Stenosing Flexor Tenosynovitis: Validity of Standard Assessment Tools of Daily Functioning and Quality of Life

PURPOSE: The purpose of the study was to assess the construct validity of the Disabilities of Arm Shoulder and Hand (DASH) and the World Health Organization Quality of Life (WHOQOL–BREF) questionnaires for people with stenosing flexor tenosynovitis (SFT); specifically, to evaluate the ability of these measures to distinguish between SFT severity grades.

BACKGROUND: SFT is a common hand disease in adulthood, yet there is paucity of knowledge regarding the validity of standard assessment tools for this population.

DESIGN: Descriptive, comparative, correlational, cross-sectional study

PARTICIPANTS: Sixty-five participants with SFT Grades 1–3 who were recruited from two hand surgeons’ clinics

METHOD: WHOQOL–BREF questionnaire consists of 26 questions, which are divided into four domains of health-related quality of Life (QOL): physical, psychological, social, and environmental. The DASH is a 30-item disability/symptom scale concerning the patient’s health status during the preceding week. Quinnell grading system: SFT fingers are rated as follows: 0, normal movement of the digit; 1, uneven movement; 2, actively correctable locking of the digit; 3, passively correctable locking; and 4, fixed deformity.

DATA COLLECTION: The questionnaires were administered to participants immediately after their visit to the doctor.

STATISTICAL PROCEDURES: Prior to main hypotheses testing Cronbach’s alpha was calculated for both questionnaires, determining their internal reliability (WHOQOL–BREF and DASH). One-way analysis of variance was used to compare the mean scores obtained by the different clinical grades, and post hoc Tukey Honestly Significant Difference test comparisons between groups were conducted. Spearman correlations were calculated between clinical grades and WHOQOL–BREF and DASH scores

RESULTS: The results of the Cronbach’s test for the DASH questionnaire demonstrated excellent internal consistency (α = .973). A significant effect of SFT grade was found (F = 3.27, p = .044, η_p ² = .09), demonstrating an increase in DASH scores with increasing severity of SFT. Post hoc comparisons revealed significant differences (p = .045) only between the Grades 1 and 3 SFT subgroups. A significant correlation (r = .272, p = .024) was found between the clinical grades and DASH scores.

The results of the Cronbach’s test for the WHOQOL–BREF questionnaire demonstrated excellent internal consistency (α = .942); therefore, a total QOL score was calculated instead of using the four domains. A significant effect of SFT grades on the total WHOQOL–BREF questionnaire was found (F = 9.22, p = .001, η_p ² = .23), demonstrating a reduction in QOL scores with increasing severity of SFT. Post hoc comparisons revealed significant differences between Grades 1 and 3 SFT subgroups (p = .001) and between Grades 2 and 3 SFT subgroups (p = .001) in WHOQOL–BREF scores. A moderate significant correlation (r = –.433, p = .001) was found between the SFT grades and QOL.

CONCLUSION: The demonstrated effect of SFT severity on functioning and QOL as measured by the DASH and WHOQL–BREF in this study is noteworthy and highlights the importance of incorporating these measures into research and clinical practice, in accordance with World Health Organization recommendations to address implications of health conditions.

IMPACT STATEMENT: According to the results of the present study it appears that the WHOQOL–BREF questionnaire is more appropriate than the DASH for use with clients with SFT, unless the clients are in the severe (Grade 3) category.