Bednarek, Marcin

Belka, Maciej

Brudnicki, Jarosław

Staszkiewicz, Magdalena

Trybus, Marek

Jagiellonian Univeristy Repository

Marcin BEDNAREK1Magdalena STASZKIEWICZ2Maciej BELKA3Jarosław BRUDNICKI1Marek TRYBUS1The analysis of the effect of Dupuytren’s contracture on the psyche of patients based on the Hand Disability Psychological Response Questionnaire (HDPRQ) - preliminary report’II Katedra Chirurgii UJ CMKierownik: Prof, dr hab. med. Andrzej Matyja2Zaktad Pielęgniarstwa Klinicznego WydziałNauk o Zdrowiu, UJ CMKierownik: Dr hab. Maria Kózka, prof. UJ’Studenckie Koło Naukowe UJ CMOpiekun: Dr n. med. Marcin BednarekAdditional key words: Dupuytren’s contracture The Quick HDPRQDodatkowe słowa kluczowe: przykurcz Dupuytrena kwestionariusz HDPRQConflict of interest not declaredReceived: 15. 10. 2018Accepted: 31. 10. 2019Address for correspondence: Dr n. med. Marcin BednarekII Katedra Chirurgii UJ CM31-501 Kraków ul. Kopernika 21 tel.: +48 12 424 82 00fax: +48 12 421 3456e-mail: marcin. bednarek@uj. edu. plIntroduction: A Dupuytren’s con­tracture is a disease which leads to limitation of hand function through the progressive fibrosis of the fascial structures of the palmar surface of the hand. The available literature and our own observations indicate that this disease significantly affects the quality of life. It decreases hand mo­bility and is also associated with the embarrassing feeling about its una- esthetic appearance. Material and Methods: Into this study 234 patients were enrolled who were qualified for surgical treatment of Dupuytren’s contracture in the Se­cond Department of General Surge­ry, University Hospital, Cracow in the years 2006-2017. Women constituted a 14. 53% (34 patients), while men dominated - 85. 47% (200 patients). The survey was conducted before surgery. It was made using the Hand Disability Psychological Response Questionnaire (HDPRQ) developed by Trybus et al. The subjective as­sessment of the hand function was made using the Disability of the Arm, Shoulder and Hand (DASH), Patient Evaluation Measure (PEM) and Hand Function Score System (HFS) qu­estionnaires. Results: The average HDPRQ questionnaire result with Standard Deviation was 26. 28±6. 51 points. A statistically significant relation­ship was found between the sub­jective assessment of the hand function and the patient’s psyche (p <0. 05) - the higher the DASH, PEM and HFS score, the greater the HDPRQ score. Conclusion: A Dupuytren’s con­tracture affects the patient’s psy­che and there is a close correlation of the HDPRQ with PEM, DASH and HFS questionnaires assessing hand function. Wprowadzenie: Przykurcz Dupuy­trena prowadzi do ograniczenia funk­cji ręki poprzez postępujący proces włóknienia powięziowych struktur dło­niowej powierzchni ręki. Z dostępnego piśmiennictwa i własnych spostrze­żeń wynika, że schorzenie to istotnie wpływa na jakość życia. Prowadzi on do zmniejszenia sprawności ruchowej ręki, a także wiąże się z niemożnością ukrycia przed otoczeniem krępujące­go i nieestetycznego jej wyglądu. Materiał i Metodyka: Badaniem zo­stało objętych 234 chorych zakwalifi­kowanych do leczenia operacyjnego przykurczu Dupuytrena w II Klinice Chi­rurgii Szpitala Uniwersyteckiego w Kra­kowie w latach 2006-2017. Dominowali mężczyźni - 85, 47% (200 chorych), ko­biety stanowiły 14, 53% (34 chorych). Badanie ankietowe zostało przeprowa­dzone przed leczeniem operacyjnym. Wykonano je z wykorzystaniem kwe­stionariusza HDPRQ (Hand Disability Psychological Response Questionnaire) opracowanego przez Trybusa i współ­pracowników. Subiektywna ocena funk­cji ręki została dokonana przy użyciu kwestionariuszy DASH (Disability of the Arm, Shoulder and Hand), PEM (Patient Evaluation Measure) i HFS (Hand Func­tion Score System). Wyniki: Średnia wartość liczbo­wa uzyskana w badaniu kwestio­nariuszem HDPRQ wynosiła 26, 28 (SD±6, 51) punktów. Stwierdzono sta­tystycznie istotną zależność pomię­dzy wpływem funkcji ręki na psychikę chorego (p<0, 05), tzn. im wyższy wy­nik uzyskany DASH, PEM i HFS tym wyższy wynik uzyskany w badaniu kwestionariuszem HDPRQ. Wniosek: Przykurcz Dupuytrena ma wpływ na psychikę chorego oraz istnieje ścisła korelacja wyników kwestionariusza HDPRQ z wynikami kwestionariuszy PEM, DASH i HFS oceniających funkcję ręki. Przegląd Lekarski 2019 / 76 / 10 501Figure 1Advanced stage of Dupuytren’s contracture of right hand (IV°). Zaawansowany przykurcz Dupuytrena ręki prawej (IV°). IntroductionA Dupuytren's