Arthritis hand function test: inter-rater reliability among self-trained raters

Psychometric properties of body structures and functions measures in non-surgical thumb carpometacarpal osteoarthritis: A systematic review

BACKGROUND

Measurement of treatment outcomes and change in health status over time is a critical component of clinical practice and research for people with osteoarthritis. Numerous clinical tools are used to assess the structures and function of the thumb in persons with thumb carpometacarpal osteoarthritis however their psychometrics have not yet been systematically explored.

PURPOSE

The purpose of this study was to explore the psychometric properties of clinical tools used in persons with non-surgical thumb carpometacarpal osteoarthritis to objectively measure thumb structures and function, evaluate the quality of such studies, and subsequently make clinical and future research recommendations.

STUDY DESIGN

Systematic review.

METHODS

A systematic search and screening was conducted across nine databases. Original research published between 2002 and 2022 that involved the assessment of psychometric properties (validity, reliability, precision, responsiveness, sensitivity, specificity, and minimal clinically important difference) of clinical tools were included. Sample characteristics, methods, and psychometric findings from each study were compiled. The methodological quality of included studies was evaluated using the COnsensus-based Standards for the selection of health Measurement Instruments' checklist. Two independent researchers screened articles and assessed methodological quality and when not in agreement, a third party was consulted.

RESULTS

Eleven studies were included in the review. The mean age of all participants in the studies was 69 years of age. The study designs included prospective case-control, prospective cohort, and cross-sectional to determine the psychometric properties of the measurements and tools. The included studies examined techniques to assess range of motion, strength, and pain-pressure thresholds, and screen for arthritis (ie, provocative tests). The intermetacarpal distance method, Kapandji index, pain-pressure threshold test, and pain-free grip and pinch dynamometry demonstrate excellent reliability and acceptable precision. Metacarpal extension, adduction, and pressure-shear provocative tests have superior sensitivity and specificity and the extension and adduction tests have excellent reliability. Other assessments included in the review yielded less robust psychometric properties. Studies were of variable methodological quality spanning from inadequate to very good.

CONCLUSIONS

Based on the available literature on the psychometric properties of assessments of body structures and functions in persons with non-operative thumb carpometacarpal osteoarthritis, we offer a limited set of recommendations for use when screening for arthritis symptomology and measuring hand strength, thumb mobility, and pain thresholds. Additional psychometric research is needed in these domains as well as in dexterity, sensation, and objective measures of hand function. Future research should employ best practices in psychometric research.

The BE-UJI hand function activity set: a reduced set of activities for the evaluation of the healthy and pathological hand

BACKGROUND

Hand kinematics during hand function tests based on the performance of activities of daily living (ADLs) can provide objective data to determine patients' functional loss. However, they are rarely used during clinical assessments because of their long duration. Starting with the 20 Sollerman Hand Function Test (SHFT) tasks, we propose identifying a reduced set of ADLs that provides similar kinematic information to the original full set in terms of synergies, ranges of motion and velocities.

METHODS

We followed an iterative method with the kinematics of 16 hand joints while performing the 20 ADLs of the SHFT. For each subject, ADLs were ordered according to their influence on the synergies obtained by means of a principal component analysis, the minimum number of ADLs that represented the original kinematic synergies (maximum angle of 30° between synergies), and the maintained ranges of joint movements (85% of the original ones) were selected for each subject. The set of the most frequently selected ADLs was verified to be representative of the SHFT ADLs in terms of motion strategies, ranges of motion and joint velocities when considering healthy subjects and Hand Osteoarthritis patients.

RESULTS

A set of 10 tasks, the BE-UJI activity set, was identified by ensuring a certain (minimum) similarity in synergy (maximum mean angle between synergies of 25.5°), functional joint ranges (maximum differences of 10°) and joint velocities (maximum differences of 15°/s). The obtained tasks were: pick up coins from purses, lift wooden cubes, pick up nuts and turn them, write with a pen, cut with a knife, lift a telephone, unscrew jar lids and pour water from a cup, a jar and a Pure-Pak. These activities guarantee using the seven commonest handgrips in ADLs.

CONCLUSION

The BE-UJI activity set for the hand function assessment can be used to obtain quantitative data in clinics as an alternative to the SHFT. It reduces the test time and allows clinicians to obtain objective kinematic data of the motor strategies, ranges of motion and joint velocities used by patients.

Performance-based outcome measures of dexterity and hand function in person with hands and wrist injuries: A scoping review of measured constructs

BACKGROUND

Dexterity impairments are common and disabling. Currently, there is no consensus on an operational definition to measure dexterity.

PURPOSE

This review aims to provide an overview of constructs measured by performance-based outcome measures of dexterity and hand function (PBOMD) validated for use in persons with musculoskeletal hand and wrist conditions.

STUDY DESIGN

Scoping review, with qualitative content analysis.

METHODS

MEDLINE, Embase, CINAHL, PsycINFO were searched from inception until November 2019. Three reviewers identified studies investigating the psychometric properties of PBOMD in persons with hand and wrist conditions. Original articles and manuals of validated PBOMD were obtained. Reviewers independently extracted and performed a content analysis of constructs comparing the theoretical concepts of dexterity and function.

