Optimal functional outcome measures for assessing treatment for Dupuytren’s disease: a systematic review and recommendations for future practice

Abstract

BackgroundDupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment.MethodsA literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures.ResultsNinety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years.ConclusionsThere is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes.

Patients’ perspective on surgical intervention for Dupuytren’s disease – experiences, expectations and appraisal of results

“…Structure aspects of care refers to human, material or organizational resources; process aspects refers to patient-health care provider communication and interaction, and patients' involvement in decision-making; and outcome refers to care effects on health [14]. DD has been extensively researched with a focus on determining functional outcomes after treatment [15][16][17][18][19]. The functional outcomes have usually been documented through physical measurements and through patient-reported outcome questionnaires [17].…”

“…DD has been extensively researched with a focus on determining functional outcomes after treatment [15][16][17][18][19]. The functional outcomes have usually been documented through physical measurements and through patient-reported outcome questionnaires [17]. Patient satisfaction with the outcome or with the treatment for DD, evaluated with different methods has also been reported in several studies [17,[20][21][22][23][24][25].…”

“…The functional outcomes have usually been documented through physical measurements and through patient-reported outcome questionnaires [17]. Patient satisfaction with the outcome or with the treatment for DD, evaluated with different methods has also been reported in several studies [17,[20][21][22][23][24][25]. However, previous research has concluded that patient satisfaction is a multidimensional concept that can be difficult to capture [26][27][28][29][30], and that it is associated with structure and process aspects of care [28].…”

Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture

“…Benefits in ROM over time have been reported occasionally for isolated joints (18), and some studies report improvement in hand function after surgery measured by the Sollerman grip function test (13,19). Few studies report assessment of sensibility before and after surgery (20), though 1 study using the Semmes-Weinstein monofilaments report diminished light touch and protective sensation after surgery (17). Scar contracture is another potential complication after surgery (5,6) and should be distinguished from recurrence, i.e.…”

“…the development of new DD tissue in the operated area (1). Despite possible drawbacks of surgery, several studies report high overall patient satisfaction or satisfaction with the procedure (15,17,(20)(21)(22)(23)(24). After fasciectomy, patients also report improved quality of life (25).…”