contracture (Fig. 1) is a condition which leads to reduced hand function through the progressive fibrosis of the fascial structures of the palmar sur­face of the hand [1-3]. It belongs to the fibrotic group of diseases called fibroma­toses [1, 2, 4, 5]. The available literature and our own observations show that this disease si­gnificantly affects patient’s quality of life [1-3, 6-9]. This is due to the reduced mobi­lity of the hand and the unaesthetic appe­arance which make patients embarrassed [5, 11-13], In the literature, only a few authors un­dertake the investigation of the impact of this disease on the patient's psyche. The­refore, it seems appropriate to conduct fur­ther research in this field [1, 3, 7-10]. Aim of studyThe main aims of this study was to: (I) assess the effect of Dupuytren’s contrac­ture on the patient’s psyche measured by Hand Disability Psychological Response Questionnaire (HDPRQ) before surgery and (II) investigate the relationships be­tween the subjective assessment of hand function scored using the Disability of the Arm, Shoulder and Hand (DASH), Patient Evaluation Measure (PEM) and Hand Function Score System (HFS) questionna­ires and the psyche of patients assessed with the HDPRQ. Material and MethodsInto this study we included 234 pa­tients who were qualified for surgical tre­atment of Dupuytren’s contracture in the Second Department of Surgery, Universi­ty Hospital in the years 2006-2017. From this group we excluded patients who: (I) were treated for recurrence of this disease and (II) who were primarily operated on in other healthcare centers. Women were 14. 53% (34 patients), while men domina­ted - 85. 47% (200 patients). The survey was conducted before surgery. Patients filled the HDPRQ qu­estionnaire (Supplementary material 1) developed by Trybus et al. [13-14] and DASH, PEM, HFS [14-19] on the same time. Table I. The results of Hand Disability Psychological Response Questionnaire. Wyniki badania kwestionariuszem HDPRQ. ‘SD - Standard deviationHDPRQQuestion number Mean SD Range1 2. 74 1. 70 1-72 2. 47 0. 98 1-73 2. 70 1. 10 1-71-3 together 7. 90 2. 82 3-204 1. 33 0. 14 1-75 1. 69 0. 79 1-76 3. 91 2. 37 1-74-6 together 6. 94 2. 51 3-217 2. 98 1. 98 1-78 1. 85 1. 06 1-79 1. 69 0. 58 1-77-9 together 6. 51 2. 43 3-2010 1. 46 0. 14 1-711 1. 76 0. 14 1-712 1. 73 1. 14 1-710-12 together 4. 94 1. 36 3-211-12 together 26. 28 6. 51 12-79ResultsThe mean age with standard deviation (SD) of patients was 61. 6 years (SD: ±9. 83; range: from 25 to 83), with women being on average 5 years older (mean age of women: 66. 8 years; SD ± 10. 94; from 47 to 80; average male age: 61. 2 years; SD ± 9. 98; from 25 to 83). The age dif­ference between women and men were statistically significant. The impact of Dupuytren's contractu­re on the patient's psyche was assessed using the HDPRQ questionnaire. The lowest possible result of the HDPRQ qu­estionnaire is 12 points, and the highest - 84 points. The mean results with SD are shown in Table I. Subjective assessment of hand func­tion was performed using the DASH, PEM and HFS questionnaires. A statistical ana­lysis was made to investigate the impact of the subjective evaluation of the function of the examined hand using the DASH, HFS and PEM questionnaires on the psyche of patients assessed by the HDPRQ qu­estionnaire. A statistically significant relationship was found between the subjective per­ception of hand function and the patient’s psyche (p <0. 05). The results show that the higher the DASH, PEM and HFS score, the higher the HDPRQ questionnaire result. Correlation coefficients are presented in Tables ll-IV and Figures 2-4. 502 M. Bednarek et al. Table IIAnalysis of the hand limitation Impact measured by the DASH questionnaire on the psyche of patients measured by the HDPRQ questionnaire. Ocena wpływu ograniczenia funkcji ręki mierzonej kwestionariuszem DASH na psychikę chorych mierzonych kwestionariuszem HDPRQ. Investigating data Correlation * PDirection of correlationStrength of correlationHDPRQ and DASH* No normal distribution of at least one of the correlated variables, Spe0. 489arman's correlation coefficp<0. 