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.

Development and clinimetric evaluation of the mouth impairment and disability assessment (MIDA).

INTRODUCTION: Burns of the face and mouth region have a profound impact on function. Currently the outcome measure that is most commonly used in the burn care literature is horizontal and vertical opening. Impairment-based outcomes such as this do not capture the functional implications of these injuries in spite of the devastating impact they can have on burn survivor's lives. PURPOSE OF THE STUDY: To generate an assessment that evaluates the impairments, activity limitations, and participation restrictions associated with mouth injuries and prospectively collect data to examine the clinimetric properties. METHODS: A multistep assessment development process was undertaken including a comprehensive literature search and review, burn care expert and burn survivor interviews, generation of a preliminary version and field-testing, modifications based on field testing and updated literature review, and further field testing with data collection of 23 burn survivors. Clinimetric properties were examined by evaluating: whether there was a ceiling or floor effect, the internal consistency, construct validity, and responsiveness. RESULTS: The mouth impairment and disability assessment (MIDA) has a 28 item self-report portion, divided into four subscales, completed by the patient and an impairment-based section completed by the burn therapist. Two items demonstrated a ceiling effect, one was removed the other retained. There was strong and statistically significant (p<0.0001) correlation of the symptoms subscale as well as vertical opening with the functional activities subscale of the MIDA. The functional activities subscale demonstrated good internal consistency and the symptoms subscale was adequate. Re-evaluation approximately seven and a half months after the baseline evaluation demonstrated a statistically significant change with time and treatment. CONCLUSIONS: The MIDA now offers clinicians the ability to assess mouth impairment and disability of burn survivors who have sustained burn injuries to their face and mouth region.

Psychometric evaluation of the Disabilities of the Arm, Shoulder and Hand (DASH) with Dupuytren's contracture: validity evidence using Rasch modeling.

BACKGROUND: Dupuytren's contracture is a progressive, fibroproliferative disorder that causes fixed finger contractures and can lead to disability. With the advances of new therapeutic interventions, the necessity to assess the functional repercussions of this condition using valid, reliable and sensitive outcome measures is of growing interest. The Disabilities of the Arm, Shoulder and Hand (DASH) is one frequently used patient-reported outcome measure but its reliability and validity have never been demonstrated specifically for a population affected with Dupuytren's contracture. The objective of this study was to evaluate the psychometric properties of the DASH, with focus on validity evidence using the Rasch measurement model. METHODS: Secondary analysis was performed on data collected as part of a randomised clinical trial. One hundred fifty-three participants diagnosed with Dupuytren's contracture completed the DASH at four time points (pre-op, 3, 6 and 12 months post-op). Baseline data were analysed using traditional analysis and to test whether they adhered to the expectations of the Rasch model. Post-intervention data were subsequently included and analyzed to determine the effect of the intervention on the items. RESULTS: DASH scores demonstrated large ceiling effects at all time points. Initial fit to the Rasch model revealed that the DASH did not adhere to the expectations of the Rasch partial credit model (χ2=119.92; p<0.05). Multiple items displayed inadequate response categories and two items displayed differential item functioning by gender. Items were transformed and one item deleted leading to an adequate fit. Remaining items fit the Rasch model but still do not target well the population under study. CONCLUSIONS: The original version of the 30-item DASH did not display adequate validity evidence for use in a population with Dupuytren's contracture. Further development is required to improve the DASH for this population.

Comparison of generic patient-reported outcome measures used with upper extremity musculoskeletal disorders: linking process using the International Classification of Functioning, Disability, and Health (ICF).

OBJECTIVE: To report the theoretical foundation of generic patient-reported outcomes for measuring functioning related to upper extremity musculoskeletal disorders and perform content coverage analysis and content comparison using the International Classification of Functioning, Disability and Health (ICF). METHODS: A literature search was performed to identify commonly used patient-reported outcomes. A comparison of their theoretical foundations and a linking exercise between the measures' meaningful concepts and the ICF and Brief ICF Core Set for Hand Conditions was accomplished based on established rules. RESULTS: Fifteen measures were selected. Multiple theoretical foundations were identified, and only 7 measures were developed based on a known conceptual model. Six measures were chosen for the linking process with 232 meaningful concepts retrieved and linked to 54 ICF categories. No concept was linked to the Body Structures component and two measures stood out for their Activity and Participation coverage. No measure covered all Brief ICF Core Set for Hand Conditions recommended categories. CONCLUSION: Some heterogeneity was observed with regards to the theoretical foundations on which the identified measures are based. The results of the linking process should help reduce these inconsistencies. They enable easy identification of content coverage and content comparison between measures using a common framework and can be used as a reference when selecting the most appropriate patient-reported outcome measure.

Bilateral thumb's active range of motion and strength in de Quervain's disease: comparison with a normal sample.

The aims of the present study were to characterize the thumb active range of motion (AROM) and strength impairments resulting from unilateral de Quervain's disease; to verify the adequacy of standard clinical assessment tools to quantify impairments resulting from this pathology; and to validate the utilization of the asymptomatic thumb as a reference to quantify the symptomatic thumb's deficits by comparing the performances of asymptomatic to control thumbs. The thumb's AROM and strength were evaluated bilaterally in 31 participants with unilateral de Quervain's disease and 18 control participants using clinical assessments involving the flexors and adductors of the thumb and experimental assessment devices measuring strength and mobility in several directions of the thumb's movements. A comparison was made between the results obtained from the symptomatic, asymptomatic, and control thumbs. The AROM performance of symptomatic thumbs was found to be reduced when compared to the asymptomatic and control thumbs for maximal thumb flexion (p=0.008 and 0.003, respectively) and total circumduction displacement (p<0.001). The strength performance of the symptomatic thumb was also found to be reduced when compared to the asymptomatic and control thumbs for palmar pinch strength (p<0.001 and 0.002, respectively) and for maximal voluntary effort in all directions (p<0.001). Differences in performance were also found between the asymptomatic and control thumbs, reaching the significance level for some movement parameters of the thumb circumduction evaluations and when palmar pinch strength results are normalized (p<0.001 and 0.009, respectively). This study revealed bilateral impairments of thumb AROM and strength for participants with de Quervain's disease, the impairments being more pronounced on the symptomatic side. This finding may question the validity of using the asymptomatic thumb as a standard measure to identify the symptomatic thumb's impairments associated with de Quervain's disease. The study also demonstrated the validity of using clinical evaluations when assessing impairments associated with this disease.