title: Measurement of upper limb ulcers in patients with systemic sclerosis: reproducibility and correlation with pain, function, and quality of life.
abstract: BACKGROUND
  There are a large number of studies addressing the treatment and assessment of chronic ulcers. Despite the fact that ischemic ulcers are frequent and difficult to manage in cases of systemic sclerosis, there is minimal literature on assessment measures regarding these wounds or on their reproducibility.
  
  
  OBJECTIVE
  The aim of this study was to investigate intraobserver and interobserver reproducibility regarding ulcer dimension measurements in patients with systemic sclerosis. Correlations between pain, upper limb function, pinch strength, and quality of life were also determined.
  
  
  METHODS
  A prospective 11-week follow-up study was carried out to assess active upper limb ulcers. Ulcer diameter, ulcer area, and interobserver reproducibility were performed weekly. Quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey), upper limb function (disabilities of the arm, shoulder, and hand), pinch strength, pain, visual analog scale, and intraobserver reproducibility were assessed at baseline, 3, 7, and 11 weeks.
  
  
  RESULTS
  Fifty-one active ulcers were recorded. Larger ulcer diameter, smaller ulcer diameter, and ulcer area demonstrated excellent intraobserver (r > .81, p < .001) and interobserver reproducibility (r > .76, p < .001). There was significant correlation between ulcer dimension and visual analog scale scores for pain (r = .42; p < .001) and some Medical Outcomes Study 36-Item Short-Form Health Survey; pinch strength; and disabilities of the arm, shoulder, and hand domains (r >or= .40; p < .01).
  
  
  CONCLUSIONS
  Simple measurement instruments for the assessment of ischemic ulcers were reproducible in patients with SSc and correlated to other variables of interest for these wounds.
authors.affiliation: Division of Rheumatology, Universidade Federal de São Paulo, Brazil.
authors.forename: Sandra Regina
authors.initials: SR
authors.lastname: Toffolo
authors.forename: Rita Nely Vilar
authors.initials: RN
authors.lastname: Furtado
authors.forename: Adriana
authors.initials: A
authors.lastname: Klein
authors.forename: Sandra
authors.initials: S
authors.lastname: Watanabe
authors.forename: Luis Eduardo Coelho
authors.initials: LE
authors.lastname: Andrade
authors.forename: Jamil
authors.initials: J
authors.lastname: Natour
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009730:Nursing Assessment; D015588:Observer Variation; D010146:Pain / Q000209:etiology; D052581:Pinch Strength; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000150:complications* / Q000451:nursing; D016037:Single-Blind Method; D012883:Skin Ulcer / Q000209:etiology / Q000451:nursing / Q000473:pathology*; D034941:Upper Extremity / Q000098:blood supply