RESULTS

Twenty PBOMD were identified. PBOMD featured 1-57 tasks and 1-8 potential grasps patterns per tool. Description of the constructs measured indicated overlap between dexterity and hand function. In newer tools, there was a greater representation of daily activities to include domains like self-care and domestic life; and measurement of qualitative aspects of performance. Concurrently, there was less focus on mobility. The majority of identified tools (70%) used speed as the criterion evaluation of performance. None of the PBOMD evaluated dexterity associated with leisure activities or modern technologies like smartphones, nor measured the ability to adapt to changing demands when completing tasks.

CONCLUSIONS

Hand function and dexterity are imprecisely defined and operationalized in PBOMD. Dexterity is a complex construct that current PBOMD incompletely captures. PBOMD often quantified as the speed of movement, ignoring other important aspects like accommodating environmental changes during task performance. Clinicians should consider tasks included in PBOMD, the quantification method, and each PBOMD's limitations when choosing PBOMD.

Clinical evaluation of thumb base osteoarthritis: A scoping review

Introduction

Thumb base osteoarthritis (OA) is a prevalent hand OA phenotype, associated with specific risk factors, treatment strategies, and requiring a distinct subset of evaluative approaches. This paper aimed at surveying our clinical evaluative methods and identifying gaps in our ability to capture the thumb's unique attributes and how they could impact our treatment recommendations.

Methods

A scoping review was conducted in accordance with the Joanna Briggs Institute methodology to gather relevant published and non-published articles regarding clinical tests currently available to assess the physical presentation of thumb base OA with special consideration of its specific multifactorial parameters namely architecture, ligaments, biomechanics, neuromuscular control, and proprioception. A full search strategy of MEDLINE, CINAHL, EMBASE, Scopus, Google Scholar, and Clinical Trials.gov from their inception through May 2020 was performed.

Results

Of 1936 citation identified, 54 met the inclusion criteria. Fifty-two clinical physical tests for the evaluation of thumb base OA were extracted, most of which well suited to address research questions regarding efficacy of clinical intervention, however providing limited information regarding the underlying impairments of ligaments, biomechanics, neuromuscular or proprioceptive components.

Conclusions

The tests and measures specific to the basal thumb OA phenotype, and capable of isolating its multifactorial contributors are scarce. Our limited physical assessment repertoire impedes our ability to describe and answer explicative research questions. Without these we cannot evaluate the effect of conservative management and provide specific treatment recommendations. Further research is needed to develop and validate distinct clinical tools for this debilitating pathology.

Relevance of grasp types to assess functionality for personal autonomy

STUDY DESIGN

Cross-sectional research design.

INTRODUCTION

Current assessment of hand function is not focused on evaluating the real abilities required for autonomy.

PURPOSE OF THE STUDY

To quantify the relevance of grasp types for autonomy to guide hand recovery and its assessment.

METHODS

Representative tasks of the International Classification of Functioning, Disability and Health activities in which the hands are directly involved were recorded. The videos were analyzed to identify the grasps used with each hand, and their relevance for autonomy was determined by weighting time with the frequency of appearance of each activity in disability and dependency scales. Relevance is provided globally and distinguished by hand (right-left) and bimanual function. Significant differences in relevance are also checked.

RESULTS

The most relevant grasps are pad-to-pad pinch (31.9%), lumbrical (15.4%), cylindrical (12%), and special pinch (7.3%) together with the nonprehensile (18.6%) use of the hand. Lumbrical grasp has higher relevance for the left hand (19.9% vs 12%) while cylindrical grasp for the right hand (15.3% vs 7.7%). Relevancies are also different depending on bimanual function.

DISCUSSION

Different relative importance was obtained when considering dependency vs disability scales. Pad-to-pad pinch and nonprehensile grasp are the most relevant grasps for both hands, whereas lumbrical grasp is more relevant for the left hand and cylindrical grasp for the right one. The most significant difference in bimanual function refers to pad-to-pad pinch (more relevant for unimanual actions of the left hand and bimanual actions of the right).

CONCLUSIONS

The relative importance of each grasp type for autonomy and the differences observed between hand and bimanual action should be used in medical and physical decision-making.

LEVEL OF EVIDENCE

N/A.

Clinical Assessments of Hand Function in First Carpometacarpal Osteoarthritis Do Not Appear to Correlate with Radiographic Findings

BACKGROUND

Thumb carpometacarpal (first CMC) osteoarthritis (OA), a degenerative process affecting hand use, is typically assessed by clinical examination and radiographs. This assessment determines treatment, but it may not reflect functional limitations.

QUESTIONS/PURPOSES

We aimed to explore the relationship between measures of hand function and radiographs in individuals with and without first CMC OA.

METHODS

We designed a cross-sectional, observational pilot study, enrolling five patients with first CMC OA (nine thumbs with modified Eaton-Littler grades ranging from 1 to 4, using retrospective radiographic data) and nine healthy controls. They underwent evaluation of hand function using four patient-reported outcome measures (PROMs)-the Patient-Specific Functional Scale (PSFS); the Patient-Rated Wrist/Hand Evaluation (PRWHE); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH)-and one performance measure, the Arthritis Hand Function Test (AHFT). Spearman's ρ with 95% subject clustered bootstrapped confidence intervals was calculated to assess for correlations between radiographic findings and measures of hand function.

