Lefevre-Colau M M, Poiraudeau S, Fermanian J, Etchepare F, Alnot J Y, Le Viet D, Leclercq C, Oberlin C, Bargy F, Revel M
Department of Physical and Rehabilitation Medicine, Hôpital Cochin, Université René Descartes, Paris, France.
Rheumatology (Oxford). 2001 Aug;40(8):843-50. doi: 10.1093/rheumatology/40.8.843.
To assess the responsiveness of the Cochin functional disability scale for the rheumatoid hand after surgery.
In a prospective study, patients with rheumatoid arthritis (RA) scheduled for surgery of the wrist and/or fingers were evaluated within 48 h before surgery and at least 6 months after surgery. Clinical outcome measures included duration of morning stiffness, total score for tenderness, total score for swelling, visual analogue scale score for pain in the hands and wrists, a score for overall mobility of the wrist and the fingers, grip and pinch strength, the Hand Functional Index (HFI), the Kapandji index and the Cochin scale. Responsiveness was assessed with the paired t-test, the effect size (ES), the standardized response mean (SRM) and the non-parametric Spearman rank correlation coefficient (r(S)).
Fifty patients (42 women) were evaluated twice at an interval of 7.16 +/- 2.10 months (mean +/- s.d.) (range 6-15 months). Thirty-six patients (72%) were very satisfied or satisfied with the results of surgery, seven (14%) were not satisfied or dissatisfied and seven (14%) were dissatisfied or very dissatisfied. The Cochin scale score improved at the second visit (P < 0.0001), with SRM and ES values of 0.66 and 0.58 respectively. The correlation of the change in Cochin score with patient overall satisfaction was r(S) = 0.40. Among the impairment measures, grip strength showed the best responsiveness (SRM = - 0.43, ES = - 0.36, correlation with patient overall satisfaction r(S) = 0.46). The change in Kapandji index had the best correlation (r(S) = 0.51) with patient overall satisfaction but its SRM and ES values were low (- 0.19 and - 0.10 respectively).
The Cochin scale is responsive and appropriate for the assessment of the effects of surgical treatments on disability in RA hands.
评估科钦类风湿手功能残疾量表对手术后类风湿手的反应性。
在一项前瞻性研究中，对计划进行手腕和/或手指手术的类风湿关节炎（RA）患者在手术前48小时内及手术后至少6个月进行评估。临床结局指标包括晨僵持续时间、压痛总分、肿胀总分、手和腕部疼痛的视觉模拟量表评分、手腕和手指的总体活动度评分、握力和捏力、手功能指数（HFI）、卡潘迪指数和科钦量表。采用配对t检验、效应量（ES）、标准化反应均值（SRM）和非参数斯皮尔曼等级相关系数（r(S)）评估反应性。
50例患者（42例女性）在平均7.16±2.10个月（范围6 - 15个月）的间隔内接受了两次评估。36例患者（72%）对手术结果非常满意或满意，7例（14%）不满意或不太满意，7例（14%）不满意或非常不满意。科钦量表评分在第二次评估时有所改善（P < 0.0001），SRM和ES值分别为0.66和0.58。科钦评分变化与患者总体满意度的相关性为r(S) = 0.40。在损伤测量指标中，握力显示出最佳的反应性（SRM = - 0.43，ES = - 0.36，与患者总体满意度的相关性r(S) = 0.46）。卡潘迪指数的变化与患者总体满意度的相关性最佳（r(S) = 0.51），但其SRM和ES值较低（分别为 - 0.19和 - 0.10）。
科钦量表具有反应性，适用于评估手术治疗对类风湿手残疾的影响。
