Original ArticleNo Access

The Impact of Perceived Upper Extremity Severity and Prior Surgery on Patient-Reported Outcomes

Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA

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Qurratul-Ain DAR

Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA

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Alexander ROMPALA

Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA

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Kenneth H. LEVY

Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA

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Joey S. KURTZMAN

Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA

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, and

Steven M. KOEHLER

Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA

E-mail Address: steven.koehler@gmail.com

Correspondence to: Steven M. Koehler, Department of Orthopaedic Surgery, Montefiore Medical Center, 1250 Waters Place, Tower 1, 11th Floor, Bronx, NY 10461, USA. Tel: + 718-920-9566.

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https://doi.org/10.1142/S2424835522500898Cited by:0 (Source: Crossref)

Abstract

Background: The recently validated Hand Questionnaire (HAND-Q) is a multifaceted patient-reported outcome measure (PROM) for hand/upper extremity (UE) pathology and treatment. Here, we conduct a pilot study utilising data collected as a participating site for the Phase II HAND-Q Pilot Multicenter International Validation Study. We hypothesised that self-reported hand functionality, symptom/disease severity, hand appearance, emotional dissatisfaction and treatment satisfaction would be worse in patients who perceived their disease severity to be more severe but would not differ between patients based on prior surgical history.

Methods: Patients were prospectively enrolled for HAND-Q participation from September 2018 to August 2019. Patients were included in this analysis if they responded to the following scales of HAND-Q: Hand Functionality Satisfaction, Symptom Severity, Hand Appearance Satisfaction, Emotional Dissatisfaction and Treatment Satisfaction. Composite scores (CS) were created for each section. Surgical versus non-surgical CS and mild versus moderate/severe CS were compared with t-tests. Bi-variate comparisons of responses were performed between surgical and non-surgical groups, and between mild and moderate/severe groups.

Results: HAND-Q individual question analysis revealed significant differences in functionality and symptom severity for patients with prior surgery (p < 0.047). CS analysis confirmed greater overall impairment in surgical patients, but no overall impact on symptom severity. Regarding disease severity HAND-Q individual question analysis, moderate/severe patients reported worse outcomes for specific aesthetic qualities and symptoms for almost all items (p < 0.05). CS analysis revealed significantly worse overall hand appearance satisfaction, hand functionality, emotional satisfaction and symptom severity for patients with moderate/severe hand conditions.

Conclusions: HAND-Q revealed worsened outcomes for UE patients with self-reported moderate/severe conditions or previous surgical history. Understanding how previous surgery and disease severity may impact clinical outcomes is important for crafting appropriate treatment.

Level of Evidence: Level II (Prognostic Study)

Keywords:

