dupuytren disease were eligible. RESULTS: Seventy-two participants were included. For all diagnosis groups, the Pearson coefficient of correlation between the DASH questionnaire and the MHQ was higher than .60, whereas the correlation between the performance scale of the COPM and either the DASH questionnaire or the MHQ was lower than .51. Correlations of these assessment tools with measures of hand impairments were lower than .46. LIMITATIONS: The small sample sizes may limit the generalization of the results. CONCLUSIONS: The results supported the hypotheses and, thus, the construct validity of the COPM after surgery in people with hand conditions.

Hand function and quality of life before and after fasciectomy for Dupuytren contracture.

PURPOSE: To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. METHODS: This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol. RESULTS: The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time. CONCLUSIONS: After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Surgical treatment of Dupuytren's disease - outcome and health economy in relation to smoking and diabetes.

BACKGROUND: The conventional treatment for Dupuytren's disease is surgery. The introduction of alternative treatment strategies creates a need to track outcomes and costs relating to surgical treatment and risk factors, such as smoking and diabetes. This was the aim of the present study. METHODS: In a prospective study, the outcome of open surgical treatment for finger flexion contracture in Dupuytren's disease (175 patients; 182 surgical procedures) was studied by evaluating valid QuickDASH forms answered by subjects before surgery and one year postoperatively. Data were also obtained from medical records, and preoperative declarations concerning health. RESULTS: In all subjects (median [25% - 75% percentiles] age 68 [62-73]), the QuickDASH score improved from 22 [9-36] to 5 [0-18]. Smokers (27/179 procedures) were younger and had a more severe degree of disease and dysfunction preoperatively than non-smokers, but the outcome of surgery did not differ between the groups. Subjects with diabetes (20/181 procedures) were younger than those without diabetes, but their disease severity or outcome did not differ. Hand specialists operated faster than residents, but the surgical outcome did not differ. Healthcare costs for surgery for Dupuytren's contracture were $ 2392 (€ 1859), which were not higher among smokers or subjects with diabetes. Only 22 patients remained in hospital (2 [1-2.3] days) and 28 patients needed sick leave (28 [21-31] days). The occurrence of necrosis of skin flaps (12%) or infections (6%) was no more frequent among smokers or those with diabetes. CONCLUSIONS: There is no difference in surgical outcome for finger flexion contracture in Dupuytren's disease between smokers and non-smokers or between subjects with or without diabetes, although smokers had more severe preoperative contracture. The costs for surgical treatment for finger flexion contracture in Dupuytren's disease should be viewed in relation to that for other treatment strategies.

A single-centre cost comparison analysis of collagenase injection versus surgical fasciectomy for Dupuytren's contracture of the hand.

BACKGROUND AND AIM: The options for treating patients with Dupuytren's contracture have broadened with the introduction of collagenase. Although the literature would suggest that collagenase treatment is effective, has few complications and is popular with patients, it has not been widely commissioned by the National Health Services of the United Kingdom and other European countries due to concerns about cost. The aim of this study was to compare the cost of surgical fasciectomy to collagenase injections for the treatment of Dupuytren's contracture in a single centre. METHOD: Prospective data on 40 patients undergoing fasciectomy or collagenase injection (20 patients in each group) were collected between January and March 2013. Financial data on the costs of the procedures, equipment, theatre time and follow-up appointments were calculated. RESULTS: The average cost of an open partial fasciectomy pathway was £ 7115.34 and that of a collagenase pathway was £ 2110.62. Eight collagenase patients had physician-led follow-up appointments and only three had hand physiotherapy appointments. By contrast, every fasciectomy patient had at least one physician and one physiotherapist follow-up appointment routinely. CONCLUSION: The results of this study demonstrate that collagenase treatment for Dupuytren's contracture of a single digit in selected patients is just over £ 5000 less than treatment for the same condition using surgical fasciectomy. Collagenase-treated patients require much less physician- and physiotherapist-led postoperative follow-up.

Surgical and therapy update on the management of Dupuytren's disease.

Advancements in surgical and therapy management for Dupuytren's disease are highlighted. Indications for treatment and various surgical options for Dupuytren's disease are described. Non-surgical techniques are also presented. Therapy interventions are reviewed. Treatment techniques for the management of secondary problems resulting from prolonged digit flexion are presented. The benefits, limitations and outcomes of treatments are reviewed to assist the reader to link patient specific problems and goals to the most appropriate treatment choice.

Collagenase injections for treatment of Dupuytren disease.

