Patients' perspective on surgical intervention for Dupuytren's disease - experiences, expectations and appraisal of results.

PURPOSE: To explore patients' perspectives on surgical intervention for Dupuytren's disease (DD), focusing on patients' appraisal of results, involving previous experiences, expectations and patient characters. METHOD: The participants were 21 men, mean age 66 years, scheduled for DD surgery. Qualitative interviews were conducted 2-4 weeks before surgery and 6-8 months after surgery. The model of the Patient Evaluation Process was used as theoretical framework. Data were analyzed using problem-driven content analysis. RESULTS: Five categories are described: previous experiences, expectations before surgery, appraisal of results, expectations of the future and patient character. Previous experiences influenced participants' expectations, and these were used along with other aspects as references for appraisal of results. Participants' appraisal of results concerned perceived changes in hand function, care process, competency and organization, and could vary in relation to patient character. The appraisal of results influenced participants' expectations of future hand function, health and care. CONCLUSIONS: Patients' appraisal of results involved multidimensional reasoning reflecting on hand function, interaction with staff and organizational matters. Thus, it is not enough to evaluate results after DD surgery only by health outcomes as this provides only a limited perspective. Rather, evaluation of results should also cover process and structure aspects of care. Implications for Rehabilitation To improve health care services, it is important to be aware of the role played by patient's previous experiences, expectations as well as staff and organizational aspects of care. Knowledge about patients' experience and view of the results from surgery and rehabilitation should be established by assessment of care effects on health as well as structure and process aspects of care. Evaluation of structure and process aspects of care can be done by using questions about if the patient felt listened to, received clear information and explanations, was included in decision-making, and their view of waiting time or continuity of care. Improving health care services means not only providing the best treatment method available but also developing individualized care by ensuring good interaction with the patient, providing accurate information, and working to improve the structure of the care process. Before treatment, health care providers should have a dialogue with the patient and consider previous experiences and expectations in order to ensure the patient has balanced expectations of the outcome.

Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. PURPOSE OF THE STUDY: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytren's disease. METHODS: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). RESULTS: The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. DISCUSSION: Safety and social issues of hand function and quality of life had an evident association with functional recovery. LEVEL OF EVIDENCE: IV.

Hand function, experienced pain, and disability after distal radius fracture.

OBJECTIVE: We sought to explore differences in range of motion (ROM), grip strength, and self-reported pain and disability over time after plate-fixation surgery for distal radius fracture. METHOD: We used a prospective repeated-measures research design with four measure points for a study sample of 101 patients. The Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire; the Global Assessment Scale; and the Canadian Occupational Performance Measure were used to assess ROM, grip strength, and pain level. RESULTS: ROM and grip strength improved over time. Pain improved until 6 mo after surgery but greatly deteriorated from 6 to 24 mo. Concurrently, overall discomfort (global index) from the wrist extensively improved from 12 to 24 mo. DASH score decreased 20.1 points from 6 wk to 6 mo and remained stable until 24 mo. CONCLUSION: Even when ROM and grip strength were almost fully regained at 12 mo, pain at rest and during activity was still an issue at 24 mo.

Hand function and quality of life before and after fasciectomy for Dupuytren contracture.

PURPOSE: To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. METHODS: This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol. RESULTS: The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time. CONCLUSIONS: After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Interrater reliability in finger joint goniometer measurement in Dupuytren's disease.

We investigated interrater reliability of motion (ROM) measurement in the finger joints of people with Dupuytren's disease. Eight raters measured flexion and extension of the three finger joints in one affected finger of each of 13 people with different levels of severity of Dupuytren's disease, giving 104 measures of joints and motions. Reliability measures, represented by intraclass correlation coefficient (ICC), standard error of the mean (SEM), and differences between raters with the highest and lowest mean scores, were calculated. ICCs ranged from .832 to .973 depending on joint and motion. The SEM was ≤3° for all joints and motions. Differences in mean between highest and lowest raters were larger for flexion than for extension; the largest difference was in the distal interphalangeal joint. The results indicate that following these standardized guidelines, the interrater reliability of goniometer measurements is high for digital ROM in people with Dupuytren's disease.