Sandqvist Gunnel, Johnsson Pia Malcus, Sturesson Anna-Lena, Tägil Magnus, Geborek Pierre
Department of Rheumatology, Lund University Hospital, Lund, Sweden.
BMC Musculoskelet Disord. 2009 May 14;10:50. doi: 10.1186/1471-2474-10-50.
Rheumatic diseases commonly affect joints and other structures in the hand. Surgery is a traditional way to treat hand problems in inflammatory rheumatic diseases with the purposes of pain relief, restore function and prevent progression. There are numerous measures to choose from, and a combination of outcome measures is recommended. This study evaluated if instruments commonly used in rheumatologic clinical practice are suitable to measure outcome of hand surgery and to identify time points relevant for follow-up.
Thirty-one patients (median age 56 years, median disease duration 15 years) with inflammatory rheumatic disease and need for post-surgical occupational therapy intervention formed this pilot study group. Hand function was assessed regarding grip strength (Grippit), pain (VAS), range of motion (ROM) (Signals of Functional Impairment (SOFI)) and grip ability (Grip Ability Test (GAT)). Activities of daily life (ADL) were assessed by means of Disabilities of the Arm, Shoulder and Hand Outcome (DASH) and Canadian Occupational Performance Measure (COPM). The instruments were evaluated by responsiveness and feasibility; follow-up points were 0, 3, 6 and 12 months.
All instruments showed significant change at one or more follow-up points. Satisfaction with activities (COPM) showed the best responsiveness (SMR>0.8), while ROM measured with SOFI had low responsiveness at most follow-up time points. The responsiveness of the instruments was stable between 6 and 12 month follow-up which imply that 6 month is an appropriate time for evaluating short-term effect of hand surgery in rheumatic diseases.
We suggest a core set of instruments measuring pain, grip strength, grip ability, perceived symptoms and self-defined daily activities. This study has shown that VAS pain, the Grippit instrument, GAT, DASH symptom scale and COPM are suitable outcome instruments for hand surgery, while SOFI may be a more insensitive test. However, the feasibility of this protocol in clinical practice awaits prospective studies.
风湿性疾病常累及手部关节及其他结构。手术是治疗炎性风湿性疾病手部问题的传统方法，目的是缓解疼痛、恢复功能并防止病情进展。有多种措施可供选择，建议采用综合的疗效评估指标。本研究评估了风湿科临床实践中常用的指标是否适用于衡量手部手术的疗效以及确定相关的随访时间点。
本试点研究组由31例（中位年龄56岁，中位病程15年）患有炎性风湿性疾病且需要术后职业治疗干预的患者组成。对手部功能进行了评估，包括握力（Grippit）、疼痛（视觉模拟评分法（VAS））、关节活动度（ROM）（功能障碍信号（SOFI））和抓握能力（抓握能力测试（GAT））。通过手臂、肩部和手部功能障碍结局量表（DASH）和加拿大职业表现测量量表（COPM）评估日常生活活动能力（ADL）。对这些指标进行反应性和可行性评估；随访时间点为0、3、6和12个月。
所有指标在一个或多个随访时间点均显示出显著变化。对活动的满意度（COPM）显示出最佳的反应性（标准化反应均值>0.8），而用SOFI测量的ROM在大多数随访时间点反应性较低。这些指标的反应性在6至12个月的随访期间保持稳定，这表明6个月是评估风湿性疾病手部手术短期疗效的合适时间。
我们建议采用一组核心指标来测量疼痛、握力、抓握能力、感知症状和自我定义的日常活动。本研究表明，VAS疼痛评分、Grippit指标、GAT、DASH症状量表和COPM是手部手术合适的疗效评估指标，而SOFI可能是一种较不敏感的测试方法。然而，该方案在临床实践中的可行性有待前瞻性研究验证。