Palmodigital fasciectomy remains the gold standard. The initial outcome is, in my experience, far more predictable than either NA or enzyme fasciotomy (EF). It is also a more durable treatment. NA and EF can be conceptualized as similar procedures--one uses a needle and the other an enzyme to weaken a cord sufficient to be able to rupture it and thus straighten a contracted joint. Both are less invasive and the hand is quick to recover. Both procedures are equally initially effective. CHH seems to offer greater durability. Today's patients are often better educated and seek a specific type of treatment, in particular, effective nonoperative treatment. Pharmaceutical companies now market directly and effectively to patients, and this strategy and Internet use have already resulted in an increase in the number of patients searching for practitioners willing to administer and capable of administering collagenase treatment.

Dupuytren disease: European hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline: results from the HANDGUIDE study.

BACKGROUND: Multidisciplinary treatment guidelines for Dupuytren disease can aid in optimizing the quality of care for patients with this disorder. Therefore, this study aimed to achieve consensus on a multidisciplinary treatment guideline for Dupuytren disease. METHODS: A European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of interventions was conducted and used as an evidence-based starting point for this study. In total, 39 experts (hand surgeons, hand therapists, and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis, and a feedback report. RESULTS: After four Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of Dupuytren disease. No nonsurgical interventions were included in the guideline. Needle and open fasciotomy, and a limited fasciectomy and dermofasciectomy, were seen as suitable surgical techniques for Dupuytren disease. Factors relevant for choosing one of these surgical techniques were identified and divided into patient-related (age, comorbidity), disease-related (palpable cord, previous surgery in the same area, skin involvement, time of recovery, recurrences), and surgeon-related (years of experience) factors. Associations of these factors with the choice of a specific surgical technique were reported in the guideline. Postsurgical rehabilitation should always include instructions and exercise therapy; postsurgical splinting should be performed on indication. Relevant details for the use of surgical and postsurgical interventions were described. CONCLUSION: This treatment guideline is likely to promote further discussion on related clinical and scientific issues and may therefore contribute to better treatment of patients with Dupuytren disease.

The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial.

PURPOSE: To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture. METHODS: We conducted a single-center, randomized, controlled trial to investigate the effect of night extension orthoses on finger range of motion and hand function for 3 months following surgical release of Dupuytren contracture. We also wanted to determine how well finger extension was maintained in the total sample. We randomized 56 patients to receive a night extension orthosis plus hand therapy (n = 26) or hand therapy alone (n = 30). The primary outcome was total active extension of the operated fingers (°). Secondary outcomes were total active flexion of the operated fingers (°), active distal palmar crease (cm), grip strength (kg), and self-reported hand function using the Disabilities of the Arm, Shoulder, and Hand questionnaire (0-100 scale). RESULTS: There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes. Between the first postoperative measure and 3 months after surgery, 62% of little fingers had maintained or improved total active extension. CONCLUSIONS: The use of a night extension orthosis in combination with standard hand therapy has no greater effect on maintaining finger extension than hand therapy alone in the 3 months following surgical release of Dupuytren contracture. Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery. Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients.

The impact of Dupuytren disease on patient activity and quality of life.

PURPOSE: To explore the impact of Dupuytren disease (DD) from the patients' perspective. METHODS: Audio-recorded interviews were conducted for patients with Dupuytren disease (DD) attending outpatient clinics. The interviews were transcribed and subjected to content analysis. This analysis highlighted key impact areas and common themes in individuals' personal experiences. These were then allocated to categories specified by the World Health Organization International Classification of Functioning, Disability, and Health (impairments and activity limitations) and the needs-based model of quality of life (QoL). RESULTS: Qualitative unstructured interviews were conducted with 34 patients (74% men; age, 41-80 y; mean [SD], 64 [13] y). The sample had a wide range of severity and duration of DD (range, 0.5-40; mean [SD], 13 [10] y). Nine hundred fifty-three statements relating to the impact of DD were identified from the interview transcripts. These statements fell into 2 major categories of impact: activity limitations (10 themes including problems with dressing, gripping, and personal care) and QoL (6 need categories: physiological, safety and security, social, affection, esteem, and cognitive needs). CONCLUSIONS: Findings from the interviews suggest that DD affects both performance of activities and QoL. To determine accurately the effectiveness of DD interventions from the patients' perspective, it is important to determine their impacts on both activity limitations and QoL. We intend to develop valid, reproducible, and responsive DD-specific scales for this purpose. CLINICAL RELEVANCE: The study identifies key issues specific to DD that influence patients' functioning and QoL. The information reported will form the basis of DD-specific patient-reported outcomes measures for use in clinical practice and evaluations of interventions.