Jane Vadher

The Southampton Dupuytren's Scoring Scheme

Abstract The aim of this study was to construct and validate a simple patient-related outcome score to quantify the disability caused by Dupuytrens disease (DD), thus enabling prioritisation of treatment, to allow reliable audit of surgical outcome and to support future research. The Southampton Dupuytrens Scoring System (SDSS) was developed in a staged fashion according to the recommendations of The Derby Outcomes Conference. (1) Item generation; (2) Item reduction; (3) Internal consistency; (4) Test–re-test; (5) Field management; (6) Sensitivity to change standardised response mean; and (7) Criterion validity: ability of the SDSS to measure what it is supposed to measure. Internal consistency measured with Cronbachs alpha indicated acceptable reliability. The test–re-test correlation coefficient showed high reliability with SDSS. Field-testing showed SDSS ratings to be higher than the QuickDASH (Disability of the arm, shoulder and hand) ratings evaluated by the patients who answered both questionnaires. Standardised response mean was more sensitive for SDSS compared with QuickDASH showing sensitivity to change. Criterion validity was used to assess if the SDSS was measuring what it is supposed to measure comparing the SDSS with QuickDASH. A highly significant correlation was found between the two scoring systems. SDSS is a disease-specific patient-related outcome measure with a good internal consistency and performs better than QuickDASH in terms of test–re-test reliability and sensitivity to change. SDSS shows better field-testing attributes suggesting that it is a relatively more patient and practitioner friendly scoring system. This study proposes to the SDSS is a useful patient-related outcome measure for DD.

The Southampton Dupuytren's Clinic: audit of an effective multidisciplinary model

Introduction The Southampton Dupuytrens Clinic (SDC) was preceded by a four-month period when the therapist accompanied the surgeon in Clinic to learn about Dupuytrens Disease (DD) and to develop a specific proforma to collect details of the patient, the condition and the planned treatment. Methods A special clinic was set up for general practitioner referrals for patients with DD. Each patient was seen by the therapist. A detailed history and examination were recorded on the proforma. Treatment options to include the outcome, risks and benefits of surgery were clearly explained, supported by a handout. The patient was then seen by the surgeon to arrange management. Results One hundred and ninety-four patients were allocated to the SDC. In all, 5% failed to attend; 8% had an alternative diagnosis made; and 16% with DD were discharged as the disease was not advanced enough for intervention or the patient decided not to have surgery. The therapist then allocated 71% for surgical assessment. The surgeon, to efficiently allocate personnel and theatre resources, listed 22% for skin graft, 8% for fasciotomy, 70% for fasciectomy, 35% for consultant to perform, 35% for fellow/registrar to perform, and 30% for the consultant to train the registrar. Conclusions We consider that triage and assessment of patients with DD is improved by a multidisciplinary approach: a hand therapist, to quantify deformity and functional deficit, and explain the purpose, risks and outcome of surgery; and a hand surgeon, to decide the type and duration of surgery and the appropriate grade of surgeon.