Both are self-administered patient questionnaires, being designed to assess functional status, stiffness, and pain in affected patients, despite some differences in format, compass and arrangement of questions. The three respective domains of the two scores correlated significantly: pain: , stiffness: , and function: all. The four identical items in both scores also correlated significantly. No significant gender specific differences were observed. Despite a different scope of items, a significant high correlation of these two scores evaluating HOA patients could be demonstrated.
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Both are self-administered patient questionnaires, being designed to assess functional status, stiffness, and pain in affected patients, despite some differences in format, compass and arrangement of questions.
The three respective domains of the two scores correlated significantly: pain: , stiffness: , and function: all. The four identical items in both scores also correlated significantly. No significant gender specific differences were observed.
Despite a different scope of items, a significant high correlation of these two scores evaluating HOA patients could be demonstrated. We conclude that both scores are equivalently valuable for the assessment of health status in these patients.
Hand osteoarthritis HOA is a highly prevalent condition, which can result in considerable disability. In September , the members of the EULAR OA task force met for the first time to start developing recommendations primarily for the management and afterwards for the diagnosis of HOA—thus emphasizing the importance of this clinical topic [ 2 , 3 ]. These respective core outcomes include pain, functional index, patient's global assessment PGA , structure, number of painful or tender joints, grip strength, and pinch strength.
There was further agreement that patients' self-reported difficulty with daily activities should be assessed with a valid and reliable measure [ 4 ]. Some efforts to develop scoring systems for rheumatoid affections of the little finger joints have been made in the past. Two of them, the algofunctional index functional index for hand osteoarthritis FIHOA by Dreiser and the rheumatoid hand functional disability scale by Duruoz only assess the functional handicap of patients [ 6 , 7 ].
These two scores, furthermore, are administered by interviewers which might result in bias due to interaction between the patient and the interviewer [ 8 ]. We attempted to create a self-administered instrument which did not only include a functional index but also incorporated pain and stiffness and therefore designed the score for the assessment and quantification of chronic rheumatic affections of the hands, the SACRAH, in [ 9 ].
Bellamy et al. In this context, it seems questionable, whether an instrument is capable of targeting HOA exclusively. Special emphasis of our investigation was put on possible differences between the two scores concerning their results in different genders. A further goal was to investigate possible differences in the responsiveness of the two scores to therapeutic interventions. Between August and April , the four authors were assessing patients at the outpatient clinic of our department.
Having been diagnosed with HOA according to the ACR criteria by one of the four, patients were included consecutively into the study [ 12 ]. Thus, sixty six outpatients completed both questionnaires. It has, meanwhile, been translated to English according to standardized procedures. Meanwhile, the questionnaire has been translated to English and Serbocroatian according to standardized procedures and has been validated in a Serbian patient group [ 15 ]. Data of the principal component analysis are given in Table 6.
It comprises 15 items covering pain , stiffness , and function. As the AUSCAN questionnaire is not in the public domain and thus not unrestrictedly available, the candidate items from the publication were used to generate a German version for this specific study. This was done by two professional English-German translaters, one translating the questionnnaire from English into German, the other one translating it back into English. Since the English translation from the German version matched the original AUSCAN questionnaire, the German version was considered primarily valid for the use in this study.
The detailed items of the questionnaire are shown in Table 1. Construct validity of this German version was assessed carrying out principal component analysis Table 7. The main difference between the two questionnaires relates to the importance of stiffness and pain. After initial instruction by a nurse or a resident, as to how the questionnaires should be tackled, the participants completed both forms without further assistance in random order, one right after arrival and the other one just before the assessment by the physician, resulting in a mean time lag of half an hour.
All questionnaires were completed during outpatient department hours between 9 a. Statistical evaluation was carried out using SPSS As all the relevant parameters proved to be normally distributed according to Kolmogorov-Smirnoff accomodation, parametric tests were applied. Correlations of continuous variables were performed using Pearson's correlation.
Groups were compared using the Student's t -test. In order to evalutate dimensionality and factorial structure of both scores, and to reveal whether scale items eventually cross-load on more than one factor, exploratory factor analysis by principial component analysis PCA was performed Tables 5 and 6. Factor analysis, including variations such as PCA, is a statistical approach which is applied to analyze interrelationships among a large number of variables and to explain these variables with respect to their common underlying dimensions factors.
The objective is the attempt to condense information contained in a number of original variables into a smaller set of variates factors with a minimum loss of information [ 16 ]. Moreover, reliability as a measure of the extent to which a variable or a set of variables is consistent in what it is intended to measure was assessed by calculating Cronbach's alpha.
The closer the value comes to one, the stronger the connection between the different variables is assumed. Values greater than 0. For the radiological assessment, the Kellgren Lawrence classification was applied. Patients with isolated thumb base osteoarthritis were not included into the study. Considering gender distribution, disease duration, and radiological status, the patient group can be regarded representative for the overall HOA patients being treated at our clinic.
All patients were Caucasian and their mother tongue was German. All of them gave written informed consent to be enrolled into the study according to the declaration of Helsinki. The design of the study has been approved by the local ethics committee. However, it seems noteworthy that for all domains except the AUSCAN function a trend to higher values was seen in male patients, see Table 3.