001ient. positive weakFigure 2Chart presenting the impact of hand limitation measured by the DASH questionnaire on the psyche of patients measured by the HDPRQ questionnaire. Ocena wpływu ograniczenia funkcji ręki mierzonej kwestionariuszem DASH na psychikę chorych mierzonej kwestionariuszem HDPRQ. Table IIIAnalysis of hand limitation impact measured by the PEM questionnaire on the psyche of patients measured by the HDPRQ questionnaire. Ocena wpływu ograniczenia funkcji ręki mierzonej kwestionariuszem PEM na psychikę chorych mierzonych kwestionariuszem HDPRQ. * No normal distribution of at least one of the correlated variables, Spearman's correlation coefficient. Investigating data Correlation * PDirection of correlationStrength of correlationHDPRQ and PEM 0. 645 pcO. 001 positive mediumFigure 3Chart presenting the impact of hand limitation measured by the PEM questionnaire on the psyche of patients measured by the HDPRQ questionnaire. Ocena wpływu ograniczenia funkcji ręki mierzonej kwestionariuszem PEM na psychikę chorych mierzonych kwestionariuszem HDPRQ. Przegląd Lekarski 2019/76/10 503Table IVAnalysis of hand limitation impact measured by the HFS questionnaire on the psyche of patients measured by the HDPRQ questionnaire. Ocena wpływu ograniczenia funkcji ręki mierzonej kwestionariuszem HFS na psychikę chorych mierzonych kwestionariuszem HDPRQ. * Wo normal distribution of at least one of the correlated variables, Spearman's correlation coefficient. Investigating data Correlation * PDirection of correlationStrength of correlationHDPRQ and HFS 0. 448 p<0. 001 positive weakFigure 4Chart presenting the impact of hand limitation measured by the HFS questionnaire on the psyche of patients measured by the HDPRQ questionnaire. Ocena wpływu ograniczenia funkcji ręki mierzonej kwestionariuszem HFS na psychikę chorych mierzonej kwestionariuszem HDPR. DiscussionAccording to the definition of the World Health Organization (WHO), health is a sta­te of physical, mental and social well-being, and not just a lack of illness or disability [20]. Dupuytren’s contracture is not a life-thre­atening disease, and rarely causes signifi­cant functional disability. However, due to its prevalence which is up to 12-74% of the adult population in northern Europe [4] it be­comes a social problem to some extent. In Poland, current data of the Dupuytren’s con­tracture occurrence are unknown. In 1969, Lipiński estimated that number to approxi­mately 675, 000, which accounted for 2% of the adult population then [21]. Many authors assessed the impact of Dupuytren’s contracture on the quality of patient’s life using various research me­thods [1, 3, 8-10, 22]. We decided to per­form our own assessment of this impact using the Hand Disability Psychological Response Questionnaire. Primarily, this survey was used to assess the impact of post-traumatic, permanent hand im­pairment on the psyche of patients. Its clinical use and the reliability of the qu­estionnaire was analyzed using the Cron- bach’s alpha coefficient. A close relation­ship between the severity of this disorderand the patient's mental state was proven then [6, 14], Patients filled the HDPRQ questionna­ire before surgery. The average result was 26. 28 (SD ± 6. 51) points. The contracture of fingers had the greatest impact on self- -perception (self-esteem), and the smallest on social life. In the questions related to the family (home) and professional life patients indicated that the Dupuytren’s contracture altered mostly the quality of manual acti­vities. Previous studies showed that for physical workers finger contracture caused greater problems [12]. This is fully under­standable, because contracture mostly af­fects the fingers of the elbow's site of the hand, which are responsible for "strength" of the hand - very important for making a strong, full hook or spherical grip [11], We also investigated the impact of sub­jective limitation of hand function measured by widely used PEM, DASH and HFS qu­estionnaires on the patient’s psyche asses­sed by the HDPRQ. A statistically significant relationship (p <0. 001) was found between all three hand function assessments and the HDPRQ results. Similar results were obtained in the post-traumatic hand asses­sment, which may be the evidence of cor­rect construction of this questionnaire [14], Conclusions1. Dupuytren’s contracture affects the patient’s psyche, especially on his self- -esteem and on some aspects of home life and professional work. 2. There is a close correlation of HDPRQ results with the PEM, DASH and HFS questionnaires when assessing the hand function. References1. Brazzelli M, Cruickshank M, Tassie E, McNamee P, Robertson C. et al: Collagenase Clostridium hi- stolyticum for the treatment of Dupuytren’s contrac­ture: systematic review and economic evaluation. Health Technol Assess. 