Turkish Journal of Physical Medicine and Rehabilitation 1999 , Vol 2 , Num 1

Romatoid El Fonksiyonel Yetersizlik Göstergesinin Klinik Değişime Duyarlılığı

Mehmet Tuncay Duruöz 1
1 Celal Bayar Üniversitesi, Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Manisa

Summary: Sensitivity to change of functional disability scale of the rheumatoid hand: 

Aim: To assess the sensitivity to change of functional disability scale of the rheumatoid hand.

Patients, methods: Outpatients and inpatients with at least one year's duration of rheumatoid arthritis (RA) according to the ACR criteria were selected randomly. Functional and disease activity variables were administered twice to each padtient: our hand scale1, Hand Functional Index (HFI), Revel's Functional Index (RFI), visual analog scale of handicap (VASHD), VAS of pain in hands (VASPH), morning stiffness in hands (MSH), swelling in hands (SH), and Ritchie's Articular Index in hands (RRAIH). The total score of our hand scale (ScoreT) and its three factor groups after factor analysis (ScoreF1, ScoreF2, ScoreF3) were calculated. Four methods were used to assess the clinical changes: 1) comparison of the mean change scores ( S) of functional and clinical variables; 95% confidence interval (CI) of mean was also used for interpretation; 2) Standardized Response Mean (SRM); 3) Effect Size (ES); 4) Spearman's correlation coefficient between change scores.

Results: 55 patients (44 female) with mean age 53.9 (SD: 11.6) were examined twice at mean 15.4 8SD: 1.4) months interval Meaningful negative changes (deterioration) were observed for Score T ( S: -2.22; Cl: -5.16 and 0.73), ScoreF2 8 S: -1.40; Cl: -2.35 and -0.45) and positive changes were observed for VASPH ( S: 8.82; Cl: -0.14 and 17.77), MSH ( S: 29.00; Cl: 1.35 and 56.65) and HFI ( S: 1.91; Cl: 0.39 and 3.43). The highest negative values of SRM were found for ScoreF2 (-0.40) and ScoreT (-0.20). The highest positive values of SRM were found for HFI (0.34), MSH (0.28) and VASPH (0.27). Although score changes of ScoreT has good and moderate corerlation with functional scales and RAIH, it has little or no correlation with other disease activity variables.

Conclusion: Our hand scale has little and meaningful sensitivity to change in longitudinal studies in RA. Although existence of disease activity remission, functional ability (ScoreT) and especially dexterity (ScoreF2) of the rheumatoid hand deteriorate insidously.

Keywords : Rheumatoid hand, sensitivity to clinical change, functional disability, rheumatoid arthritis.