背景:测量治疗结果和健康状况随时间的变化是骨关节炎患者临床实践和研究的重要组成部分。许多临床工具用于评估拇指腕掌骨关节炎患者的拇指结构和功能,但是尚未系统地探索其心理计量学。
目的:本研究的目的是探索非手术拇指腕掌骨关节炎患者使用的临床工具的心理测量特性,以客观地测量拇指结构和功能,评估此类研究的质量,并随后提出临床和未来研究建议。
方法:系统评价。
方法:在9个数据库中进行系统搜索和筛选。2002年至2022年之间发表的原始研究涉及心理测量特性的评估(有效性,可靠性,精度,响应性、响应性灵敏度,特异性,和最小的临床重要差异)包括临床工具。样品特征,方法,并汇总了每项研究的心理测量结果。纳入研究的方法学质量采用基于健康测量仪器选择标准清单进行评估。两名独立的研究人员筛选了文章并评估了方法学质量,如果不一致,咨询了第三方。
结果:11项研究纳入本综述。研究中所有参与者的平均年龄为69岁。研究设计包括前瞻性病例对照,前瞻性队列,和横截面来确定测量和工具的心理测量特性。纳入的研究检查了评估运动范围的技术,力量,和疼痛压力阈值,和筛查关节炎(即,挑衅性测试)。掌骨间距离法,Kapandji指数,疼痛-压力阈值测试,和无痛的抓地力和捏测力显示出优异的可靠性和可接受的精度。掌骨延伸,内收,和压力剪切激发试验具有优越的灵敏度和特异性,延伸和内收试验具有优越的可靠性。审查中包括的其他评估产生了较不可靠的心理测量特性。研究的方法学质量从不足到非常好。
结论:基于现有的关于非手术拇指腕掌骨关节炎患者身体结构和功能评估的心理测量特性的文献,我们提供了一组有限的建议,用于筛查关节炎症状和测量手的力量,拇指活动能力,和疼痛阈值。在这些领域以及灵活性方面都需要额外的心理测量学研究,感觉,和客观衡量手的功能。未来的研究应该采用心理测量研究的最佳实践。
BACKGROUND: Measurement of treatment outcomes and change in health status over time is a critical component of clinical practice and research for people with osteoarthritis. Numerous clinical tools are used to assess the structures and function of the thumb in persons with thumb carpometacarpal osteoarthritis however their psychometrics have not yet been systematically explored.
OBJECTIVE: The purpose of this study was to explore the psychometric properties of clinical tools used in persons with non-surgical thumb carpometacarpal osteoarthritis to objectively measure thumb structures and function, evaluate the quality of such studies, and subsequently make clinical and future research recommendations.
METHODS: Systematic
review.
METHODS: A systematic search and screening was conducted across nine databases. Original research published between 2002 and 2022 that involved the assessment of psychometric properties (validity, reliability, precision, responsiveness, sensitivity, specificity, and minimal clinically important difference) of clinical tools were included. Sample characteristics, methods, and psychometric findings from each study were compiled. The methodological quality of included studies was evaluated using the COnsensus-based Standards for the selection of health Measurement Instruments\' checklist. Two independent researchers screened articles and assessed methodological quality and when not in agreement, a third party was consulted.
RESULTS: Eleven studies were included in the
review. The mean age of all participants in the studies was 69 years of age. The study designs included prospective case-control, prospective cohort, and cross-sectional to determine the psychometric properties of the measurements and tools. The included studies examined techniques to assess range of motion, strength, and pain-pressure thresholds, and screen for arthritis (ie, provocative tests). The intermetacarpal distance method, Kapandji index, pain-pressure threshold test, and pain-free grip and pinch dynamometry demonstrate excellent reliability and acceptable precision. Metacarpal extension, adduction, and pressure-shear provocative tests have superior sensitivity and specificity and the extension and adduction tests have excellent reliability. Other assessments included in the
review yielded less robust psychometric properties. Studies were of variable methodological quality spanning from inadequate to very good.
CONCLUSIONS: Based on the available literature on the psychometric properties of assessments of body structures and functions in persons with non-operative thumb carpometacarpal osteoarthritis, we offer a limited set of recommendations for use when screening for arthritis symptomology and measuring hand strength, thumb mobility, and pain thresholds. Additional psychometric research is needed in these domains as well as in dexterity, sensation, and objective measures of hand function. Future research should employ best practices in psychometric research.