REFERENCES

1. Chen Y, Chen X, Li Z, Yan H, Zhou F, Gao W. Safety and efficacy of operative versus nonsurgical management of distal radius fractures in elderly patients: A systematic review and meta-analysis. J Hand Surg Am. 2016;41(3):404–413. https://doi.org/10.1016/j.jhsa.2015.12.008. Crossref, Google Scholar
2. Tay TKW, Tien H, Lim EYL. Comparison between collagenase injection and partial fasciectomy in the treatment of Dupuytren’s contracture. Hand Surg. 2015;20(3):386–390. https://doi.org/10.1142/S0218810415500288. Link, Google Scholar
3. Lin JS, Samora JB. Surgical and nonsurgical management of mallet finger: A systematic review. J Hand Surg Am. 2018;43(2):146–163.e2. https://doi.org/10.1016/j.jhsa.2017.10.004. Crossref, Google Scholar
4. Greenhalgh J, Dalkin S, Gibbons E, et al.. How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis. J Health Serv Res Policy. 2018;23(1):57–65. https://doi.org/10.1177/1355819617740925. Crossref, Google Scholar
5. Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire : Longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003 Jun 16;4:11. https://doi.org/10.1186/1471-2474-4-11. Crossref, Google Scholar
6. Paranaíba VF, Santos JBGD, Raduan Neto J, Moraes VY, Belotti JC, Faloppa F. PRWE application in distal radius fracture: Comparison and correlation with established outcomes. Rev Bras Ortop (English Ed). 2017;52(3):278–283. https://doi.org/10.1016/j.rboe.2016.07.007. Crossref, Google Scholar
7. Leite JC de C, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord. 2006;7:78. https://doi.org/10.1186/1471-2474-7-78. Crossref, Google Scholar
8. Bessette L, Sangha O, Kuntz KM, et al.. Comparative responsiveness of generic versus disease-specific and weighted versus unweighted health status measures in carpal tunnel syndrome. Med Care. 1998;36(4):491–502. https://doi.org/10.1097/00005650-199804000-00005. Crossref, Google Scholar
9. Sierakowski K, Dean NR, Pusic AL, et al.. International multiphase mixed methods study protocol to develop a cross-cultural patient-reported outcome and experience measure for hand conditions (HAND-Q). BMJ Open. 2019;9(3):e025822. https://doi.org/10.1136/bmjopen-2018-025822. Crossref, Google Scholar
10. Aaronson N, Alonso J, Burnam A, et al.. Assessing health status and quality-of-life instruments: Attributes and review criteria. Qual Life Res. 2002;11(3):193–205. https://doi.org/10.1023/a:1015291021312. Crossref, Google Scholar
11. U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research, U.S. Department of Health and Human Services FDA Center for Biologics Evaluation and Research, U.S. Department of Health and Human Services FDA Center for Devices and Radiological Health. Guidance for industry: Patient-reported outcome measures: Use in medical product development to support labeling claims: Draft guidance. Health Qual Life Outcomes. 2006;4:79. https://doi.org/10.1186/1477-7525-4-79. Crossref, Google Scholar
12. Sierakowski KL, Dean NR, Evans Sanchez K, et al.. The HAND-Q: Psychometrics of a new patient-reported outcome measure for clinical and research applications. Plast Reconstr Surg Glob Open. 2022;10(1):e3998. https://doi.org/10.1097/GOX.0000000000003998. Crossref, Google Scholar
13. Masud M, Rashid M, Malik SA, Ibrahim Khan M, Sarwar SUR. Does the duration and severity of symptoms have an impact on relief of symptoms after carpal tunnel release? J Brachial Plex Peripher Nerve Inj. 2019;14(1):E1–E8. https://doi.org/10.1055/s-0038-1668552. Crossref, Medline, Google Scholar
14. Hankins CL, Brown MG, Lopez RA, Lee AK, Dang J, Harper RD. A 12-year experience using the brown two-portal endoscopic procedure of transverse carpal ligament release in 14,722 patients: Defining a new paradigm in the treatment of carpal tunnel syndrome. Plast Reconstr Surg. 2007;120(7):1911–1921. https://doi.org/10.1097/01.prs.0000287287.85044.87. Crossref, Google Scholar
15. Özkan S, Zale EL, Ring D, Vranceanu AM. Associations between pain catastrophizing and cognitive fusion in relation to pain and upper extremity function among hand and upper extremity surgery patients. Ann Behav Med. 2017;51(4):547–554. https://doi.org/10.1007/s12160-017-9877-1. Crossref, Google Scholar
16. Teunis T, Bot AGJ, Thornton ER, Ring D. Catastrophic thinking is associated with finger stiffness after distal radius fracture surgery. J Orthop Trauma. 2015;29(10):e414–e420. https://doi.org/10.1097/BOT.0000000000000342. Crossref, Google Scholar
17. Graham B, Schofield M. Self-reported symptoms of cold intolerance in workers with injuries of the hand. Hand. 2008;3(3):203–209. https://doi.org/10.1007/s11552-008-9116-0. Crossref, Google Scholar
18. Carlsson IK, Dahlin LB. Self-reported cold sensitivity in patients with traumatic hand injuries or hand-arm vibration syndrome–An eight year follow up. BMC Musculoskelet Disord. 2014;15(1):83. doi:https://doi.org/10.1186/1471-2474-15-83 Crossref, Google Scholar
19. Nancarrow JD, Rai SA, Sterne GD, Thomas AK. The natural history of cold intolerance of the hand. Injury. 1996;27(9):607–611. https://doi.org/10.1016/S0020-1383(96)00110-6. Crossref, Google Scholar
20. Ruijs ACJ, Niehof SP, Hovius SER, Selles RW. Cold-induced vasodilatation following traumatic median or ulnar nerve injury. J Hand Surg Am. 2011;36(6):986–993. https://doi.org/10.1016/j.jhsa.2011.02.009. Crossref, Google Scholar
21. Vaksvik T, Hetland K, Røkkum M, Holm I. Cold hypersensitivity 6–10 years after replantation or revascularisation of fingers: Consequences for work and leisure activities. J Hand Surg Eur Vol. 2009;34(1):12–17. https://doi.org/10.1177/1753193408094440. Crossref, Google Scholar
22. Ruijs ACJ, Jaquet JB, van Riel WG, Daanen HAM, Hovius SER. Cold intolerance following median and ulnar nerve injuries: Prognosis and predictors. J Hand Surg Eur Vol. 2007;32(4):434–439. https://doi.org/10.1016/j.jhsb.2007.02.012. Crossref, Google Scholar
23. Carlsson IK, Nilsson JA, Dahlin LB. Cut-off value for self-reported abnormal cold sensitivity and predictors for abnormality and severity in hand injuries. J Hand Surg Eur Vol. 2010;35(5):409–416. https://doi.org/10.1177/1753193409354184. Crossref, Google Scholar