Are standardized patient self-reporting instruments applicable to the evaluation of ulnar neuropathy at the elbow?

Zimmerman, Neal B.; Kaye, Marc B.; Wilgis, E.F. Shaw; Zimmerman, Ryan M.; Dubin, Norman H.

doi:10.1016/j.jse.2009.02.010

Cited by 20 publications

(13 citation statements)

References 30 publications

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“…A 10-point difference in mean DASH scores has been reported as a minimal clinically important difference (37), which suggests that both patient groups had clinically importantly elevated DASH scores when compared to their matched population referents. Our results indicated that symptom and disability scores decreased over time, Svendsen et al and in agreement with this, the observed mean DASH scores of around 23 for both patient groups were lower than preoperative scores of 28 to 33 reported for patients with ulnar neuropathy, but higher than corresponding postoperative values of 7 to 13 (21,23). The DASH scores were substantially lower than mean DASH scores of 44 (SD 22) reported for patients who were assessed between 6 months and 15 years (median 14 months) after a traumatic upper-extremity nerve injury, including brachial plexus injury in 37% of the cases (15).…”

Section: Discussionsupporting

confidence: 91%

“…DASH (18)(19)(20) is widely used in studies of upper-extremity musculoskeletal disorders, but has rarely been used in studies of peripheral nerve affection (15,(21)(22)(23). The validity of DASH for assessing disability related to ulnar neuropathy at the elbow has recently been corroborated by results showing that scores reflected clinical staging (23). UNEQ is a disease specific questionnaire designed to assess severity of symptoms related to ulnar neuropathy at the elbow (24).…”

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confidence: 99%

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Prognosis of ulnar neuropathy and ulnar neuropathy-like symptoms in relation to occupational biomechanical exposures and lifestyle

Svendsen¹,

Johnsen²,

Fuglsang-Frederiksen³

et al. 2013

Scand J Work Environ Health

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Prognosis of ulnar neuropathy and ulnar neuropathy-like symptoms in relation to occupational biomechanical exposures and lifestyle by Svendsen SW, Johnsen B, Fuglsang-Frederiksen A, Frost P Little is known on prognostic factors for ulnar neuropathy confirmed by nerve conduction studies (NCS) and ulnar neuropathy-like symptoms with normal ulnar nerve NCS. Negative prognostic factors included high occupational force requirements, current smoking, obesity, and abnormal NCS. Reduction of high occupational force requirements, smoking, and obesity might improve prognosis of ulnar neuropathy and ulnar neuropathy-like symptoms. Original article Scand J Work Environ Health. 2013;39(5):506-514. doi:10.5271/sjweh.3352 Prognosis of ulnar neuropathy and ulnar neuropathy-like symptoms in relation to occupational biomechanical exposures and lifestyle Objective The aim of this paper was to identify prognostic factors for severity of symptoms and disability among patients with ulnar neuropathy confirmed by nerve conduction studies (NCS) or ulnar neuropathy-like symptoms with normal ulnar nerve NCS. Affiliation MethodsWe conducted a cohort study based on a matched case-referent study. In 2008, we mailed a questionnaire to 1179 patients who were examined by NCS for suspected ulnar neuropathy at the age of ≥18-<65 years, [2001][2002][2003][2004][2005][2006][2007]. Potential prognostic factors included occupational biomechanical exposures, lifestyle factors, and NCS result. Outcomes were severity of symptoms and disability according to questionnaire scores. Referents delivered reference values. We used ordinal logistic regression. ResultsThe proportion who responded was 61%, comprising 324 patients with ulnar neuropathy and 396 with ulnar neuropathy-like symptoms. At follow-up, both patient groups had more severe symptoms and disability than age-and sex-matched referents. Abnormal NCS indicated a poorer prognosis regarding symptom severity [odds ratio (OR) 1.44, 95% confidence interval (95% CI) 1.01-2.01], but not disability (OR 0.78, 95% CI 0.57-1.08). High occupational force requirements indicated a poorer prognosis regarding both symptom severity (OR 1.78, 95% CI 1.10-2.88) and disability (OR 1.66, 95% CI 1.06-2.59). Other negative prognostic factors for both outcomes were current smoking, obesity, distal upper-extremity fractures, female sex, and a recent NCS date (suggesting improvement over time).Conclusions NCS confirmation of ulnar neuropathy identified patients with a poorer prognosis regarding symptoms. A negative impact of high occupational force requirements, current smoking, and obesity on both outcomes suggested that reduction of these factors might improve prognosis of ulnar neuropathy and ulnar neuropathy-like symptoms.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Prognosis of ulnar neuropathy and ulnar neuropathy-like symptoms in relation to occupational biomechanical exposures and lifestyle

Svendsen¹,

Johnsen²,

Fuglsang-Frederiksen³

et al. 2013

Scand J Work Environ Health

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“…The construct validity of the DASH was demonstrated in samples regrouping various upper extremity conditions, and no floor or ceiling effects (ie: referring to a large distribution near the bottom and top scores respectively) were observed in a sample of people with either wrist\hand or shoulder problems [10]. Based on traditional analyses, the results of multiple studies support the use of the DASH as an appropriate measure of functional performance in persons with proximal humeral fractures [11], shoulder disabilities [12, 13], ulnar neuropathy at the elbow [14], rheumatoid arthritis [15], work-related musculoskeletal complaints [16], and thumb osteoarthritis [17]. A recent review reported numerous studies that used the DASH to assess functional performance with a population affected by DC [18].…”

Section: Introductionmentioning

confidence: 99%

Psychometric evaluation of the Disabilities of the Arm, Shoulder and Hand (DASH) with Dupuytren’s contracture: validity evidence using Rasch modeling

Forget

Jerosch‐Herold

Shepstone

et al. 2014

BMC Musculoskelet Disord

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BackgroundDupuytren’s contracture is a progressive, fibroproliferative disorder that causes fixed finger contractures and can lead to disability. With the advances of new therapeutic interventions, the necessity to assess the functional repercussions of this condition using valid, reliable and sensitive outcome measures is of growing interest. The Disabilities of the Arm, Shoulder and Hand (DASH) is one frequently used patient-reported outcome measure but its reliability and validity have never been demonstrated specifically for a population affected with Dupuytren’s contracture. The objective of this study was to evaluate the psychometric properties of the DASH, with focus on validity evidence using the Rasch measurement model.MethodsSecondary analysis was performed on data collected as part of a randomised clinical trial. One hundred fifty-three participants diagnosed with Dupuytren’s contracture completed the DASH at four time points (pre-op, 3, 6 and 12 months post-op). Baseline data were analysed using traditional analysis and to test whether they adhered to the expectations of the Rasch model. Post-intervention data were subsequently included and analyzed to determine the effect of the intervention on the items.ResultsDASH scores demonstrated large ceiling effects at all time points. Initial fit to the Rasch model revealed that the DASH did not adhere to the expectations of the Rasch partial credit model (χ2 = 119.92; p < 0.05). Multiple items displayed inadequate response categories and two items displayed differential item functioning by gender. Items were transformed and one item deleted leading to an adequate fit. Remaining items fit the Rasch model but still do not target well the population under study.ConclusionsThe original version of the 30-item DASH did not display adequate validity evidence for use in a population with Dupuytren’s contracture. Further development is required to improve the DASH for this population.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-361) contains supplementary material, which is available to authorized users.

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“…Similarly, Zimmerman and colleagues compared the DASH and CTQ among UNE patients. 24 The study assessed criterion validity for DASH and CTQ, using the DASH as the “gold standard.” In this sample, the CTQ symptom and function scores were strongly correlated with DASH scores. However, criterion validity is a challenging psychometric property to assess because typically no “gold standard” exists.…”

Section: Discussionmentioning

confidence: 99%

An Outcome Study for Ulnar Neuropathy at the Elbow

Song

et al. 2013

Neurosurgery

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Background Many instruments have been developed to measure upper extremity disability, but few have been applied to ulnar neuropathy at the elbow (UNE). Objective We measured patient outcomes following ulnar nerve decompression to 1) identify the most appropriate outcomes tools for UNE and 2) describe outcomes following ulnar nerve decompression. Methods Thirty-nine patients from 5 centers were followed prospectively after nerve decompression. Outcomes were measured preoperatively, 6-weeks, 3-months, 6-months, and 12-months postoperatively. Each patient completed the Michigan Hand Questionnaire (MHQ), Carpal Tunnel Questionnaire (CTQ), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires. Grip, key-pinch strength, Semmes-Weinstein monofilament (SWM) and 2-point discrimination (2PD were measured. Construct validity was calculated using Spearman correlation coefficients between questionnaire scores and physical and sensory measures. Responsiveness was assessed by standardized response means. Results Key pinch (p=0.008) and SWM testing of the ulnar ring (p<0.001) and small finger (radial: p=0.004; ulnar: p<0.001) improved following decompression. 2PD improved significantly across the radial (p=0.009) and ulnar (p=0.007) small finger. Improved symptoms and function were noted by the CTQ (Preoperative CTQ symptom score 2.73 vs. 1.90 postoperatively, p<0.001), DASH (p<0.001), and MHQ: function (p<0.001), activities of daily living (p=0.003), work (p=0.006), pain (p<0.001), and satisfaction (p<0.001). All surveys demonstrated strong construct validity, defined by correlation with functional outcomes, but MHQ and CTQ symptom instruments demonstrated the highest responsiveness. Conclusions Patient-reported outcomes improve following ulnar nerve decompression, including pain, function and satisfaction. The MHQ and CTQ are more responsive than the DASH for isolated UNE treated with decompression.

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Are standardized patient self-reporting instruments applicable to the evaluation of ulnar neuropathy at the elbow?

Cited by 20 publications

References 30 publications

Prognosis of ulnar neuropathy and ulnar neuropathy-like symptoms in relation to occupational biomechanical exposures and lifestyle

Prognosis of ulnar neuropathy and ulnar neuropathy-like symptoms in relation to occupational biomechanical exposures and lifestyle

Psychometric evaluation of the Disabilities of the Arm, Shoulder and Hand (DASH) with Dupuytren’s contracture: validity evidence using Rasch modeling

An Outcome Study for Ulnar Neuropathy at the Elbow

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