RESULTS

Only the DASH work score showed strong positive correlation with radiographic OA grade, with PSFS, PRWHE, M-SACRAH, and AHFT scores demonstrating low to moderate correlations. Notable differences were found between patients and control subjects in median scores of the DASH, PSFS, PRWHE, and M-SACRAH, as well as in the grip, pinch, and button scores of the AHFT.

CONCLUSION

While only the DASH work score strongly correlated with radiographic grade of first CMC OA, several measures detected considerable differences in functional hand use between patients and control subjects. The findings of this pilot study suggest that hand function scores be considered in addition to radiographs when determining severity of first CMC OA. The findings can also inform the design of a larger, powered study.

Effects of a massage-like essential oil application procedure using Copaiba and Deep Blue oils in individuals with hand arthritis

BACKGROUND AND PURPOSE

Existing research suggests that both massage and essential oils may have analgesic and anti-inflammatory benefits. We investigate the benefits of the AromaTouch Hand Technique^® (ATHT), a procedure that combines a moderate pressure touch with the application of essential oils to the hand, in individuals with hand arthritis.

METHODS AND MATERIALS

Thirty-six participants with rheumatoid arthritis, osteoarthritis, and/or chronic inflammation received ATHTs with either a 50/50 preparation of Deep Blue^® and Copaiba oil or a coconut oil placebo twice daily for 5 consecutive days. Changes in maximum flexion in finger and thumb joints, items from the Arthritis Hand Function Test, and hand pain scores were evaluated.

RESULTS

Participants treated with the essential oil preparation required significantly less time to complete dexterity tasks and showed about 50% decrease in pain scores, increased finger strength, and significantly increased angle of maximum flexion compared to subjects treated with coconut oil.

CONCLUSION

The ATHT with Copaiba and Deep Blue may have ameliorative effects on hand arthritis.

Reliability and Validity of the Arthritis Hand Function Test in Adults with Osteoarthritis

The Arthritis Hand Function Test (AHFT) has shown promise as a standardized, reliable measure of hand function in adults with rheumatoid arthritis in previous studies. This study adds to the development of the multi-item AHFT by evaluating its inter-rater and test-retest reliability in a sample of 26 adults (mean age, 67 years) with osteoarthritis. Further, because ability to perform activities of daily living (ADD is predicated on physical components such as hand function, the validity of the AHFT is examined by correlating the scores achieved by these subjects with their scores from self-report measures of physical ADL and instrumental ADL. Analysis indicates strong inter-rater reliability ( r= 0.99 or better for all AHFT items) and moderate to strong test-retest reliability (range, r= 0.74 to r=0.96). Moderate correlations for most AHFT items with physical ADL and instrumental ADL lend support to its development as a valid test of hand function.

Effect of Fampridine-PR (prolonged released 4-aminopyridine) on the manual functions of patients with Multiple Sclerosis

BACKGROUND

Persons with MS (PwMS) commonly present ambulatory and manual dysfunctions. While ambulation is recognized as important to PwMS, manual dysfunction is only lately gaining attention. Fampridine-PR was approved for MS ambulatory impairments. Anecdotal evidences indicate possible therapeutic effects on manual function.

OBJECTIVE

To comprehensively assess the effect of Fampridine-PR on manual functions of PwMS.

METHODS

Twenty six PwMS with ambulatory and manual dysfunction assessed before, 1 and 3months after treatment with Fampridine-PR, applying Timed 25-Foot Walk (T25FW) for ambulation while manual functions were evaluated by several tools addressing the International Classification of Functioning (ICF) concepts. This includes hand grip and pinch strength, 9 Hole Peg Test (9HPT), Arthritis Hand Function Test (AHFT), activities of daily life (ADL) tests, ABILHAND questionnaire and Computerized Penmanship Evaluation Tool (ComPET).

RESULTS

Fampridine-PR increased dominant hand grip and pinch strength 1month following treatment initiation by 12% and 10% (p<0.05), respectively. 9HPT improved by 11.3% after 3months of treatment (p<0.05%) and ABILHAND improved by 16% and 31% (p<0.05%) after 1 and 3months of treatment. Mean stroke duration in air of the name writing task improved by 21% (p<0.05) following 3months of treatment. T25FW results were similar to previous reports.

CONCLUSION

The results of this pilot study suggest that Fampridine-PR improves manual function of PwMS. Methods herein indicate that an integrative approach may be useful for evaluation of manual function in MS and in additional neurological diseases.

Activity Limitations, Participation, and Quality of Life in American Indians with and without Diabetes

The objective of this study was to examine activity limitations, participation, and quality of life (QOL) in American Indians with and without diabetes. It was a cross-sectional study that included 43 participants with diabetes and 31 healthy controls. Participants received evaluations of QOL, activity and participation limitations and factors such as pain, joint motion, hand function, and depression. There were no significant differences between the two groups for past, present, or future global QOL. However, there were significant differences between the two groups for the activity and participation measures and all measures of body structure/function except for left hand strength and depression. Current health and pain, and activity limitation correlated with QOL in both groups. Joint motion and participation correlated with QOL in the group with diabetes. American Indians with diabetes had more impairments in body structure and function and limitations in activities and participation compared to American Indians without diabetes.

