Abstract
This issue highlights that outcome measures continue to be focus of hand rehabilitation research. So much of our time as hand therapists is spent undertaking evaluations. Selecting the most appropriate measures involves many decisions, including what we or our patients consider relevant to assess, what is the evidence base to their validity and reliability, and finally how do we interpret the results in a meaningful way. Research into outcome measures is also an important precursor to undertaking service evaluations, audits and trials of effectiveness, and it is pleasing to see three articles that cover different types of outcome measures as well as methodologies to investigate these. The use of patient-rated outcome measures (PROMs) is increasingly being advocated and seen as complementary to the clinical measures of impairment such as strength and mobility that we use. PROMs provide an important patient perspective of the functional consequences of hand disorders.
Our first article by Lean Poltawski and Tim Watson from the UK considers one such instrument, the patient-rated tennis elbow evaluation (PRTEE). The PRTEE, a disease-specific measure developed for patients with lateral epicondylalgia, was evaluated in a responsiveness study to estimate the magnitude of change and to look at this in relation to patients’ global assessment of change. Such anchor-based methods are very useful in estimating the minimal clinically important change. Their work is helpful in informing sample size calculations for future intervention studies, where the PRTEE is used as a primary outcome measure.
Moving from a disease-specific to a generic perspective, Sandra Kus and colleagues from Germany present their work on the validation of the ICF Core Set for Hand Conditions. This work builds on the initial development of a Core Set for Hand Conditions using the International Classification of Functioning, Disability and Health, which was previously reported in Hand Therapy. 1 In a national cross-sectional study involving face-to-face interviews with 260 patients with a range of hand conditions the frequency of patients’ problems were rated against each ICF category of the Comprehensive Core Set for Hand Conditions. Researchers found that all categories were applicable in at least 10% of patients and that none of the categories in the Core Set were redundant; however, additional categories were identified and added. The authors acknowledge the need to replicate this work in other countries and health-care settings, and no doubt we will see further work published on the Core Set in future.
The third article on outcomes is by Angela Toemen and colleagues from the UK who report the results of a reliability study comparing manual muscle testing (MMT) with hand-held dynamometry (HDD) to measure wrist strength. Their study was based on symptomatic and asymptomatic patients and evaluates both within-rater and between-rater reliability. They confirm that MMT has variable reliability and is insensitive to small changes and that HHD yields higher reliability in symptomatic patients. They also highlight the need for further work on optimizing the testing procedures, especially with regard to positioning and stabilization.
This issue concludes with an article by Julie Collis from New Zealand on ulnar neuropathy at the elbow. She presents findings from a single cadaveric study of the anatomy and relates this to a comprehensive review of the literature to inform current understanding of the pathology, diagnostic tests, and conservative and surgical approaches to management.