Recurrence of Dupuytren’s contracture: A consensus-based definition

Purpose: One of the major determinants of Dupyutren disease (DD) treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence. Methods: To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren’s research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. We defined consensus when at least 70% of the experts agreed on a topic. Results: Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as “more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment”. In addition, “recurrence should be reported individually for every treated joint” and afterwards measurements should be repeated and reported yearly. Conclusion: This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives

The consequences of different definitions for recurrence of Dupuytren's disease

Background: Recurrence rates are important in the evaluation of the effectiveness of treatment for Dupuytren's disease (DD). In the literature, recurrence rates vary between 0% and 100%. The definition of recurrence of DD after treatment is inconsistently used. The aim of this study is to review all definitions of recurrence after treatment of DD and to evaluate the impact of using these definitions on a single cohort of patients treated for DD. Methods: A literature search was performed in PubMed and Embase to identify studies. Titles and abstracts were analysed to collect all articles that described recurrence rates or definitions of recurrence. Two independent reviewers selected relevant studies and extracted data. The different definitions of recurrence were applied on our data set of 66 patients. Results: Of the 113 articles reporting recurrent rates of DD, 56 (49%) presented a definition of recurrence. We could categorise the definitions into three groups. By applying the different definition on our data set of a randomised controlled trial, the recurrence rates ranged from 2% to 86%. Conclusions: In the literature, different definitions of recurrence of DD are used and many authors failed to define recurrence. This study shows that the wide range of reported recurrence rates may largely be contributed by inconsistency in recurrence definitions. As a result, it is difficult or even impossible to compare recurrence rates between different treatments reported in the literature. The study indicates that consensus on a recurrence definition is needed. (C) 2012 Published by Elsev

Progressie bij MCI en beginnende dementie in kaart brengen: De ontwikkeling, validatie en implementatie van de Cognitive-Functional Composite

Dementie kenmerkt zich door geleidelijke progressieve cognitieve achteruitgang en bijkomende problemen in het dagelijks functioneren. Voor goede begeleiding, zorg en onderzoek naar nieuwe behandelingen is het essentieel om veranderingen in cognitie en dagelijks functioneren goed te kunnen meten. Dit is echter lastig, omdat het merendeel van het neuropsychologisch instrumentarium gericht is op de diagnostiek van dementie en niet altijd geschikt is om klinisch relevante veranderingen over tijd ná de diagnose te meten. Er is dus behoefte aan een meetinstrument om klinische progressie gericht, betrouwbaar en valide in kaart te brengen. In samenwerking met experts, mensen met dementie en hun naasten werd de Cognitive- Functional Composite (CFC) ontwikkeld: een selectie van zeven bestaande cognitieve tests en de verkorte versie van de Amsterdam IADL- vragenlijst. In dit overzichtsartikel beschrijven we de ontwikkeling en validatie van de CFC. We presenteren de onderzoeken naar de kwaliteit van het meetinstrument en de implementatie in de klinische praktijk