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for hand osteoarthritis

Hand osteoarthritis (OA) is a very frequent disease, but yet understudied. However, a lot of works have been published in the past 10 years, and much has been done to better understand its clinical course and structural progression. Despite this new knowledge, few therapeutic trials have been conducted in hand OA. The last OARSI recommendations for the conduct of clinical trials in hand OA dates back to 2006. The present recommendations aimed at updating previous recommendations, by incorporating new data. The purpose of this expert opinion, consensus driven exercise is to provide evidence-based guidance on the design, execution and analysis of clinical trials in hand OA, where published evidence is available, supplemented by expert opinion, where evidence is lacking, to perform clinical trials in hand OA, both for symptom and for structure-modification. They indicate core outcome measurement sets for studies in hand OA, and list the methods and instruments that should be used to measure symptoms or structure. For both symptom- and structure-modification, at least pain, physical function, patient global assessment, HR-QoL, joint activity and hand strength should be assessed. In addition, for structure-modification trials, structural progression should be measured by radiographic changes. We also provide a research agenda listing many unsolved issues that seem to most urgently need to be addressed from the perspective of performing "good" clinical trials in hand OA. These updated OARSI recommendations should allow for better standardizing the conduct of clinical trials in hand OA in the next future.

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials of rehabilitation interventions for osteoarthritis

A Task Force of the Osteoarthritis Research Society International (OARSI) has previously published a set of guidelines for the conduct of clinical trials in osteoarthritis (OA) of the hip and knee. Limited material available on clinical trials of rehabilitation in people with OA has prompted OARSI to establish a separate Task Force to elaborate guidelines encompassing special issues relating to rehabilitation of OA. The Task Force identified three main categories of rehabilitation clinical trials. The categories included non-operative rehabilitation trials, post-operative rehabilitation trials, and trials examining the effectiveness of devices (e.g., assistive devices, bracing, physical agents, electrical stimulation, etc.) that are used in rehabilitation of people with OA. In addition, the Task Force identified two main categories of outcomes in rehabilitation clinical trials, which include outcomes related to symptoms and function, and outcomes related to disease modification. The guidelines for rehabilitation clinical trials provided in this report encompass these main categories. The report provides guidelines for conducting and reporting on randomized clinical trials. The topics include considerations for entering patients into trials, issues related to conducting trials, considerations for selecting outcome measures, and recommendations for statistical analyses and reporting of results. The focus of the report is on rehabilitation trials for hip, knee and hand OA, however, we believe the content is broad enough that it could be applied to rehabilitation trials for other regions as well.

Hand impairment and activity limitations in four chronic diseases

STUDY DESIGN

Retrospective cohort.

INTRODUCTION

Hand involvement in osteoarthritis (OA) and rheumatoid arthritis (RA) are well known to occupational and physical therapists; however, it is not known whether the impairments and activity limitations with diabetes (DMII) and systemic sclerosis (SSc) are as severe as those observed with OA and RA.

PURPOSE

To compare the hand impairments and activity limitations in the 4 diseases.

METHODS

A convenience sample of 156 participants received evaluations of hand impairments: strength, joint motion, and dexterity and completed a hand activity limitations questionnaire.

RESULTS

The SSc and RA participants had weaker pinch, decreased joint motion and more activity limitations than the DMII and OA groups. There were no significant differences between the groups for right hand grip strength and pegboard dexterity, and applied dexterity.

CONCLUSIONS

OA and DMII groups had significantly less impairments and activity limitations than the SSc and RA groups.

LEVEL OF EVIDENCE

2C.

Task-oriented training with computer gaming in people with rheumatoid arthritisor osteoarthritis of the hand: study protocol of a randomized controlled pilot trial

Background

Significant restriction in the ability to participate in home, work and community life results from pain, fatigue, joint damage, stiffness and reduced joint range of motion and muscle strength in people with rheumatoid arthritis or osteoarthritis of the hand. With modest evidence on the therapeutic effectiveness of conventional hand exercises, a task-oriented training program via real life object manipulations has been developed for people with arthritis. An innovative, computer-based gaming platform that allows a broad range of common objects to be seamlessly transformed into therapeutic input devices through instrumentation with a motion-sense mouse has also been designed. Personalized objects are selected to target specific training goals such as graded finger mobility, strength, endurance or fine/gross dexterous functions. The movements and object manipulation tasks that replicate common situations in everyday living will then be used to control and play any computer game, making practice challenging and engaging.

Methods/Design

The ongoing study is a 6-week, single-center, parallel-group, equally allocated and assessor-blinded pilot randomized controlled trial. Thirty people with rheumatoid arthritis or osteoarthritis affecting the hand will be randomized to receive either conventional hand exercises or the task-oriented training. The purpose is to determine a preliminary estimation of therapeutic effectiveness and feasibility of the task-oriented training program. Performance based and self-reported hand function, and exercise compliance are the study outcomes. Changes in outcomes (pre to post intervention) within each group will be assessed by paired Student t test or Wilcoxon signed-rank test and between groups (control versus experimental) post intervention using unpaired Student t test or Mann–Whitney U test.

Discussion

The study findings will inform decisions on the feasibility, safety and completion rate and will also provide preliminary data on the treatment effects of the task-oriented training compared with conventional hand exercises in people with rheumatoid arthritis or osteoarthritis of the hand.

