Full Length Article| Volume 35, ISSUE 4, P613-627, October 2022

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Measuring functional outcome in Dupuytren's disease: A systematic review of patient-reported outcome measures

Published:April 14, 2021DOI:


      • The Disability of Arm, Shoulder and Hand (QuickDASH), Michigan Hand Questionnaire (MHQ), BriefMHQ, and URAM present adequate convergent validity.
      • The MHQ, BriefMHQ, Unité Rhumatologique des Affections de la Main (URAM), Southampton Dupuytren's Scoring Scheme (SDSS), Short Form-36 and the multi-attribute of the Health Utility Index -3 have good test-retest reliability.
      • The MHQ and BriefMHQ are highly responsive.
      • The results of this systematic review support the use of the MHQ and BriefMHQ in individuals with Dupuytren's Disease.



      Functional impairments related to Dupuytren's disease (DD) can be assessed using patient-reported outcome measures (PROMs). A systematic review was published in 2013 on outcome measures for assessing treatment in individuals with DD; however, several articles have since been published on this matter.


      To conduct a systematic review to analyze the quality and content of the evidence on the psychometric properties of PROMs used in individuals with DD.

      Study design

      Systematic review.


      CINAHL, EBM reviews, Embase, Medline, and Web of Science were searched to identify studies evaluating the psychometric properties of PROMs used with individuals with DD. All studies retained were appraised by two independent assessors using two validated critical appraisal tools.


      Fifteen articles on the psychometric properties of 10 PROMs were included. Construct validity and responsiveness were the most studied. Eighty percent of the studies were of good to very good methodological quality according to MacDermid's Critical appraisal checklist for psychometric articles, whereas 67% of the studies comported risks of bias according to the COSMIN checklist. Of the 10 PROMs, three were specifically developed for DD but remain mostly under-studied for their psychometric properties (≤ 2 studies for the SDSS and DIF-CHUM). The QuickDASH, MHQ, BriefMHQ, and URAM present moderate to good convergent validity. Test-retest reliability was found to be good for the MHQ, briefMHQ, URAM, SDSS, SF-36, and the multi-attribute of the HUI-3. The MHQ and BriefMHQ are highly responsive.


      There is a need for more psychometric studies on the PROMs used with individuals with DD. However, to date, the results included in this systematic review support that the MHQ and briefMHQ are the PROMs with the most acceptable psychometric properties.


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        • Bayat A.
        • McGrouther D.A.
        Management of Dupuytren's disease – clear advice for an elusive condition.
        Ann R Coll Surg Engl. 2006; 88: 3-8
        • Ball C.
        • Pratt A.L.
        • Nanchahal J.
        Optimal functional outcome measures for assessing treatment for Dupuytren's disease: a systematic review and recommendations for future practice.
        BMC Musculoskelet Disord. 2013; 14: 131
        • Beaudreuil J.
        • Allard A.
        • Zerkak D.
        • et al.
        Unité Rhumatologique des Affections de la Main (URAM) Scale: development and validation of a tool to assess Dupuytren's disease-specific disability.
        Arthritis Care Res. 2011; 63: 1448-1455
        • Bendixen L.L.
        • Jorgensen R.W.
        • Jensen C.H.
        A patient-reported outcome measure for patients with Dupuytren's disease.
        Dan Med J. 2020; 67: 1-5
        • Bernabé B.
        • Lasbleiz S.
        • Gerber R.A.
        • et al.
        URAM scale for functional assessment in Dupuytren's disease: A comparative study of its properties.
        Joint Bone Spine. 2014; 81: 441-444
        • Broekstra D.C.
        • Van den Heuvel E.R.
        • Lanting R.
        • Werker P.M.N.
        Measurement properties of the Dutch Unite Rhumatologique des Affections de la Main and its ability to measure change due to Dupuytren's disease progression compared with the michigan hand outcomes questionnaires.
        J Hand Surg Eur Vol. 2018; 43: 855-863
        • Budd H.
        • Larson D.
        • Chojnowski A.
        • Shepstone L.
        The QuickDASH Score: A patient-reported outcome measure for Dupuytren's surgery.
        J Hand Ther. 2011; 24: 15-21
        • Cohen J.
        Applied multiple regression/correlation analysis for the behavioral sciences.
        Lawrence Erlbaum Associates, Hillsdale (NJ)1983
        • Draviaraj K.P.
        • Chakrabarti I.
        Functional outcome after surgery for Dupuytren's contracture: a prospective study.
        J Hand Surg. 2004; 29A: 804-808
        • Forget N.J.
        • Higgins J.
        • Rivard M.
        • Harris P.G.
        Going beyond activity and participation: Development of the DIF_CHUM – A patient-reported outcome measure for individuals with Dupuytren's contracture.
        J Hand Ther. 2020; 33: 305-313
        • Forget N.J.
        • Jerosch-Herold C.
        • Shepstone L.
        • Higgins J.
        Psychometric evaluation of the Disabilitues of the Arm, Shoulder and Hand (DASH) with Dupuytren's contracture: validity evidence using Rasch modeling.
        BMC Musculoskele Disord. 2014; 15: 361-372
        • Hensler S.
        • Wehrli M.
        • Herren D.B.
        • Marks M.
        Measurement properties of the German Unité Rhumatologique des Affections de la Main (URAM) scale in patients treated for Dupuytren's disease.
        Hand Surg Rehabil. 2020; 39: 568-574
        • Lanting R.
        • Broekstra D.C.
        • Werker P.M.N.
        • Van den Heuvel E.R.
        A systematic review and meta-analysis on the prevalence of dupuytren disease in the general population of western countries.
        Plast Reconstr Surg. 2014; 133: 593-603
      1. MacDermid J.C. Evidence-Based Rehabilitation: A Guide to Practice. In: Law M, ed. Critical appraisal of study design for psychometric articles evaluation form and interpretation guide. Thorofare, NJ Slack; 2008:387-392.

