Doyle Index is a valuable additional pain measure in osteoarthritis
ABSTRACT To determine reliability, feasibility, and validity of the Doyle Index (DI), a pain score proposed for osteoarthritis (OA).
The DI was performed in 260 patients with OA at multiple sites (mean age 64.9 years, 84% women) by grading pain (0-3) in 48 joints and joint groups by pressure or passive movement. Reliability and feasibility were determined in a random sample of 18 patients, by examining them twice using four raters. Intraclass correlation coefficients (ICCs) for intra- and interrater reliability were calculated, as well as the mean time to perform the DI. Validity was assessed in 260 patients, by correlating DI total scores and DI scores for the hand and knee/hip joints separately, to the pain and function subscales of the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), using Spearman's rank coefficient (r).
In the total population the median (interquartile range) DI score was 11.0 (5.0-19.0). Intraobserver ICCs [95% confidence interval (CI)] ranged from 0.94 (0.84, 0.98) to 0.97 (0.93, 0.99). Interobserver ICC was 0.88 (0.77, 0.94). The mean time to perform the total DI was 5.1min (range 2.4-7.8). DI total scores as well as scores for the hand and knee/hip joints separately were related to AUSCAN (r range 0.61-0.65) and WOMAC (r range 0.43-0.51), although the level of correlation was moderate.
The DI is a reliable, easy to perform, and valid measure for OA pain during physical examination and therefore a promising additional outcome measure not only for OA research but also for clinical practice.
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ABSTRACT: In elderly people with haemophilia (PWH), surgery of more than one joint of the lower extremities might be needed. Multiple joint procedures (MJP) were introduced in 1995, defined as any combination of Total Knee or Total Hip Arthroplasty or Ankle Arthrodesis during one in-hospital stay. The expectation is that by means of such procedures this specific population is able to physically function better for an extended period of time. Thus, they will participate in their society in an optimal way. In this study, we tried to describe an outcome after MJP, including pre- and post-operative pain and range of motion (ROM), and recommend measurement tools. 22 of 37 PWH who underwent MJP between 1995 and 2012 were available for assessment. Pain (WFH score) and range of motion were compared pre and postoperatively. Current outcome was described by VAS per joint, nocturnal and overall pain, MACTAR, Hemophilia Activity List, SF36, and EQ-5D. Mean age at surgery was 50, 3 years (SD 8, 3); mean follow-up 12 years (1-18 years). Pain (VAS) decreased post-surgery (Median 1 - 1, 5), but moderate pain remained. Extension of knees slightly increased, but both knee flexion and ankle plantar and dorsal flexion decreased. PWH reported the ability to stand longer but also pointed at specific problems, e.g. riding a bike (MACTAR). The HAL showed limited activities (functional domains), especially in the 'complex lower extremity' (22, 8/100). The SF36 and EQ-5D showed a mix of physical problems of our population, while experiencing moderate pain and reasonable physical functioning. This led us to the conclusion that adequate follow-up is needed: ROM of all joints, VAS of all joints as well as nocturnal and overall pain, HAL, SF36 and EQ5D. Performance based activities and participation need further attention.Haemophilia 03/2014; 20(2):276-81. DOI:10.1111/hae.12285 · 2.47 Impact Factor
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ABSTRACT: Osteoarthritis (OA) is one of the most common musculoskeletal disorders, frequently affecting the hands. In the last decade there has been increased awareness concerning this disorder because of its clinical burden. Unfortunately, only limited treatments for symptom alleviation are available, and no effective treatment for disease modification exists. The lack of treatment is due not only to a lack of understanding of the disease process, but also to poor outcome measures to assess the condition. The OMERACT Hand OA Special Interest Group (SIG) has started to develop a core set of outcome measures for hand OA clinical trials, observational studies, and clinical record keeping. At OMERACT 11, results from a Delphi exercise were presented, and a preliminary set of core domains was discussed. The group attempted to adopt the new OMERACT Filter 2.0 in the process, and literature overviews of conventional radiographs, ultrasonography, and magnetic resonance imaging as outcome measures in hand OA were presented. Discussions that followed highlighted further suggestions for core domains, the heterogeneity of hand OA, and future research priorities.The Journal of Rheumatology 01/2014; 41(4). DOI:10.3899/jrheum.131253 · 3.17 Impact Factor
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ABSTRACT: OBJECTIVE: To assess risk factors for progression of hand osteoarthritis (OA). METHODS: In a systematic review of cohort studies, medical literature databases were searched up to May 2012 for articles reporting data on the association between risk factors and hand OA progression. The quality of these studies was assessed by two independent reviewers using a criteria scoring system of 16 items, and studies were dichotomized in those with scores over or under ò69%. Best-evidence synthesis was used to determine the level of evidence per risk factor. RESULTS: Fourteen articles were included that fulfilled the selection criteria, of which eight were of high quality. The most frequently investigated risk factors were age, sex, radiographic features (e.g. erosive OA) and scintigraphy. Progression was mostly defined on radiographic criteria, but also clinical progression as outcome was described. Most investigated factors showed limited or inconclusive evidence for the association with hand OA progression. Limited evidence according to the best-evidence synthesis with most available studies was present for the association between a positive scintigraphic scan and radiographic progression (up to 2.8 times more progression than negative joints). CONCLUSION: Limited evidence is available for a positive association between an abnormal scintigraphic scans and radiographic hand OA progression. These data suggest that a positive scintigraphy as inclusion criteria for studies that aim to show structural modification can increase the power of such studies. Future longitudinal studies with a well-defined baseline population are needed to search for risk factors of hand OA progression. © 2012 by the American College of Rheumatology.04/2013; 65(4). DOI:10.1002/acr.21851