Trial registration

ClinicalTrials.gov: NCT01635582

Arthritis in systemic sclerosis: systematic review of the literature and suggestions for the performance of future clinical trials in systemic sclerosis arthritis

OBJECTIVES

Musculoskeletal (MSK) pain is a frequent (between 40-80%) complaint of patients with systemic sclerosis (SSc). Unfortunately, there are virtually no systematic studies of the causes or the management of MSK involvement in SSc and with few exceptions there have been no controlled trials to determine what are and should be the best strategies for managing MSK pain and synovitis in patients with SSc.

METHODS

A literature search was conducted for published reports that have addressed the clinical assessment of "arthritis" and "musculoskeletal" involvement in SSc. The literature search was a prelude to developing recommendations/suggestions for performing clinical trials (preferably randomized) in the future in SSc-related arthritis.

RESULTS

The search netted a number of articles that reported clinical assessments of arthritis in SSc, but very few reported results of controlled clinical trials. Nevertheless, a prevalence of clinical arthritis and tools used to assess the involvement (clinical examination, functional assessments and assessments of quality of life, and radiographic imaging) was found.

CONCLUSIONS

Most of the tools used to assess arthritis in SSc patients have not been validated and additional work is needed to develop a "core set" of variables for assessment of arthritis in SSc and its response to treatment. This report furnishes the background information that can help provide the building blocks for the development of a "core set" that can be used to chart the efficacy of new treatments for SSc-related arthritis in the future.

Quality of life in American Indian women with arthritis or diabetes

OBJECTIVE

We investigated quality of life (QOL) in American Indian women with different chronic diseases.

METHOD

Sixty American Indian women with diabetes mellitus (DM), rheumatoid arthritis (RA), or both DM and RA (DM + RA), and healthy control women received evaluations of joint motion, hand strength dexterity, pain, activity and participation limitations and QOL.

RESULTS

The DM + RA and RA groups had significantly more pain, less joint motion, decreased hand strength, and more activity limitations. Participation was similar for all groups except the DM + RA group. Past and present QOL were similar; however, the DM + RA group reported significantly decreased future QOL.

CONCLUSION

Results suggest that the presence of more than one chronic disease affects activity and participation. Factors that related to QOL were different for each disease group, with the exception of pain. Identification of factors related to QOL can help occupational therapists identify areas for intervention.

Self-reports of hand function in persons with diabetes

ABSTRACT The purpose of this study was to examine the reliability and validity of three self-reports of hand function for persons with diabetes. Thirty-six people with type II diabetes completed self-report questionnaires of hand function including the Hand Function Disability Scale (HFDS), Michigan Hand Outcomes Questionnaire (MHQ), and Dreiser's Functional Hand Index (DFI) at two points in time to assess test-retest reliability. To determine validity, participants were also administered performance-based tests of hand strength, dexterity, and joint motion using the Keital Function Test, and Hand Mobility in Scleroderma Test. Test-retest reliability intraclass correlation coefficients for test-retest reliability ranged from 0.89 to 0.96 for the HFDS; 0.58 to 0.94 for the MHQ; and 0.90 for the DFI. Spearman Rho correlations showed fair correlations between the HFDS and applied hand strength. Fair correlations were also found between the scores on the MHQ and hand strength and joint motion, while scores on the DFI did not correlate with hand strength, dexterity, or joint motion. Overall, the HFDS and the MHQ appear to be reliable and valid measures of hand function in persons with diabetes and may help occupational therapists determine the level of difficulty with daily tasks and monitor outcomes of therapy in persons with diabetes.

Validity and responsiveness of the Michigan Hand Questionnaire in patients with rheumatoid arthritis: a multicenter, international study

OBJECTIVE

Millions of patients experience the disabling hand manifestations of rheumatoid arthritis (RA), yet few hand-specific instruments are validated in this population. Our objective was to assess the reliability, validity, and responsiveness of the Michigan Hand Questionnaire (MHQ) in patients with RA.

METHODS

At enrollment and at 6 months, 128 RA patients with severe subluxation of the metacarpophalangeal joints completed the MHQ, a 37-item questionnaire with 6 domains: function, activities of daily living (ADL), pain, work, aesthetics, and satisfaction. Reliability was measured using Spearman's correlation coefficients between time periods. Internal consistency was measured using Cronbach's alpha. Construct validity was measured by correlating MHQ responses with the Arthritis Impact Measurement Scales 2 (AIMS2). Responsiveness was measured by calculating standardized response means (SRMs) between time periods.

RESULTS

The MHQ demonstrated good test-retest reliability (r = 0.66, P < 0.001). Cronbach's alpha scores were high for ADL (α = 0.90), function (α = 0.87), aesthetics (α = 0.79), and satisfaction (α = 0.89), indicating redundancy. The MHQ correlated well with AIMS2 responses. Function (r = -0.63), ADL (r = -0.77), work (r = -0.64), pain (r = 0.59), and summary score (r = -0.74) were correlated with the physical domain. Affect was correlated with ADL (r = -0.47), work (r = -0.47), pain (r = 0.48), and summary score (r = -0.53). Responsiveness was excellent among arthroplasty patients in function (SRM 1.42), ADL (SRM 0.89), aesthetics (SRM 1.23), satisfaction (SRM 1.76), and summary score (SRM 1.61).

CONCLUSION

The MHQ is easily administered, reliable, and valid to measure rheumatoid hand function, and can be used to measure outcomes in rheumatic hand disease.

