Development and Validation of a Disease-Specific Questionnaire for Basal Joint Arthritis

Abstract

Background The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is the most commonly used instrument to assess outcomes of basal joint arthritis (BJA). However, the DASH is subject to influence by the entire upper extremity.

Purpose This study aims to develop and validate a disease-specific questionnaire for BJA that would be more sensitive to changes in thumb function and pain, and correlate better with objective and subjective metrics.

Patients and Methods The thumb disability examination (TDX) was developed and 80 patients presenting with BJA at one of the two hospital-based hand clinics were enrolled in the validation study. At enrollment, subjects were given the TDX, DASH, and visual analog pain scale with activity (A-VAS) surveys. The strength was assessed. Patients receiving corticosteroid injection were seen for follow-up at 6 weeks and those who underwent surgery were seen between 3 and 6 months postoperatively. Both the groups were given the TDX, DASH, and A-VAS scales at follow-up.

Results In total, 65 subjects were included in the analysis. Average TDX completion time was 134.3 seconds. The TDX correlated more strongly with A-VAS scores at baseline than the DASH, but less strongly with tip-pinch measures. The TDX was more responsive to injection and surgical treatments for BJA than the DASH, yielding a larger effect size and standardized response mean, and was the only instrument to significantly correlate with changes in A-VAS.

Conclusion The TDX is a reliable instrument for assessing BJA treatment outcomes. It bears less of a burden on patients, is more responsive to symptomatic changes, and correlates better with most objective and subjective measures than the DASH.

Level of Evidence II, diagnostic.

Keywords

thumb carpometacarpal arthritis - basal joint - outcome instrument - thumb disability examination - disease specific

Note

This work was approved by the ethical review committee of the associated hospital. Data were collected at the Columbia University Medical Center and the Vanderbilt Orthopedic Institute.

