Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Rheumatology (Oxford). 2018 Mar 1;57(3):525-532. doi: 10.1093/rheumatology/kex438.
To investigate metric properties of four hand mobility tests in hand OA patients, using the OMERACT filter.
Trained assessors examined the Hand Mobility in Scleroderma test (HAMIS), fingertip-to-palm distance (FPD), modified Kapandji index (MKI) and number of hand joints with limited mobility in participants from two cohorts [Genetics ARthrosis and Progression (n = 207) and Hand OSTeoArthritis in Secondary care (n = 174)]. Validity was appraised by assessment of correlations with other outcome measures, and ability to measure thumb vs finger mobility specifically, using cumulative probability plots. The proportion of participants changing in hand mobility based on the smallest detectable difference was calculated for responsiveness. Intraclass correlation coefficients (ICCs) for intra- and interobserver reliability, and feasibility (time to perform tests) were studied in a random sample (n = 20).
Participants displayed large variation in mobility scores. Strongest correlations were observed with structural damage (rs = 0.43-0.52) and bony swelling (rs = 0.46-0.58); correlation patterns were similar among tests. HAMIS, FPD and MKI could all measure finger mobility specifically, but only HAMIS measured thumb mobility particularly. Interobserver reliability was best for HAMIS, ICC 0.90 (95% CI: 0.76, 0.96); intraobserver reliability was excellent for all (ICCs 0.94-0.97). In 2 years, little change was observed; HAMIS was the most sensitive-to-change (smallest detectable difference 3.7% of maximum score). The mean performance time ranged from 0.7 (s.d. 0.5, for FPD) to 5.7 (s.d. 1.3, for HAMIS) min.
HAMIS, FPD, MKI and number of joints with limited mobility are all valid, reliable and feasible measures for assessing hand mobility in hand OA, although HAMIS had slightly more favourable properties. Studies assessing sensitivity-to-change in a clinical trial setting are warranted.
使用 OMERACT 筛选器研究手部 OA 患者四种手部活动度测试的计量学特性。
在两个队列（[遗传关节炎和进展（n = 207）和二级护理手部骨关节炎（n = 174）]）的参与者中，经过培训的评估员使用 Hand Mobility in Scleroderma 测试（HAMIS）、指尖到手掌的距离（FPD）、改良 Kapandji 指数（MKI）和活动受限的手部关节数来评估手部移动度。通过与其他结果测量的相关性评估和使用累积概率图评估专门测量拇指和手指活动度的能力来评估有效性。根据最小可检测差异计算基于参与者手部移动度变化的反应性比例。在随机样本（n = 20）中研究了观察者内和观察者间可靠性的内类相关系数（ICC）和可行性（执行测试的时间）。
参与者的活动度评分差异较大。与结构损伤（rs = 0.43-0.52）和骨肿胀（rs = 0.46-0.58）相关性最强；测试之间的相关性模式相似。HAMIS、FPD 和 MKI 均能专门测量手指活动度，但只有 HAMIS 特别能测量拇指活动度。HAMIS 的观察者间可靠性最佳，ICC 为 0.90（95%CI：0.76，0.96）；所有测试的观察者内可靠性均为优（ICC 为 0.94-0.97）。在 2 年内，观察到的变化很小；HAMIS 是最敏感的变化指标（最小可检测差异为最大评分的 3.7%）。平均执行时间范围为 0.7（s.d. 0.5，FPD）至 5.7（s.d. 1.3，HAMIS）分钟。
HAMIS、FPD、MKI 和活动受限的关节数都是评估手部 OA 手部活动度的有效、可靠和可行的方法，尽管 HAMIS 的特性略有优势。需要进行研究以评估在临床试验环境中的敏感性变化。
