Abstract
We read this provocative article with interest. Because provocative is not always right, we would like to underline its scientific limits and to explain why, contrary to the article conclusions, the URAM scale is relevant for assessing functional limitation in Dupuytren’s disease.
First, we remind you that functional limitation, a consequence of key importance in Dupuytren’s disease, does not represent all consequences of the disease, such as pain and aesthetic damages. Unfortunately, the authors took into account such criteria, which are not included in the domain of our tool, the URAM scale. Second, the method used to capture and analyse difficulties due to the disease does not seem to reach a suitable level of quality for relevant information. The work by Rodrigues et al. is only descriptive, subjective and lacks any statistical analysis. It should be, therefore, considered more an author point of view than scientific evidence.
The authors asked more than 100 patients to report their difficulties without scoring the difficulties, which prevents any weighted consideration. The authors should have defined domains of patient difficulties using an objective method, such as factorial analysis, rather subjectively. The main presented result is that more than half of the problems patients reported are not captured by the URAM scale. The presentation is skewed. All reported problems are not related to functional limitation. The authors should have reported the complementary perspective that, all items of the URAM scale are related to reported problems.
We would like to remind you that the URAM scale was developed and validated by sound methodology (Beaudreuil et al., 2011). The scale showed good to excellent reliability and suitable construct validity. Furthermore, it showed higher responsiveness and stronger convergent validity with the Tubiana score and with the self-assessed disability than other functional scales, such as the disabilities of the arm, shoulder and hand questionnaire (Beaudreuil et al. 20011; Bernabé et al., 2014). To our knowledge, the URAM scale is the first patient-reported functional measure specifically developed for Dupuytren’s disease and validated in this indication.
Assessing functional limitation does not mean capturing each specific problem experienced by the patient, even if these data must also be part of the global assessment before treatment decision. Patients in the Rodrigues et al. study underwent surgery for Dupuytren’s disease, but data on surgery were not linked with URAM scores. Unfortunately, the authors did not present any follow-up results using the URAM scale. This study would have been an opportunity to test the properties of our tool in the population examined. Indeed, the authors suggested that the population we used for development and validation of the URAM scale may not have been representative of patients with Dupuytren’s contractures. The populations we investigated showed a large spectrum of Dupuytren’s disease (Beaudreuil et al., 2011). Our tool has been adapted for non-French-speaking patients in each considered country. Results of treatment for Dupuytren’s disease using the URAM scale in 254 patients from eight European countries have recently been reported (Warwick et al., 2014). The data indicated suitable responsiveness and ability of the URAM scale to demonstrate functional improvement after treatment and at 6-month follow-up in this multinational population.
We agree that functional evaluation should not summarize global and specific assessment of patients with Dupuytren’s disease. However, functional evaluation is necessarily part of this assessment. Because of its psychometric properties, the URAM scale should be recommended in clinical practice and clinical studies to assess functional limitation in Dupuytren’s disease.