What outcomes are important when evaluating people with hand scars? Results of an international clinician and researcher survey

Abstract

Background: Outcome evaluation in people with hand and wrist scars is not standardised. To improve clinical care and research rigour, the authors are developing a core outcome set (COS) for the evaluation of hand scars. This survey identified what international clinicians and academics consider important outcomes for inclusion when evaluating people with hand scarring. Methods: An electronic survey was developed, peer reviewed and disseminated via professional networks and social media. Professionals of diverse clinical backgrounds and geographical location with experience in the evaluation of hand and wrist scar outcomes in adults were invited to participate. The survey opened in February and closed in May 2022. Results: 162 participants, representing all World Health Organisation geographical regions, completed the survey. 32% of respondents reported using standardised scar patient reported outcome measures (PROMs); 31% using standardised scar clinician reported outcome measures (CROMs). In assessing physical symptoms of scar, sensitivity/hypersensitivity received the highest importance rating, and 36 additional physical symptom constructs were added as free text items by 72 participants. Regarding physical characteristic of scar, evaluation of adhesions was rated as most important and 19 additional physical characteristics were reported by 21 participants. Active range of motion was rated the most important impairment evaluation. In the domain of psychological impact of scarring, satisfaction with scarring and appearance acceptability were rated equally important. Sixty percent of participants reported using a standardised patient-reported outcome measure (PROM) for evaluating the functional impact of scars in the hand and wrist. Discussion: This survey identified items for inclusion in the first round of a stakeholder Delphi consensus study, to agree a COS for the evaluation of hand and wrist scars. Frequency of importance ratings for evaluation constructs were determined to gauge the priorities of survey participants, not to exclude constructs. The disparate outcomes reported by free text within outcome domains highlights the lack of an agreed scar evaluation taxonomy, an important consideration for future consensus work. 107 (66%) of survey respondents consented to contact regarding further scar outcome evaluation consensus work, highlighting this work as a clinical priority.