Measures and time points relevant for post-surgical follow-up in patients with inflammatory arthritis: a pilot study

Background

Rheumatic diseases commonly affect joints and other structures in the hand. Surgery is a traditional way to treat hand problems in inflammatory rheumatic diseases with the purposes of pain relief, restore function and prevent progression. There are numerous measures to choose from, and a combination of outcome measures is recommended. This study evaluated if instruments commonly used in rheumatologic clinical practice are suitable to measure outcome of hand surgery and to identify time points relevant for follow-up.

Methods

Thirty-one patients (median age 56 years, median disease duration 15 years) with inflammatory rheumatic disease and need for post-surgical occupational therapy intervention formed this pilot study group.

Hand function was assessed regarding grip strength (Grippit), pain (VAS), range of motion (ROM) (Signals of Functional Impairment (SOFI)) and grip ability (Grip Ability Test (GAT)). Activities of daily life (ADL) were assessed by means of Disabilities of the Arm, Shoulder and Hand Outcome (DASH) and Canadian Occupational Performance Measure (COPM). The instruments were evaluated by responsiveness and feasibility; follow-up points were 0, 3, 6 and 12 months.

Results

All instruments showed significant change at one or more follow-up points. Satisfaction with activities (COPM) showed the best responsiveness (SMR>0.8), while ROM measured with SOFI had low responsiveness at most follow-up time points. The responsiveness of the instruments was stable between 6 and 12 month follow-up which imply that 6 month is an appropriate time for evaluating short-term effect of hand surgery in rheumatic diseases.

Conclusion

We suggest a core set of instruments measuring pain, grip strength, grip ability, perceived symptoms and self-defined daily activities. This study has shown that VAS pain, the Grippit instrument, GAT, DASH symptom scale and COPM are suitable outcome instruments for hand surgery, while SOFI may be a more insensitive test. However, the feasibility of this protocol in clinical practice awaits prospective studies.

Mapping hand functioning in hand osteoarthritis: comparing self-report instruments with a comprehensive hand function test

OBJECTIVE

To determine which self-report instruments best explain hand functioning measured by a generic comprehensive hand function test.

METHODS

Six questionnaires currently used in hand osteoarthritis (OA), namely, the Arthritis Impact Measurement Scales 2 Short Form (AIMS2-SF), the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Cochin scale, the Functional Index of Hand OA (FIHOA), the Health Assessment Questionnaire (HAQ), and the Score for Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (SACRAH), were administered once in 100 patients with hand OA together with the Jebsen-Taylor Hand Function Test (JTHFT). In addition, 3 other hand function tests with short administration time were used: the Moberg Picking-Up Test (MPUT), the Button Test (BT), and grip strength. The Short Form 36 was used to describe health status. The relationship between the instruments and the JTHFT was determined by correlation analyses.

RESULTS

AIMS2-SF total scores had the highest raw correlation coefficient to the JTHFT, followed by AIMS2-SF upper body limitation subscale, SACRAH stiffness subscale, and SACRAH total score. If controlled for age, the HAQ had the highest correlation coefficient. Of the 3 short hand function tests, the MPUT showed the highest raw correlation coefficient to the JTHFT; if controlled for age, the BT had the highest correlation coefficient.

CONCLUSION

To comprehensively assess hand functioning in patients with hand OA, we recommend using both a self-report instrument used more generally in various arthritides and a self-report instrument specifically developed for hand OA. If a short test is preferred, we recommend using the MPUT or BT.

Repeatability and reproducibility of numerical rating scales and visual analogue scales for canine pruritus severity scoring

Although they are used frequently in veterinary dermatology, the reliability of canine pruritus severity scales has not been reported. The objective of this study was to evaluate the reliability of pruritus severity numerical rating scales (NRS) and pruritus severity visual analogue scales (VAS). Videos of 16 dogs were evaluated for pruritus severity by 24 observers utilizing three NRS and three VAS. Intraobserver repeatability and interobserver reproducibility were evaluated with Cohen's kappa and Kendall's rank correlation statistics, respectively. The repeatability of pruritus severity NRS was fair, with mean Cohen's weighted kappa (kappa(w)) values ranging from 0.49 to 0.60. The mean Kendall's rank correlation coefficient (t) for the three VAS ranged from 0.62 to 0.73. The reproducibility of mid-range pruritus severity ranks was poor with both scale types. Scales describing overall pruritus severity were found to be reliable most consistently. Neither NRS nor VAS displayed the degree of reliability desired in a health measurement scale. Interpretation of research results evaluating canine pruritus severity with NRS and VAS scales should account for suboptimal reliability.

Research in hand osteoarthritis: time for reappraisal and demand for new strategies. An opinion paper

BACKGROUND

Osteoarthritis of the hands is a prevalent musculoskeletal disease with a considerable effect on patients' lives, but knowledge and research results in the field of hand osteoarthritis are limited. Therefore, the Disease Characteristics in Hand OA (DICHOA) initiative was founded in early 2005 with the aim of addressing key issues and facilitating research into hand osteoarthritis.

OBJECTIVE

To review and discuss current knowledge on hand osteoarthritis with regard to aetiopathogenesis, diagnostic criteria, biomarkers and clinical outcome measures.

METHODS

Recommendations were made based on a literature review.

