Construct Validity and Reliability of the Disability of Arm, Shoulder and Hand Questionnaire for Upper Extremity Complaints in Rheumatoid Arthritis

Objective. The Disability of Ann, Shoulder and Hand (DASH) questionnaire is a tool for measuring physical function and symptoms of the upper extremity. Although widely used, it is not validated for rheumatoid arthritis (RA). In this study the DASH was validated for this patient group. Methods. In total, 102 patients participated in this study. For the validation, the questionnaires of the DASH, the Health Assessment Questionnaire (HAQ), the Medical Outcomes Study Short Form-36 (SF-36), and the Arthritis Impact Measurement Scale (ATMS2) were used. Patients were examined clinically before completing the questionnaires. Pain was scored by each patient using a visual analog scale (VAS). The Disease Activity Score (DAS28) was obtained and grip strength was measured. Reliability was tested by a second DASH questionnaire after 2 days. Validity was tested using a Pearson correlation analysis for the relevant domains of the questionnaires and for the clinical aspects. Results. The reliability of the DASH was excellent (intraclass correlation coefficient 0.97). Internal consistency was strong (Cronbach's alpha 0.97). Validity was proven with excellent results for Pearson correlation with the relevant domains of the questionnaires: HAQ, r = 0.88; SF-36, r = 0.70; and AIMS2, r = 0.85. The clinical scores had a relatively low correlation with the DASH (DAS28, r = 0.42; and grip strength, r = 0.41-0.48), except for the VAS (r = 0.60-0.65). Conclusion. The DASH is a reliable and valid questionnaire in patients with RA. It can be used as a measurement tool of physical disability of the upper extremity. (First Release Nov 1 2008; J Rheumatol 2008;35:2334-8; doi: 10.3899/jrheum.080067

Patients with severe radiographic osteoarthritis have a better prognosis in physical functioning after hip and knee replacement: a cohort-study.

INTRODUCTION: Although Total Hip and Knee Replacements (THR/TKR) improve Health-Related Quality of Life (HRQoL) at the group level, up to 30% of patients are dissatisfied after surgery due to unfulfilled expectations. We aimed to assess whether the pre-operative radiographic severity of osteoarthritis (OA) is related to the improvement in HRQoL after THR or TKR, both at the population and individual level. METHODS: In this multi-center observational cohort study, HRQoL of OA patients requiring THR or TKR was measured 2 weeks before surgery and at 2-5 years follow-up, using the Short-Form 36 (SF36). Additionally, we measured patient satisfaction on a 11-point Numeric Rating Scale (NRSS). The radiographic severity of OA was classified according to Kellgren and Lawrence (KL) by an independent experienced musculoskeletal radiologist, blinded for the outcome. We compared the mean improvement and probability of a relevant improvement (defined as a patients change score ≥ Minimal Clinically Important Difference) between patients with mild OA (KL Grade 0-2) and severe OA (KL Grade 3+4), whilst adjusting for confounders. RESULTS: Severe OA patients improved more and had a higher probability of a relevant improvement in physical functioning after both THR and TKR. For TKR patients with severe OA, larger improvements were found in General Health, Vitality and the Physical Component Summary Scale. The mean NRSS was also higher in severe OA TKR patients. DISCUSSION: Patients with severe OA have a better prognosis after THR and TKR than patients with mild OA. These findings might help to prevent dissatisfaction after THR and TKR by means of patient selection or expectation management

Improvement in Health-Related Quality of Life and Satisfaction after Knee Replacement: A Comparison Between Patients with Mild to Moderate and Severe Radiographical Pre-Operative Osteoarthritis.

<p>Odds Ratios >1 indicate a higher probability of achieving a Minimal Clinically Important Difference in HRQoL after THR in patients with Kellgren Grade 3+4, compared to Grade 0–2.</p><p>The odds ratios adjusted for age, sex, Charnley Comorbidity Classification and BMI and stratified for quartiles of follow-up.</p

Improvement in Health-Related Quality of Life and Satisfaction after Knee Replacement: A Comparison Between Patients with Mild to Moderate and Severe Radiographical Pre-Operative Osteoarthritis.

<p>Positive values indicate a higher mean improvement in HRQoL after THR in patients with Kellgren Grade 3+4, compared to Grade 0–2. The mean differences between radiographic severity are adjusted for age, sex, Charnley Comorbidity Classification and BMI and stratified for quartiles of follow-up.</p

Improvement in Health-Related Quality of Life and Satisfaction after Hip Replacement: A Comparison Between Patients with Mild to Moderate and Severe Radiographical Pre-Operative Osteoarthritis.

<p>Odds Ratios >1 indicate a higher probability of achieving a Minimal Clinically Important Difference in HRQoL after THR in patients with Kellgren Grade 3+4, compared to Grade 0–2.</p><p>The odds ratios adjusted for age, sex, Charnley Comorbidity Classification and BMI and stratified for quartiles of follow-up.</p

Patient Inclusion Flow-chart.

<p>Patient Inclusion Flow-chart.</p

Patient Characteristics.

<p>All values are mean (SD), unless stated otherwise.</p