Department of Rehabilitation, Hässleholm Hospital, Hässleholm, Sweden.
Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, Hässleholm, Sweden.
J Patient Rep Outcomes. 2023 Apr 13;7(1):38. doi: 10.1186/s41687-023-00579-7.
Patients with Dupuytren disease experience various activity limitations. Treatment aims to reduce finger joint contractures to improve hand function and activity performance. For assessing improvement different patient-centered measures have been used. The Canadian Occupational Performance Measure (COPM) was developed as an interview-based outcome measure to detect changes over time in patients' perception of their performance and satisfaction in self-identified activity issues. The 11-item disabilities of the arm, shoulder and hand (QuickDASH) scale consists of fixed items that ask patients to rate the difficulty in performing specific daily activities. Few studies have compared the responsiveness of these two types of patient-reported measures in Dupuytren disease.
We included 30 patients with Dupuytren disease enrolled in a prospective cohort study of collagenase injection. We used the COPM (score range 1-10), the QuickDASH (score range 0-100) and measurement of finger joint contracture before and 5 weeks after treatment.
Using the COPM the patients identified 107 activity problems (55 in self-care, 19 in productivity and 33 in leisure). The two most common activity problems were to wash self (21 patients) and to don gloves (19 patients). A clinically important improvement with 3 points or greater from baseline to 5 weeks was seen for performance in 77 activities (72%). The median COPM performance score improved from 4.4 at baseline to 9.0 at 5 weeks and the median QuickDASH score improved from 13.6 to 2.5. Responsiveness (Cohen's d) for the COPM performance was 2.6 (95% CI 1.9-3.3) and for the QuickDASH 0.6 (95% CI 0.1-1.1).
The COPM had about 6-fold larger responsiveness than the QuickDASH, which supports use of an individualized measure when assessing treatment effects in Dupuytren disease.
患有杜普伊特伦挛缩症的患者会经历各种活动受限。治疗的目的是减少手指关节挛缩，以改善手部功能和活动表现。为了评估改善情况，已经使用了不同的以患者为中心的措施。加拿大职业表现测量（COPM）是一种基于访谈的结果测量方法，用于检测患者对自我识别活动问题的表现和满意度的感知随时间的变化。11 项手臂、肩部和手部残疾（QuickDASH）量表由固定项目组成，要求患者对执行特定日常活动的难度进行评分。很少有研究比较这两种类型的患者报告测量方法在杜普伊特伦挛缩症中的反应能力。
我们纳入了 30 名接受胶原酶注射的前瞻性队列研究的杜普伊特伦挛缩症患者。我们使用 COPM（评分范围 1-10）、QuickDASH（评分范围 0-100）和手指关节挛缩测量值，分别在治疗前和 5 周后进行测量。
使用 COPM，患者识别出 107 项活动问题（自我护理 55 项、生产力 19 项、休闲 33 项）。最常见的两个活动问题是自我清洗（21 名患者）和戴手套（19 名患者）。与基线相比，有 77 项活动（72%）的表现有 3 分或更大的临床重要改善。COPM 表现评分从基线时的 4.4 分提高到 5 周时的 9.0 分，QuickDASH 评分从 13.6 分提高到 2.5 分。COPM 表现的反应性（Cohen's d）为 2.6（95%CI 1.9-3.3），QuickDASH 为 0.6（95%CI 0.1-1.1）。
COPM 的反应性比 QuickDASH 大约大 6 倍，这支持在评估杜普伊特伦挛缩症的治疗效果时使用个体化测量方法。
