Pap Géza, Angst Felix, Herren Daniel, Schwyzer Hans-Kaspar, Simmen Beat R
Schulthess Clinik, Zürich, Lengghalde 2, CH-8008 Zürich, Switzerland.
Hand Clin. 2003 Aug;19(3):471-81. doi: 10.1016/s0749-0712(03)00004-0.
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.
风湿病学中的功能评估工具应采用标准化程序，且应具备可量化、有效、可靠以及对变化有反应/敏感等特性。对于大多数评估工具而言，这些方面都已得到考量和测试。评估类风湿关节炎患者手部受累情况时，最重要的问题之一是应采用何种单一评估方法。如果在手部专科门诊以常规方式进行手部评估，或者在关于疾病进展或手术干预效果的科学研究中进行评估，可能会存在显著差异。除其他要点外，回答这个问题对患者接受检查所需的时间以及手部治疗师或手外科医生参与其中的时间有重大影响。因此，除了准确性、可靠性和有效性等方面外，一些评估工具还认为进行手部功能临床检查和评估所需的时间也很重要。此外，必须认识到，解剖状态的描述、损伤的测量和残疾的评估不能简单地相互替代，而且即使是单一方面的测量往往也不够充分。因此，有人指出，不同的离散手部功能评估方法相结合能更全面地反映手部能力。此外，尽管先前已证明残疾结局测量指标比损伤测量指标具有更好的反应性（例如，在治疗Colles骨折的患者中），但残疾与损伤测量指标之间的关系尚未明确确立。虽然一些研究报告了损伤与残疾测试之间存在显著相关性，但在评估类风湿性手部时，其他研究表明残疾评分、损伤和疾病活动度测量指标之间仅存在较弱或中等程度的相关性。得出的结论是，损伤与残疾之间的关系并非直接明了。新的国际功能、残疾和健康分类（ICF）模型通过不同的评估概念来处理这两个与健康相关的生活质量层面。因为损伤反映了疾病在器官层面的后果，而残疾反映了疾病对功能表现和活动的影响，所以对于手部残疾的综合评估而言，残疾测量更为全面，也更贴近患者进行日常生活活动的需求。