RESULTS

Outcomes of hand osteoarthritis should be explored, including patient perspective on the separate components of disease activity, damage and functioning. All imaging techniques should be cross-validated for hand osteoarthritis with clinical status, including disease activity, function and performance, biomarkers and long-term outcome. New imaging modalities are available and need scoring systems and validation. The role of biomarkers in hand osteoarthritis has to be defined.

CONCLUSION

Future research in hand osteoarthritis is warranted.

Reliability and validity of a self-report of hand function in persons with rheumatoid arthritis

The purpose of this study was to examine the test-retest reliability and the concurrent validity of the Duruöz Hand Index (DHI) in persons with rheumatoid arthritis (RA). Forty participants with RA and no other major medical problems completed the DHI, a self-report of hand function, at two points in time to assess test-retest reliability. To determine concurrent validity, participants were also administered three performance-based tests, the Arthritis Hand Function Test (AHFT), the Hand Mobility in Scleroderma Test (HAMIS), and the Keitel Functional Test (KFT), and two self-report questionnaires of functional ability, the Health Assessment Questionnaire (HAQ) and the Scleroderma Functional Assessment Questionnaire (SFAQ). Test-retest reliability intraclass correlation coefficients for the DHI ranged from 0.83 to 0.90. Scores on the DHI were significantly correlated with scores on the AHFT (r(s)=0.36-0.54), the HAMIS (r(s)=0.39), the HAQ (r(s)=0.78), the HAMIS (r(s)=0.39), and the SFAQ (r(s)=0.85). Scores on the DHI did not correlate with KFT scores. The results from this study show the DHI to be a reliable and valid test for hand function in persons with RA.

A modified Hammersmith functional motor scale for use in multi-center research on spinal muscular atrophy

The Hammersmith functional motor scale for children with spinal muscular atrophy was modified to establish a standard measure of functional ability in children with non-ambulant spinal muscular atrophy types 2 and 3 in a longitudinal multi-center clinical trial. This study assessed the intra- and interrater reliability and the test-retest stability of a modified version of the scale. Both intra- and interrater reliability were established. Results indicate that the scale is reliable and stable over a 6 month period. Reliability was maintained when patient sample criteria were expanded to include children younger than 30 months and children with popliteal angles greater than 20 degrees . These data establish the modified Hammersmith functional motor scale for children with spinal muscular atrophy as a reliable instrument for use in multi-center treatment trials in non-ambulant spinal muscular atrophy children. Our data provides additional support for the use of original scale items in terms of ease of administration, usefulness and reliability, while incorporating modifications to optimize its use in a multi-center clinical research setting.

Klinische Ergebnismessgrößen bei Arthrose der Hand- und Fingergelenke aus der Perspektive der Patienten

Osteoarthritis (OA) is the most common joint disease. While research activities in OA have concentrated on the knee and hip in recent years, knowledge and research results in the field of hand OA are still limited. In order to measure the effects of treatment or to obtain information on the course of a disease and the health status of a patient, outcome measures are commonly used in rheumatology. Such measures are variables which can be quantified and which represent either the perspective of health professionals or the perspective of patients or both. The aim of this article is to evaluate clinical outcome measures and corresponding instruments which are currently used for patients with hand OA, and to examine whether these measures and instruments represent the perspective of patients. For hand OA, measurements of disease activity and inflammation, function and performance, pain, mobility and stiffness, deformity and aesthetic damage are recommended by experts. Corresponding instruments are available for most of these outcome measures, but these often do not sufficiently represent the perspective of the patients. Some instruments lack reliability because standardized protocols for measurement have not yet been developed.

A systematic search and critical review of measures of disability for use in a population survey of hand osteoarthritis (OA)

OBJECTIVE

In order to develop a hand assessment questionnaire for a population survey, a systematic review was undertaken of measures of hand disability. The purpose of this review was to identify valid measures to evaluate hand osteoarthritis (HOA) in the general population and primary care and to perform a quality appraisal of them.

METHOD

Measurement tools were identified from an online search of databases (Medline, CINAHL and Institute for Scientific Information (ISI), 1990-2002) restricted to English language and adult population. Search terms combined "osteoarthritis" and "arthritis" with "hand" and ["function" or "disability" or "outcome"]. Instruments used in the evaluation of HOA were identified following application of strict eligibility criteria. The use of these tools in HOA was rated by pairs of independent reviewers according to criteria developed by the Medical Outcomes Trust.

RESULTS

The initial search yielded a list of articles which were not mutually exclusive (ISI, 127; Medline, 64; CINAHL, 61). Full journal articles were ordered from relevant abstracts (ISI, 28; Medline, 3; CINAHL, 5). Further hand searching of articles produced an additional 34 references. A total of 61 references were identified, 18 measurement tools, 5 of which met the inclusion criteria [Algofunctional Index (FIHOA), Arthritis Impact Measurement Scale 2 (AIMS2), Stanford Health Assessment Questionnaire (HAQ), Australian/Canadian Osteoarthritis Hand Index (AUSCAN), Cochin]. Overall, the AIMS2 and AUSCAN were more highly rated than the FIHOA, Cochin and HAQ.

CONCLUSIONS

The aim of this review was not to recommend any one instrument over another but to provide an overall summary of the robustness of commonly used measures. The choice of instrument will depend on many factors, and will differ from project to project depending on the question asked.

