Severity of contracture and self-reported disability in patients with Dupuytren's contracture referred for surgery.
The purpose of the study was to explore the relationship between preoperative flexion contracture (FC) and self-reported disability in patients undergoing surgical release by fasciectomy or dermofasciectomy. The study design used was a prospective observational study: Dupuytren's disease (DD) is a fibroproliferative disorder of the palmar fascia and may lead to functional deficits requiring surgical intervention. Outcomes are usually reported using digital range of motion although recent studies have also included patient-rated outcome measures with the extensively validated Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire commonly used. One hundred fifty-four patients consecutively enrolled in a prospective randomized trial were assessed before surgery for active range of movement using goniometry and self-reported functioning using DASH questionnaire. The small finger was affected in 69% of patients with a mean FC of 77.8 degrees (standard deviation=43.5°). The mean DASH score was 16 points (range, 0-62). The correlation between severity of FC in all four fingers and DASH was weak (r=0.264, p=0.001). At individual digital level, the correlation between FC and DASH was weak in the index (r=0.26), middle (r=0.28), and ring (r=0.21) fingers but almost absent in the small finger (r=0.07). These results show that the relationship between severity of FC and functional disability measured by the DASH questionnaire appear to be very weak or even absent.


METHODS
Level III prospective cohort study.
Institute of Health and Social Sciences Research, Faculty of Health, University of East Anglia, Norwich, UK. c.jerosch-herold@uea.ac.uk
Christina
C
Jerosch-Herold
Lee
L
Shepstone
Adrian
A
Chojnowski
Debbie
D
Larson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053587:Arthrometry, Articular; D004185:Disability Evaluation; D004387:Dupuytren Contracture / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D016059:Range of Motion, Articular; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires