Development and Validation of a Disease-Specific Questionnaire for Basal Joint Arthritis

Abstract

The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is the most commonly used instrument to assess outcomes of basal joint arthritis (BJA). However, the DASH is subject to influence by the entire upper extremity. This study aims to develop and validate a disease-specific questionnaire for BJA that would be more sensitive to changes in thumb function and pain, and correlate better with objective and subjective metrics. The thumb disability examination (TDX) was developed and 80 patients presenting with BJA at one of the two hospital-based hand clinics were enrolled in the validation study. At enrollment, subjects were given the TDX, DASH, and visual analog pain scale with activity (A-VAS) surveys. The strength was assessed. Patients receiving corticosteroid injection were seen for follow-up at 6 weeks and those who underwent surgery were seen between 3 and 6 months postoperatively. Both the groups were given the TDX, DASH, and A-VAS scales at follow-up. In total, 65 subjects were included in the analysis. Average TDX completion time was 134.3 seconds. The TDX correlated more strongly with A-VAS scores at baseline than the DASH, but less strongly with tip-pinch measures. The TDX was more responsive to injection and surgical treatments for BJA than the DASH, yielding a larger effect size and standardized response mean, and was the only instrument to significantly correlate with changes in A-VAS. The TDX is a reliable instrument for assessing BJA treatment outcomes. It bears less of a burden on patients, is more responsive to symptomatic changes, and correlates better with most objective and subjective measures than the DASH. II, diagnostic.

Tradução e adaptação cultural do questionário “Thumb Disability Exam – TDX” para o português brasileiro

“…The original questionnaire showed value for internal consistency with α > 0.79. 10 No ceiling or floor effect was found in the questionnaire or in the subdivisions. The number of questions and the presence Rev Bras Ortop of many alternatives reduce the possibility of this effect.…”

“…Noback et al 10 proposed a specific questionnaire for rhizarthrosis, the TDX, in order to improve accuracy when comparing therapeutic outcomes. 10,11 The questionnaire evaluates activities performed by patients in the last week and the 20 items are divided into 3 subdivisions, all graded in 5 degrees (following the Likert Scale , where N is the total sum, Q is the number of total questions and B the number of questions left blank.…”

Thumb Disability Examination (TDX) as a New Reliable Tool for Basal Joint Arthritis

“…When the TDX was first validated, Noback et al reported an average completion time of 134 seconds, whereas it took approximately 7 minutes to complete the DASH score. 12,18 The TDX therefore lends itself to greater compliance as patients and physicians are more willing to complete a questionnaire fully that is brief and specific for BJA. Grip strength has shown higher significant correlation with CMC joint osteoarthritis (p < 0.001) compared with pinch strength (p ¼ 0.049) in the literature.…”

“…The TDX score and associated validation procedures were subsequently published in 2017. 12 Based on the validation of the questionnaire in 65 patients, it was reported to be a quick, easy, and reliable tool that could be assessed in approximately 2 minutes and correlated strongly with grip strength (p < 0.01), A-VAS (p < 0.01), and DASH score (p < 0.001). 12 The primary purpose of this study was to further evaluate whether the TDX is a reliable, sensitive, and disease-specific tool for BJA.…”

“…12 Based on the validation of the questionnaire in 65 patients, it was reported to be a quick, easy, and reliable tool that could be assessed in approximately 2 minutes and correlated strongly with grip strength (p < 0.01), A-VAS (p < 0.01), and DASH score (p < 0.001). 12 The primary purpose of this study was to further evaluate whether the TDX is a reliable, sensitive, and disease-specific tool for BJA. The secondary purposes of this study were to report on the demographics of the patients in the database and to compare the TDX with the A-VAS, range of motion (ROM), grip strength, and Eaton-Littler score.…”