        • Mohan A.
        • Vadher J.
        • Ismail H.
        • Warwick D.
        The Southampton Dupuytren's Scoring Scheme.
        J Plast Surg Hand Surg. 2014; 48: 28-33
        • Moher D.
        • Liiberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.
        PLOS Med. 2009; 6e100097
        • Mokkink L.B.
        • de Vet H.C.W.
        • Prinsen C.A.C.
        • et al.
        COSMIN risk of bias checklist for systematic reviews of patient-reported outcome measures.
        Qual Life Res. 2018; 27: 1171-1179
        • Mokkink L.B.
        • Terwee C.B.
        • Patrick D.L.
        • et al.
        The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes.
        J Clin Epidemiol. 2010; 63: 737-745
        • Munro B.
        Statistical methods for health care research.
        JB Lippincott, Philadelphia (PA)2000
        • Prinsen C.A.C.
        • Mokkink L.B.
        • Bouter L.M.
        • et al.
        COSMIN guideline for systematic reviews of patient-reported outcome measures.
        Qual Life Res. 2018; 27: 1147-1157
        • Rodrigues J.N.
        • Zhang W.
        • Scammell B.E.
        • et al.
        Recovery, responsiveness and interpretability of patient-reported outcome measures after surgery for Dupuytren's disease.
        J Hand Surg. 2017; 42E: 301-309
        • Rodrigues J.N.
        • Zhang W.
        • Scammell B.E.
        • Davis T.
        What patients want from the treatment of Dupuytren's disease - is the Unité Rhumatologique des Affections de la Main (URAM) scale relevant?.
        J Hand Surg. 2015; 40E: 150-154
        • Rodrigues J.N.
        • Zhang W.
        • Scammell B.E.
        • et al.
        Validity of the Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and the Quickdash when used in Dupuytren's disease.
        J Hand Surg. 2016; 41E: 589-599
        • Sinha R.
        • Cresswell T.R.
        • Mason R.
        • Chakrabarti I.
        Functional benefit of Dupuytren's surgery.
        J Hand Surg. 2002; 27B: 378-381
        • Streiner D.
        • Norma G.
        Reliability. Health Measurement Scales: A Pratical Guide To Their Development And Use.
        Oxford University Press, New York (NY)1995
        • Terwee C.B.
        • Bot S.D.M.
        • Boer M.R.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Terwee CB
        • Prinsen CAC
        • Chiarotto A
        • et al.
        COSMIN methodolgy for evaluating the content validity of patient-reported outcome measures : a Delphi study.
        Quality of Life Research. 2018; 27: 1159-1170
        • Thoma A.
        • Kaur M.N.
        • Ignacy T.A.
        • et al.
        Psychometric properties of health-related quality of life instruments in patients undergoing palmar fasciectomy for dupuytren's disease: a prospective study.
        Hand. 2014; 9: 166-174
        • Valdes K.
        • Macdermid J.
        • Algar L.
        • et al.
        Hand therapist use of patient report outcome (PRO) in practice: A survey study.
        J Hand Ther. 2014; 27: 299-308
        • Van de Ven-Stevens L.
        • Graff M.
        • Peters M.
        • van der Linde H.
        • Geurts A.
        Construct validity of the canadian occupationnal performance measure in participants with tendon injury and dupuytren disease.
        Phys Ther. 2015; 95: 750-757
        • Wehrli M.
        • Hensler S.
        • Schindele S.
        • Herren D.
        • Marks M.
        Measurement properties of the brief michigan hand outcome questionnaire in patients with Dupuytren contracture.
        J Hand Surg Am. 2016; 41: 896-902
        • Wilburn J.
        • McKenna S.P.
        • Perry-Hinsley D.
        • Bayat A.
        The impact of Dupuytren disease on patient activity and quality of life.
        J Hand Surg Am. 2013; 38: 1209-1214

      JHT Read for Credit

      Quiz: # 921

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • # 1.
        The design of the study is
        • a.
        • b.
          systematic review
        • c.
        • d.
          prospective cohort
      • # 2.
        The investigators were interested in assessing the
        • a.
          cost of administering a variety of PROMs for Dupuytren's Disease
        • b.
          utilization rates of various PROMs for Dupuytren's Disease
        • c.
          functional outcomes of patients with Dupuytren's Disease
        • d.
          psychometric properties of available PROMs for Dupuytren's Disease
      • # 3.
        The author's used ___________ critical appraisal checklist in determining acceptable psychometric articles
        • a.
        • b.
        • c.
        • d.
      • # 4.
        The final sample was _________ articles
        • a.
        • b.
        • c.
        • d.
      • # 5.
        While the MHQ and the briefMHQ are currently considered acceptable for clinical use, the authors feel additional PROMs are needed to better assess outcomes for DD
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.