• References

• 1 Kamal RN, Kakar S, Ruch D , et al. Quality Measurement: A Primer for Hand Surgeons. J Hand Surg Am 2016; 41 (5) 645-651
• 2 Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000; 25 (24) 3186-3191
• 3 Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther 2001; 14 (2) 128-146
• 4 Veehof MM, Sleegers EJ, van Veldhoven NH, Schuurman AH, van Meeteren NL. Psychometric qualities of the Dutch language version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH-DLV). J Hand Ther 2002; 15 (4) 347-354
• 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; 4: 11 . Doi: 10.1186/1471-2474-4-11
• 6 Padua R, Padua L, Ceccarelli E , et al. Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Cross-cultural adaptation and validation. J Hand Surg [Br] 2003; 28 (2) 179-186
• 7 Gay RE, Amadio PC, Johnson JC. Comparative responsiveness of the disabilities of the arm, shoulder, and hand, the carpal tunnel questionnaire, and the SF-36 to clinical change after carpal tunnel release. J Hand Surg Am 2003; 28 (2) 250-254
• 8 Jester A, Harth A, Wind G, Germann G, Sauerbier M. Disabilities of the arm, shoulder and hand (DASH) questionnaire: Determining functional activity profiles in patients with upper extremity disorders. J Hand Surg [Br] 2005; 30 (1) 23-28
• 9 MacDermid JC, Richards RS, Donner A, Bellamy N, Roth JH. Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. J Hand Surg Am 2000; 25 (2) 330-340
• 10 Beaton DE, Davis AM, Hudak P, McConnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: what do we know about it now?. J Hand Ther Br. 2001; 6: 109-118
• 11 Hudak PL, Amadio PC, Bombardier C ; The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29 (6) 602-608
• 12 Pellegrini Jr VD. Osteoarthritis at the base of the thumb. Orthop Clin North Am 1992; 23 (1) 83-102
• 13 Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg [Br] 1994; 19 (3) 340-341
• 14 Marks M, Schoones JW, Kolling C, Herren DB, Goldhahn J, Vliet Vlieland TP. Outcome measures and their measurement properties for trapeziometacarpal osteoarthritis: a systematic literature review. J Hand Surg Eur Vol 2013; 38 (8) 822-838
• 15 Marks M, Audigé L, Herren DB, Schindele S, Nelissen RG, Vliet Vlieland TP. Measurement properties of the German Michigan Hand Outcomes Questionnaire in patients with trapeziometacarpal osteoarthritis. Arthritis Care Res (Hoboken) 2014; 66 (2) 245-252
• 16 Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am 1998; 23 (4) 575-587
• 17 Bellamy N, Campbell J, Haraoui B , et al. Dimensionality and clinical importance of pain and disability in hand osteoarthritis: Development of the Australian/Canadian (AUSCAN) Osteoarthritis Hand Index. Osteoarthritis Cartilage 2002; 10 (11) 855-862
• 18 Ware JE, Gandek B. The SF-36 Health Survey: development and use in mental health research and the IQOLA Project. Int J Ment Health 1994; 23 (2) 49-73
• 19 Levine DW, Simmons BP, Koris MJ , et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993; 75 (11) 1585-1592
• 20 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (8) 577-586
• 21 Kremer E, Atkinson Jr JH. Pain measurement: construct validity of the affective dimension of the McGill Pain Questionnaire with chronic benign pain patients. Pain 1981; 11 (1) 93-100
• 22 Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am 1973; 55 (8) 1655-1666
• 23 Mokkink LB, Terwee CB, Knol DL , et al. The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 2010; 10: 22 . Doi: 10.1186/1471-2288-10-22
• 24 Model Z, Liu AY, Kang L, Wolfe SW, Burket JC, Lee SK. Evaluation of Physical Examination Tests for Thumb Basal Joint Osteoarthritis. Hand (NY) 2016; 11 (1) 108-112
• 25 Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17 (1) 45-56
• 26 McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Methods 1996; 1: 30 . Doi: 10.1037/1082-989X.1.1.30
• 27 Rice ME, Harris GT. Comparing effect sizes in follow-up studies: ROC Area, Cohen's d, and r. Law Hum Behav 2005; 29 (5) 615-620
• 28 Richards Jr JM, Hemstreet MP. Measures of life quality, role performance, and functional status in asthma research. Am J Respir Crit Care Med 1994; 149 (2 Pt 2): S31-S39 , discussion S40–S43
• 29 Boyce MB, Browne JP, Greenhalgh J. The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ Qual Saf 2014; 23 (6) 508-518
• 30 Andrawis JP, Chenok KE, Bozic KJ. Health policy implications of outcomes measurement in orthopaedics. Clin Orthop Relat Res 2013; 471 (11) 3475-3481
• 31 Florack TM, Miller RJ, Pellegrini VD, Burton RI, Dunn MG. The prevalence of carpal tunnel syndrome in patients with basal joint arthritis of the thumb. J Hand Surg Am 1992; 17 (4) 624-630
• 32 Amadio PC, Millender LH, Smith RJ. Silicone spacer or tendon spacer for trapezium resection arthroplasty--comparison of results. J Hand Surg Am 1982; 7 (3) 237-244
• 33 Lins RE, Gelberman RH, McKeown L, Katz JN, Kadiyala RK. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg Am 1996; 21 (2) 202-209
• 34 Lovell ME, Nuttall D, Trail IA, Stilwell J, Stanley JK. A patient-reported comparison of trapeziectomy with Swanson Silastic implant or sling ligament reconstruction. J Hand Surg [Br] 1999; 24 (4) 453-455
• 35 Tomaino MM, Pellegrini Jr VD, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am 1995; 77 (3) 346-355
• 36 Massy-Westropp N, Krishnan J, Ahern M. Comparing the AUSCAN Osteoarthritis Hand Index, Michigan Hand Outcomes Questionnaire, and Sequential Occupational Dexterity Assessment for patients with rheumatoid arthritis. J Rheumatol 2004; 31 (10) 1996-2001
• 37 Dias JJ, Rajan RA, Thompson JR. Which questionnaire is best? The reliability, validity and ease of use of the Patient Evaluation Measure, the Disabilities of the Arm, Shoulder and Hand and the Michigan Hand Outcome Measure. J Hand Surg Eur Vol 2008; 33 (1) 9-17
• 38 Citron N, Hulme CE, Wardle N. A self-administered questionnaire for basal osteoarthritis of the thumb. J Hand Surg Eur Vol 2007; 32 (5) 524-528
• 39 Greenslade JR, Mehta RL, Belward P, Warwick DJ. Dash and Boston questionnaire assessment of carpal tunnel syndrome outcome: what is the responsiveness of an outcome questionnaire?. J Hand Surg [Br] 2004; 29 (2) 159-164
• 40 De Smet L, Sioen W, Spaepen D, van Ransbeeck H. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Hand Surg 2004; 9 (1) 5-9
• 41 Fowler A, Swindells MG, Burke FD. Intra-articular corticosteroid injections to manage trapeziometacarpal osteoarthritis-a systematic review. Hand (NY) 2015; 10 (4) 583-592
• 42 Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002; 23 (4) 183-189
• 43 Belatti DA, Phisitkul P. Trends in orthopedics: an analysis of Medicare claims, 2000-2010. Orthopedics 2013; 36 (3) e366-e372