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Impact of Medical Comorbidities on Patient-Rated Upper Extremity Disability
Ugochi Okoroafor, MD; Matthew Bengard, MD; Daniel London, BA; Spencer Brown; Ryan Calfee, MD, MSc
Washington University, St. Louis., MO

Introduction: Comorbidities have been shown to impact patient-rated outcomes in patients with musculoskeletal conditions. In prior studies, medical comorbidities have been quantified through various algorithms. Without a consensus approach to account for medical comorbidities, this study was designed to determine the impact of alternative methods of calculating comorbidities on Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) scores in patients suffering from common hand conditions.
Materials and Methods: This cross-sectional review analyzed 220 adult patients at the time of an initial visit with a hand surgeon at a tertiary institution from August 2008 to August 2009. Patients were diagnosed with atraumatic hand conditions (thumb carpal-metacarpal osteoarthritis, carpal tunnel syndrome, dequervain's tendonitis). All patients completed the QuickDASH and a comprehensive medical history questionnaire used to identify comorbid conditions. Medical comorbidities were assessed through several methods of quantification: simple dichotomization (present/absent any comorbidity), total number of comorbidities, the Charlson Comorbidity Index (CCI), and the Functional Comorbidity Index (FCI). Statistical analysis was conducted to determine the correlation between each comorbidity method and QuickDASH score and the impact of comorbidities on QuickDASH scores.
Results: The mean QuickDASH score for the population was 43 (SD 23). Patients suffered from a mean of 2.6 comorbidities (SD 2.3, range 0-10). 45 patients reported no comorbidities. All methods for quantifying comorbidities had limited correlation with QuickDASH scores (FCI rp=0.17, CCI r rp =0.03, total number comorbidities rp =0.18). Substantial correlation existed between total number of comorbidities and other methods of assessing comorbidities (FCI rp =0.91, CCI rp =0.66). Dichotomized comorbidities (present/absent) had minimal impact on QuickDASH scores (44 vs 39 respectively). Comparisons between the most healthy patients and those in the highest categories of comorbidities failed to reveal any difference in the mean QuickDASH score exceeding the minimal clinically important difference of 15 (Table 1).
Conclusions: No single method of quantifying medical comorbidities demonstrated superior performance in predicting QuickDASH scores. In patients with hand complaints, medical comorbidities do not substantially affect QuickDASH scores. Due to the advantage of simplified scoring and high correlation with other methods, we recommend simple summation of total comorbidities in hand surgery research.
Table 1. Mean QuickDASH according to comorbidity category.


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