A crossover trial of custom-made and commercially available wrist splints in adults with inflammatory arthritis

OBJECTIVE

To compare the effect of 3 wrist splints (2 prefabricated commercial splints and 1 custom made) on perceived wrist pain, hand function, and perceived upper extremity function in adults with inflammatory arthritis.

METHODS

Subjects (n = 45, mean age 49 years, mean disease duration 8.6 years) were randomly assigned to treatment order in a 3-phase crossover trial. Splints were worn for 4 weeks, separated by 1-week washouts. Outcomes were assessed at baseline, after each splint phase and washout period, and at 6 months' followup using a pain visual analog scale (VAS), the Arthritis Hand Function Test, and McMaster-Toronto Arthritis Patient Function Preference questionnaire. Data were analyzed with multivariate analyses of variance (MANOVAs), t-tests, and chi-square tests.

RESULTS

There did not appear to be order or carryover effects. MANOVA indicated that wrist splints significantly reduced pain (P = 0.007). The custom leather splint was most effective in reducing pain, from 4.1 cm to 2.8 cm on the VAS (P = 0.001). All splints improved hand strength, and the commercial Rolyan splint provided significantly stronger grip than the Anatech commercial splint (P = 0.04). In contrast to previous studies, splints did not compromise dexterity. There were several significant differences among splints, depending on the outcome measure. Improvements were maintained at 6 months.

CONCLUSION

After 4 weeks' use, wrist splints reduce pain, improve strength, and do not compromise dexterity. Similar improvements were achieved with the custom leather splint and Rolyan commercial splint, which were superior to the Anatech commercial splint.

Reliability and validity of the Arthritis Hand Function Test in adults with systemic sclerosis (scleroderma)

OBJECTIVE

To determine the interrater and test-retest reliability and validity of the Arthritis Hand Function Test (AHFT) in persons with systemic sclerosis.

METHODS

Interrater reliability of the AHFT was established by two raters independently scoring the performances of 20 women with systemic sclerosis. The same group of subjects was tested again 7-10 days later to determine test-retest reliability. Concurrent validity was established by the subjects' self-reports of their abilities to perform activities of daily living as measured by the Health Assessment Questionnaire and the Arthritis Impact Measurement Scales 2 (AIMS2).

RESULTS

All of the items had excellent interrater intraclass correlation coefficients (ICC = 0.99-1.00). The ICCs for test-retest reliability were in the excellent (ICC = 0.80-0.97) range for most of the items and moderate (ICC = 0.57-0.73) for the others. Most of the items were moderately correlated with items on the AIMS2 (r = 0.45-0.69).

CONCLUSION

The results from this study suggest that the AHFT is a reliable and valid test to measure hand function in persons with systemic sclerosis.

Evaluation of wrist and hand handicap and postoperative outcome in rheumatoid arthritis

Functional instruments in rheumatology should use standardized procedures and should be quantifiable, valid, reliable, and responsive/sensitive to change. For most assessment tools, these aspects have been considered and tested. One of the most important questions in assessing hand involvement in patients with RA is what the single assessment should be used for. There could be a substantial difference should hand assessment be done in a routine way in a hand practice or should it be performed within scientific studies on disease progression or the effect of operative interventions. Among other points, answering this question has a significant impact on the time the patient has to spend with the tests and on the time the hand therapist or hand surgeon is involved with it. In addition to aspects such as accuracy, reliability, and validity, therefore, in some evaluation tools the time needed to perform the clinical examination and assessment of hand function has also been considered to be of importance. In addition, it has to be considered that description of the anatomic status, measurements of impairment, and assessment of disability cannot simply be replaced by each other, and even measurements of single aspects often are not sufficient. It has been stated, therefore, that the combination of different discrete hand-function assessment methods provides a more complete picture of hand ability. Moreover, although better responsiveness of disability outcome measures over impairment measures has been demonstrated previously (eg, in patients treated for Colle fracture), the relationship between disability and impairment measures is not clearly established. Although some studies reported significant correlations between impairment and disability tests, other studies showed only poor or moderate correlations between disability scores, impairment, and disease activity measures when rheumatoid hands were assessed. It has been concluded that the relationship between impairment and disability is not straightforward. The new ICF-model addresses these two levels of health-related quality of life by different concepts of assessment. Because impairment reflects the consequences of the disease at the organ level, whereas disability reflects the consequences of the disease for functional performance and activity, for comprehensive assessment of hand handicap, measurement of disability is more comprehensive and closer to the patient's needs for performing ADLs.

Session 2: clinical aspects. Clinical assessment of hand OA

The aim of the session was to discuss the current definitions of and criteria for hand osteoarthritis (OA) and to review the tools proposed for the clinical assessment of hand OA in research and trials. The American College of Rheumatology criteria for the classification and reporting of hand OA were discussed and their limitations noted; specifically, they are designed for symptomatic OA and based on physical examination. The differences between erosive and non-erosive hand OA were discussed as was the relationship between hand OA and generalized OA, since hand OA represents a generalized OA of hand joints and can be considered as a marker for developing generalized OA (i.e. OA at other sites). Different clinical tools to assess patients were presented and discussed, such as pain assessment, Dreiser's functional index or Bellamy's AUSCAN for function assessment, assessment of the mobility, stiffness, inflammation and aesthetic damages. The agreements, disagreements and further studies to be performed to answer questions still debated are presented.