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Patient-Reported Outcome Measures in Adults with Hand Trauma: A Systematic Review
Achilles Thoma, MD, MSc, FRCS(C); Daniel Waltho, BHSc, MD, (cand); Mary Ellen Gedye, MD; Manraj Kaur, MSc, PhD, (cand)
Joseph's Healthcare and McMaster University, Hamilton, ON, Canada

Introduction: Hand-related injuries are common. Several patient-reported outcome measures (PROMs) may be used in the clinical and research setting to measure the extent and impact of these injuries. At this time, it is unclear as to which PROM/s is/are appropriate in this population. The purpose of this review was to (a) identify the available validated PROMs in the hand trauma population, (b) report on their psychometric properties, (c) outline the domains addressed by each PROM, and (d) offer recommendations for their use in clinical practice and research.
Methods: A systematic review was performed using a standard search strategy on publications from January 1990 to Oct 2014 from MEDLINE, CINAHL, Cochrane Library, PubMed Clinical Queries, Scopus and Web of Science. Data extraction and synthesis was conducted therein.
Results: The search strategy yielded 416 hits. A total of 10 PROMs were identified, of which 8 PROMs were found to be validated in the hand trauma population. These were: Disability of the Arm, Shoulder and Hand (DASH), Manchester-Modified Disability of the Arm, Shoulder and Hand (M2DASH), QuickDASH, Michigan Hand Outcomes Questionnaire (MHQ), Cold Intolerance Symptom Severity questionnaire (CISS), Cold Sensitivity Severity questionnaire (CSS), Injured Workers Survey (IWS), and Hand Assessment Tool (HAT). In addition to validity, reliability and responsiveness data was also identified for these PROMs in the hand trauma population.
Conclusions: A well-selected PROM(s) is essential to measure change following treatment and throughout the recovery period, be it in a clinical or research setting. The DASH and the MHQ are the only two PROMs that have been sufficiently studied in the hand trauma population, and for which data are available on validity (criterion and construct), reliability (test-retest and internal consistency), and responsiveness. The domains of the DASH and MHQ are relatively inclusive with respect to hand trauma outcomes. Based on our findings, we recommend that the DASH, the MHQ, or possibly the QuickDASH be considered in all clinical and research cases of hand trauma. The CISS or CSS may be used as additional PROMs in geographically cold environments and the IWS in work- related injuries with suspected psychological overtones.


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