Measures that quantify symptom intensity and activity tolerance in a precise, efficient, and user-friendly manner are in common use. Computer adaptive tests (CATs) may provide similar psychometrics in less time than established fixed scales. We reviewed the performance of CATs compared with fixed-length scales in the assessment of patient-reported outcomes in patients with trauma of the upper limb. The results showed valid and reliable outcome measurement with CATs performing as well as established fixed scales with fewer ceiling effects (1).  

Some third-party payers require hand therapists to rate a patient’s functional disability based on patient self-rating using patient-reported outcome measures (PROMs), objective measurements of impairment, and observation of functional tasks-hand therapist-rated function (HTRF). We tested the correlation between HTRF and PROMs and the association with psychological factors. It was found that hand therapist ratings of patient function correlate less strongly with PROMs than PROMs correlate with one other (2). The discrepancy between HTRF and PROMs may reflect discrepancies between objective pathophysiology and impairment on the one hand and PROMs on the other. Such discrepancies raise opportunities to address stress, distress, and unhelpful cognitive biases regarding pain that can reduce health.

Almost two decades have passed since the development of the items contained in the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and during this time, daily tasks have changed to adapt to changes in technology. We studied whether a technologically updated QuickDASH questionnaire correlates with the standard QuickDASH questionnaire, but our results demonstrated that the technologically updated questionnaire had no advantage over the standard (3).

Another study evaluated the construct validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health instrument by establishing its correlation to the QuickDASH questionnaire in patients with upper extremity illness. The consistent finding that general patient-reported outcomes correlate moderately with regional patient-reported outcomes suggests that a small number of relatively nonspecific patient-reported outcome measures might be used to assess a variety of illnesses (4). In our opinion, the blending of physical and mental health questions in the PROMIS Global Health makes this instrument less useful for research or patient care.

Symptoms and disability at the trapeziometacarpal (TMC) joint are typically assessed with general measures that may not be able to accurately discriminate between TMC arthrosis–specific concerns versus other hand and arm conditions. We developed and preliminary validated the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire designed to assess symptoms and disability at the TMC joint. The concise TASD was found to be useful in assessing symptoms and disability related to TMC arthrosis, has a simple scoring system and administration mode (self-administered), and is free (5). The measure was found to have high internal consistency reliability, good structural validity, and good convergent, discriminant, and known-groups construct validity. The TASD can be very useful in clinical and research practice, to help differentiate symptoms of TMC arthrosis from other confounding hand or upper extremity-specific illnesses, aid in symptom management, and help monitor change and treatment effects.

References

1. Jayakumar P, Overbeek C, Vranceanu AM, Williams M, Lamb S, Ring D, Gwilym S. The use of computer adaptive tests in outcome assessments following upper limb trauma. Bone Joint J. 2018 Jun 1;100-B(6):693-702. doi: 10.1302/0301-620X.100B6.BJJ-2017-1349.R1. PubMed PMID: 29855231.
2. Braun Y, Mellema JJ, Peters RM, Curley S, Burchill G, Ring D. The relationship between therapist-rated function and patient-reported outcome measures. J Hand Ther. 2016 Nov 29. pii: S0894-1130(16)30077-1. doi: 10.1016/j.jht.2016.02.022.[Epub ahead of print] PubMed PMID: 27912920.
3. Moradi A, Menendez ME, Kachooei AR, Isakov A, Ring D. Update of the Quick DASH Questionnaire to Account for Modern Technology. Hand (N Y). 2016 Dec;11(4):403-409. doi: 10.1177/1558944715628006. PubMed PMID: 28149205; PubMed Central PMCID: PMC5256652.
4. Stoop N, Menendez ME, Mellema JJ, Ring D. The PROMIS Global Health Questionnaire Correlates With the QuickDASH in Patients With Upper Extremity Illness. Hand (N Y). 2017 Feb 1:1558944717691127. doi: 10.1177/1558944717691127. [Epub ahead of print] PubMed PMID: 28718322.
5. Becker SJ, Teunis T, Ring D, Vranceanu AM. The Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire: Development and Preliminary Validation. Hand (N Y). 2016 Jun;11(2):197-205. doi: 10.1177/1558944715627239. Epub 2016 Feb PubMed PMID: 27390563; PubMed Central PMCID: PMC4920530.