Dupuytren’s disease (DD) is a fibroproliferative disorder causing deformity of fingers and disability. Different treatments exist ranging from dividing cords (needle aponeurotomy) through disease excision (fasciectomy) to disease excision with resurfacing with a skin graft (dermofasciectomy). A range of outcome measurements has been used in DD, including angular measurements of finger joints and patient-reported outcome measures (PROMs). This thesis hypothesised that the leading candidate outcome measures are inadequate (subject to bias, invalid, and/or uninterpretable) and that currently there is insufficient evidence to inform patient-centred treatment choice in DD. To investigate this, existing evidence was appraised and studies of validity and interpretability of outcomes were conducted. This comprised a systematic review and meta-analysis of surgical trials, a systematic review of interpretability of outcome measures, cross sectional studies of the validity of leading candidate outcome measures (joint angles, the Disabilities of the Arm, Shoulder and Hand tool (DASH), and the Unité Rhumatologique des Affections de la Main scale (URAM)), and a prospective cohort study of outcome interpretability and variables associated with functional outcome. Key findings: • There were too few trials comparing treatments to inform practice in DD, and methodological quality was generally poor. • There were limited interpretability data to guide the design of future studies. • Dynamism was present in 89% of digits, with mean MCPJ dynamism of 6o and PIPJ dynamism of 14o; 11% of digits exhibited over 30 degrees of dynamism. • Patients had virtually unique goals for surgery, with 26% captured by the URAM • The DASH and the URAM were not structurally valid in factor analysis • The DASH was uninterpretable; the URAM’s minimal important change was 10.5 • The factors associated with poor functional outcome differ from those associated with recurrence. Future work should examine validity for other outcome measures; qualitative investigation of patients’ experiences; and patient-centred high quality randomised controlled trials.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:757339 |
| Date | January 2016 |
| Creators | Rodrigues, Jeremy |
| Publisher | University of Nottingham |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://eprints.nottingham.ac.uk/32894/ |
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