Validity, factor structure, and clinical relevance of the AUSCAN Osteoarthritis Hand Index

Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 02/2006; 54(2):551-6. DOI: 10.1002/art.21615
Source: PubMed


The Australian/Canadian (AUSCAN) Osteoarthritis Hand Index is a self-report assessment of pain, stiffness, and function in patients with hand osteoarthritis (OA). Small studies have confirmed the reliability, construct validity, and responsiveness of this measure, but the factor structure has not been examined. In this study, we examined the clinimetric properties and clinical relevance of the AUSCAN index in a large sample of patients with familial hand OA.
The study group comprised 700 patients (80% female, mean age 69 years) who were part of a study on the genetics of generalized OA. All patients had radiographic hand OA bilaterally. The analyses examined internal consistency, factor structure, and relationships of the subscales to grip and pinch strength and a single-item pain measure.
Internal consistency was high for the total AUSCAN index and the subscales (Cronbach's alpha = 0.93-0.96). The AUSCAN function subscale had the strongest correlation with grip and pinch strength, and the pain subscale had the strongest correlation with the single-item pain measure, thus supporting the construct validity of these subscales. Factor analysis showed that all pain and function items clearly loaded on the subscale they were intended to measure. Each 1-unit increase in the AUSCAN function subscale was associated with a clinically relevant decrease in hand strength.
The results of this study strongly confirm the clinimetric properties of the AUSCAN index, including the validity of specific subscales. Results indicate that the AUSCAN index can measure meaningful changes in pain, stiffness, and function.

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Available from: Virginia B Kraus, Jan 08, 2015
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    • "The results of this analysis are consistent with a previous study that showed an association between pain and both functional and overall health status in patients with hand OA [34] and OA of the knee and hip [21]. In a study assessing the validity of the AUSCAN hand index, all three AUSCAN subindices were significantly correlated with an independent measure of pain and with grip strength [34]. "
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    ABSTRACT: Nonsteroidal anti-inflammatory drugs are recommended for the relief of pain associated with hand osteoarthritis (OA) but do not alter the underlying structural changes that contribute to impaired physical function. The current analysis examined the relationship of pain relief with measures of function and global rating of disease in patients with hand OA. This was a combined analysis of 2 prospective, randomized, double-blind, 8-week, multicenter, parallel-group studies comparing diclofenac sodium 1% gel with placebo gel (vehicle) in patients with radiographically confirmed mild to moderate hand OA. Patients (n = 783) aged > or = 40 years applied diclofenac sodium 1% gel (2 g) or vehicle to each hand 4 times daily for 8 weeks. Outcome measures included pain intensity assessed on a 100-mm Visual Analog Scale (VAS); the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) subscales for pain, stiffness, and physical function (100-mm VAS); and a global rating of disease (100-mm VAS). Change in VAS pain intensity from baseline to week 8 was categorized (<0%, 0%-<15%, 15%-<30%, 30%-<50%, 50%-<70%, and > or = 70%) without regard to treatment and compared in each category with the mean change from baseline in each AUSCAN subindex and the global rating of disease. Pearson correlations between changes in outcome measures from baseline to week 8 were calculated. Changes in VAS pain intensity were accompanied by similar changes in AUSCAN scores and global rating of disease. Pearson correlations confirmed significant associations (P < 0.001) between change in VAS pain intensity and changes in AUSCAN pain (correlation coefficient [r] = 0.81), AUSCAN function (r = 0.75), AUSCAN stiffness (r = 0.66), and global rating of disease (r = 0.76). Pain relief correlated with improvements in physical function, stiffness, and global rating of disease in patients with hand OA, irrespective of treatment. This suggests that pain or anticipation of pain inhibits physical function and influences patient perception of disease severity in hand OA. These results also suggest that any intervention to relieve the pain of hand OA may improve function and patient perception of disease severity, despite the absence of a disease-modifying mechanism of action. NCT00171652, NCT00171665.
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    • "Addressing this topic, recent data have revealed significant differences of the SACRAH as well as the M-SACRAH in HOA and RA patients [15]. Detailed data on validity and factor structure of the AUSCAN have been published in 2006 [19, 20]. "
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    ABSTRACT: Objectives. To compare the modified score for the assessment and quantification of chronic rheumatoid affections of the hands (M-SACRAH) with the Australian/Canadian osteoarthritis hand index (AUSCAN) in hand osteoarthritis (HOA). Both are self-administered patient questionnaires, being designed to assess functional status, stiffness, and pain in affected patients, despite some differences in format, compass and arrangement of questions. Methods. 66 HOA patients (51 females), attending the outpatient clinic, were included. Patients completed the AUSCAN (15 visual analogue scales) (VAS) and the M-SACRAH (12 VAS). Results. AUSCAN-pain amounted to a mean of 41.9 (±2.9 SEM), AUSCAN-stiffness to 53.1 (3.7) and AUSCAN function to 42.6 (3.2). M-SACRAH-function amounted to 25.4 (2.4), M-SACRAH-stiffness to 42.6 (3.0), and M-SACRAH-pain to 43.7 (3.1). The total mean M-SACRAH was 37.2 (2.4) (all P's < .0001). The three respective domains of the two scores correlated significantly: pain: r = 0.73, stiffness: r = 0.75, and function: r = 0.76 (all P's < .0001). The four identical items in both scores also correlated significantly. No significant gender specific differences were observed. Conclusion. Despite a different scope of items, a significant high correlation of these two scores evaluating HOA patients could be demonstrated. We conclude that both scores are equivalently valuable for the assessment of health status in these patients.
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