From the Editor's Desk

This autumn issue contains two articles that report the results of pilot studies. Debbie Larson from Norwich, UK presents a review of the literature on the responsiveness of patient-reported outcome measures together with the results of a pilot study to compare responsiveness of three measures (Quick-DASH, Patient Evaluation Measure and the Patient Outcomes of Surgery) in patients undergoing surgery for Dupuytren's disease.

Barbara Davenport and colleagues from Derby, UK report a pilot randomized controlled trial comparing two types of exercises for basal thumb osteoarthritis. Pilot studies, sometimes also referred to as feasibility studies, are smaller scale versions or ‘trial runs’ undertaken before a major study. Readers are referred to Thabane et al. ¹ and Shanyinde et al. ² for an excellent overview of pilot and feasibility studies.

Both Larson and Davenport et al. correctly state the purpose of their respective pilot studies as testing the feasibility of methods and procedures in preparation for a large-scale definitive study. Pilot and feasibility studies focus on the processes of the study and not efficacy. The statistical analyses in such studies are often greatly underpowered due to small sample sizes and they need to be interpreted cautiously, especially as a lack of observed differences is not evidence of no effect. Instead, the effect estimates, for example the between-group difference in pain score of 2 points on a visual analogue scale, should be used to assess whether it is worth proceeding to a larger study and to inform sample size calculations. Pilot studies can also provide useful evidence to persuade funders that it is worthwhile and feasible proceeding to a large study.

I look forward to seeing both of these studies undertaken as larger studies and to the results being published sometime in the future.

The third article is by Zoe Adams and colleagues at St George's Hospital, London who report an audit of outcomes from a rehabilitation group for patients with complex hand injuries. Treating patients in such a group setting can be an efficient way of managing the limited resource available. However the authors concede that the expected high level of improvement set as a standard could not be achieved in most patients and that patients with an additional diagnosis of complex regional pain syndrome were least likely to benefit from group rehabilitation. This audit has resulted in a review of the service and care pathways.

Finally Sarah Turner with surgical colleagues from Manchester, UK report an unusual case of an avulsion fracture of the base of the second metacarpal. Timely diagnosis and surgical management of this injury resulted in an overall good outcome for this patient.