Changes of both scores following a therapeutic change, for example, from an ineffective NSAID to another one, were not statistically significantly different, however, the respective changes of the mean values were well comparable for both items, see Table 4. The same, PhGA and the single domains of either instrument correlated significantly.
Reliability testing of both scores was carried out by Cronbach's alpha, which amounted to 0. This statistical procedure revealed both aggregate scores to be three dimensional, while the respective single-domain scores were found to be strictly one dimensional, see also the backgrounds within the respective tables. We were able to show an equal ability of either instrument to describe physical function, pain, and stiffness in this specific patient group.
To facilitate an objective follow-up of patients suffering from HOA, the application of appropriate aggregate scores to describe the patient's status has been considered desirable aside the assessment of pain and functioning [ 5 , 17 ].
The modified score reduced item set was reached by excluding all items of the SACRAH, which correlated with a coefficient of equal or more than 0. This item pool was rationalized according to prevalence, frequency, and importance to the patient.
As the AUSCAN is not unrestrictedly available, even for scientific purposes, a linguistic validation procedure of these items had to be performed. However, if a questionnaire is translated into another language, a linguistic validation is necessary but not sufficient unless the psychometric characteristics have been verified.
Thus, the following psychometric evaluation can also be regarded as a proof of this instrument validity [ 18 ]. Both scores encompass a comparable number of questions but put a different emphasis on the investigated domains function, stiffness, and pain due to their development process. We, therefore, decided to investigate as to whether these differences would take effect on the results of the scores. The absolute values indeed significantly differed with respect to the function and stiffness domains.
The differences in the function domain can be seen due to the different scope of questions addressing functions requiring physical force like holding a pan or wringing out washcloths that are highlyer represented within the AUSCAN questionnaire.
Despite these differences regarding absolute values, however, an expected consistently high correlation between the three domains of both instruments could be found indicating that both scores describe the investigated cohort equally well. As alpha can also be regarded as a measure of redundancy, the small differences between both scores are based on the greater number of items included into the AUSCAN, as commonly reliability coefficients of compositive indices increase by an increasing number of single components [ 16 ].
The consistently high correlation between the single items of both instruments can be regarded a strong marker for convergent validity. Despite no significant difference between female and male patients' results, a predominance of items addressing household activities in the AUSCAN was obvious. Although the investigated number of male patients is small, a considerable part of those considered the scope of the AUSCAN's items as not fully suitable describing their difficulties in daily life.
Nevertheless, changes in the three domains of the two instruments were of the same magnitude and toward the same direction. The correlations of both scores with PGA underline either ability to express the patient's present situation.
PhGA did not correlate that strongly with both instruments. This can be seen in line with our findings about the different view of physicians and patients concerning their present disease activity as well as the respective changes in RA patients [ 21 ]. An important aspect of this study was to test the construct validity of both scores, which was done by principal component analysis. Both scores, when analyzed as an aggregate, appeared to be tridimensional instruments, reflecting the three domains covered by the scores.
As expected, this statistical approach revealed a considerable number of redundant questions. Thus, it would be possible to reduce the number of items of both scores significantly according to these results.
The authors conclude that clinicians, when selecting an instrument for comprehensive measurement of functioning, are advised to include both one instrument with a low diversity ratio for disease specific aspects and another instrument with a high diversity ratio for broader aspects of functioning including some aspects of participation. Hand osteoarthritis and its specific assessment and treatment have received less attention than hip and knee OA in the past.
Recent efforts to this entity mirror an increasing scientific interest in HOA, ending up with the creation and application of patient-centered outcome measures [ 2 , 3 ]. Future research on HOA is expected to focus on good longitudinal studies and improved interventions. In summary, apart from the observed differences in absolute values, both instruments can be regarded equally well able to describe physical function, pain, and stiffness of patients suffering from HOA.
They may, therefore, both be considered equally suitable as core items in the evaluation of these patients. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We will be providing unlimited waivers of publication charges for accepted articles related to COVID Sign up here as a reviewer to help fast-track new submissions.
Journal overview. Special Issues. Academic Editor: Kenneth C. Received 30 Jul Revised 12 Dec Accepted 12 Jan Published 10 Feb Abstract Objectives. Introduction Hand osteoarthritis HOA is a highly prevalent condition, which can result in considerable disability. Material and Methods Between August and April , the four authors were assessing patients at the outpatient clinic of our department.
Questionnaires under Comparison 2. Table 1.
Hand OA Questionnaires Are Not Comprehensive
Prior studies have examined its validity in small clinical samples and family-based samples. This study examined measurement properties of the AUSCAN in a large, community-based sample, extending knowledge about the scale's generalizability. We examined the internal consistency, construct validity, and factor structure of the AUSCAN among the total sample, as well as in subgroups according to gender, race, presence of hand pain, and presence of radiographic hand osteoarthritis OA. Construct validity was also supported, as grip and pinch strength were more strongly correlated with the AUSCAN function subscale than with the pain and stiffness subscales. Factor analysis showed that for the full sample and most subgroups, all pain items loaded on one factor standardized regression coefficients 0. However, for African Americans, a different factor pattern emerged, with three function items loading on a factor with the pain items. Results support the validity of the AUSCAN in a general sample of adults, as well as across demographic and clinical subgroups, although the subscale structures differed slightly by race.
Australian/Canadian Osteoarthritis Hand Index (AUSCAN)