Highlights
- •We identified 750 cases of surgery for Dupuytren's disease at a single center with preoperative QuickDASH scores.
- •We performed Exploratory Factor Analysis on these QuickDASH responses in R, using established methodology.
- •Based on the results of this analysis, we hypothesize that the QuickDASH patient-reported outcome measure (PROM) may measure 2 distinct factors in patients with Dupuytren's disease.
- •Separation of the QuickDASH PROM into 2 sub-scales with distinct scores to measure “hand function” and “hand symptoms” may improve its structural validity in patients with Dupuytren's disease.
ABSTRACT
Study Design
Retrospective cohort
Background
Exploratory Factor Analysis (EFA) and structural equation modelling (SEM) assess relationships
between questionnaire items and the constructs (“factors”) measured by a questionnaire.
The QuickDASH has not been subjected to these analyses in Dupuytren's disease.
Purpose
To undertake EFA and SEM to identify the factors measured by the QuickDASH in patients
with Dupuytren's disease.
Methods
We identified 750 cases of surgery for Dupuytren's disease at a single center with
preoperative QuickDASH scores. We performed EFA on QuickDASH responses in R, using
established methodology. Based on the EFA results, we conducted SEM in a training
sample of 200 participants. A test SEM analysis was performed in a second, independent
sample of 200 participants.
Results
EFA suggested a 2-factor model. Items 1-6 measured one factor (we interpreted this
as “hand function”), whereas items 9-11 measured a different factor (“hand symptoms”).
Items 7 and 8 (social and work activities) did not reflect either of these factors
well, and may be influenced by other variables. A structural equation model based
on the EFA results, with 2 first-order factors, demonstrated excellent fit in our
first SEM sample. This was confirmed with a second independent sample in a test analysis.
Conclusions
The QuickDASH PROM may measure 2 distinct factors in patients with Dupuytren's disease.
This aligns with previous analyses of the full-length DASH PROM. Separation of the
QuickDASH PROM into 2 sub-scales with distinct scores to measure “hand function” and
“hand symptoms” may improve its structural validity in patients with Dupuytren's disease.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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 Eur Vol. 2016; 41: 589-599https://doi.org/10.1177/1753193415601350
- 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 Eur. 2015; 40: 150-154https://doi.org/10.1177/1753193414524689
- Self-perceived hand normality before and after surgical treatment of Dupuytren contracture.J Hand Surg Am. 2021; 46: 403-408https://doi.org/10.1016/j.jhsa.2021.01.022
- Content validity and responsiveness of the patient-specific functional scale in patients with Dupuytren's disease.J Hand Ther. 2021; 34: 446-452https://doi.org/10.1016/J.JHT.2020.03.009
- Experiences of men living with Dupuytren's disease—consequences of the disease for hand function and daily activities.J Hand Ther. 2020; 33: 386-393https://doi.org/10.1016/J.JHT.2019.04.004
- Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease.J Hand Ther. 2015; 28: 255-260https://doi.org/10.1016/J.JHT.2014.11.006
- 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 (Hoboken). 2011; 63: 1448-1455https://doi.org/10.1002/acr.20564
- Measuring functional outcome in Dupuytren’s disease: a systematic review of patient-reported outcome measures.J Hand Ther. 2021; (. S0894-1130(21)00057-0)https://doi.org/10.1016/J.JHT.2021.04.010
- The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content.BMC Med Res Methodol. 2010; 10: 22https://doi.org/10.1186/1471-2288-10-22
- The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content.BMC Med Res Methodol. 2010; 10: 22https://doi.org/10.1186/1471-2288-10-22
- Optimal functional outcome measures for assessing treatment for Dupuytren's disease: a systematic review and recommendations for future practice.BMC Musculoskelet Disord. 2013; 14: 1-11https://doi.org/10.1186/1471-2474-14-131
- Development of the QuickDASH: comparison of three item-reduction approaches.J Bone Joint Surg Ser A. 2005; 87: 1038-1046https://doi.org/10.2106/JBJS.D.02060
- R: A Language and Environment for Statistical Computing.2013
- Exploratory factor analysis: a five-step guide for novices.J Emerg Prim Heal Care. 2010; 8: 1-13https://doi.org/10.33151/ajp.8.3.93
- Principal Component Analysis.Springer-Verlag, New York1986
James D. Choosing the Right Number of Components or Factors in PCA and EFA. JALT Test Eval SIG.
Kenny D. Measuring model fit. Available at: http://www.davidakenny.net/cm/fit.htm. 2015. Accessed February 6, 2021.
- Confirmatory factor analysis with ordinal data: comparing robust maximum likelihood and diagonally weighted least squares.Behav Res Methods. 2016; 48: 936-949https://doi.org/10.3758/s13428-015-0619-7
- Robust statistical methods: a primer for clinical psychology and experimental psychopathology researchers.Behav Res Ther. 2017; 98: 19-38https://doi.org/10.1016/j.brat.2017.05.013
- Reporting structural equation modeling and confirmatory factor analysis results: a review.J Educ Res. 2006; 99: 323-338https://doi.org/10.3200/JOER.99.6.323-338
- The screen test for the number of factors.Multivariate Behav Res. 1966; 1: 245-276https://doi.org/10.1207/s15327906mbr0102_10
- Parallel Analysis Engine to Aid in Determining Number of Factors to Retain using R [Computer Software].2017
- Which patient-reported outcomes shall we use in hand surgery?.J Hand Surg Eur Vol. 2020; 45: 5-11https://doi.org/10.1177/1753193419882875
- 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: 305-313https://doi.org/10.1016/J.JHT.2019.03.013
- Recovery, responsiveness and interpretability of patient-reported outcome measures after surgery for Dupuytren's disease.J Hand Surg Eur Vol. 2017; 42: 301-309https://doi.org/10.1177/1753193416677712
- Outcome measurement in plastic surgery.J Plast Reconstr Aesthetic Surg. 2018; 71: 283-289https://doi.org/10.1016/j.bjps.2017.11.015
- Assessing patient reported outcome measures: a practical guide for gastroenterologists.United Eur Gastroenterol J. 2014; 2: 463-470https://doi.org/10.1177/2050640614558345
- When and why the second-order and bifactor models are distinguishable.Intelligence. 2017; 61: 120-129https://doi.org/10.1016/j.intell.2017.01.012
- Understanding correlation: Factors that affect the size of r.Journal of Experimental Education. 2006; 74: 251-266https://doi.org/10.3200/JEXE.74.3.249-266
- Factor analysis and scale revision.Psychol Assess. 2000; 12: 287-297https://doi.org/10.1037/1040-3590.12.3.287
Article info
Publication history
Published online: December 28, 2021
Accepted:
November 13,
2021
Received in revised form:
November 5,
2021
Received:
September 17,
2021
Publication stage
In Press Corrected ProofFootnotes
Conflict of interest: None.
Funding: None.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