2015; 19: 1-202. 2. Dritsaki M, Rivero-Arias O, Gray A, Ball C, Nanchahal J: What do we know about managing Dupuytren's disease cost-effectively? BMC Muscu- loskelet Disord. 2018: 25; 34. 3. Gu NY, Botteman MF, Gerber RA, Ji X, Postema R. et al: Eliciting health state utilities for Dupuytre­n's contracture using a discrete choice experiment. Acta Orthop. 2013; 84: 571-578. 4. Gudmundsson KG, Arngrimsson R, Sigfusson N, Bjórnsson A, Jónsson T: Epidemiology of Du­puytren's disease: clinical, serological, and social assessment. The Reykjavik Study. Clin Epidemiol. 2000; 53: 291-296. 5. Jerosch-Herold C, Shepstone L, Chojnowski A, Larson D: Severity of contracture and self-repor-504 M. Bednarek et al. Supplementary material 1. HDPRQ questionnaire1. My disease brought me about being less valuable person1 2 3 4 5 6 7Definitely no no rather no I do not know rather yes yes definitely yes2. Because of my disease I consider myself to be less attractive and disfigured1Definitely no2 no3 rather no4I do not know5 rather yes6 yes7 definitely yes3. I am ashamed of my hand (hands) and I try to disguise it (them) from other people1Definitely no2 no3 rather no4I do not know5 rather yes6 yes7 definitely yes4. Because of my progressive disease my relationships with family got worse1Definitely no2 no3 rather no4I do not know5 rather yes6 yes7 definitely yes5. My disability (hand deformity) has negative influence on my intimate life1Definitely no2 no3 rather no4I do not know5 rather yes6 yes7 definitely yes6. I am angry with the fact that fingers contracture limitâtes performing of some daily activities1Definitely no2 no3 rather no4I do not know5 rather yes6 yes7 definitely yes7. My disease caused worst performing of my professional job1 Definitely no2 no3 rather no4I do not know5 rather yes6 yes7 definitely yes8. Because of my disease my bosses cosider me as less valuable employee1 2 3 4 5 6 7Definitely no9. Because of my1 Definitely no10. My entourage1Definitely no11. Due to my dis friends and collet1 Definitely no12. Due to disabi1 Definitely nono' disability nr2 noi reacts in n2 nolability (defc gues2nolity of my he2norather noly colleagues at wi3 rather noegative way on mj3 rather noirmity) of my hand3 rather noind (hands) I had t3 rather noI do not know□rk patronize me and s4I do not knowl hand presentation (ei4I do not know(hands) I avoid partie4I do not knowo change or limit my u4I do not knowrather yes sometimes do more5rather yesg. gibe, mistrust, ur5rather yes san I consider mys5rather yes sual way of spendi5rather yesyes; precise acti6 yeslwillignest fo6 yeself unconfort6yesng leisure tin6yesdefinitely yesvities instead of me7definitely yesr shaking hand)7definitely yesable in company of my7 definitely yes ne7definitely yesPrzeglad Lekarski 2019 / 76 /10 50! ted disability in patients with Dupuytren's contractu­re referred for surgery. J Hand Ther. 2011; 24: 6-10. 6. 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The reliability, validity and ease of use of the Patient Evaluation Measure, the Di­sabilities of the Arm, Shoulder and Hand and the Michigan Hand Outcome Measure. J Hand Surg Eur. 2008; 33: 9-17. 17. Hudak PC, Amadio C, Bombardier C: Develop­ment of fan upper extremitaty outcome meansure: the DASH (Disabilities of The Arm, Schoulder and Hand). Am J Ind Med. 1996; 29: 602-608. 18. Dias JJ, Braybrooke J: Dupuytren's contracture: an audit of the outcomes of surgery. J Hand Surg Br. 2006; 31: 514-521. 19. Watts AMI, Greenstock M, Cole RP: Outcome fol­lowing the rehabilitation of hand trauma patients. J Hand Surg Br. 1998; 23: 485-489. 20. WHO definition of health. WHO Constitution. Gene­va, 1948. World Health Organization, 2002. 21. Lipiński J: Ocena wyników wczesnych i odległych leczenia operacyjnego przykurczu Dupuytrena w zależności od rozległości wycięcia rozcięgna dło­niowego. Acta Biol et Med Soc Sc Gedan. 1972; 17: 215-256. 22. 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The analysis of the effect of Dupuytren's contracture on the psyche of patients based on the Hand Disability Psychological Response Questionnaire (HDPRQ) - preliminary report

The analysis of the effect of Dupuytren's contracture on the psyche of patients based on the Hand Disability Psychological Response Questionnaire (HDPRQ) - preliminary report

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