Abstract
Introduction
Evaluating the success of a treatment has changed. Currently, the emphasis is on patient-rated outcome scores rather than surgeon recording of outcome measures. Functional outcome and patient satisfaction following Dupuytren's disease surgery is poorly quantified in the literature. This study aimed to assess subjective patient hand function, disability and satisfaction using a PEM score and its correlation with residual contracture.
Methods
Percutaneous Needle Fasciotomy (PNF) is performed in our outpatient clinic to treat Dupuytren's contracture at MCP joints. A validated patient completed questionnaire (PEM) was used to record patient demographics, side of surgery, finger involved, time since surgery, residual symptoms, disability, subjective hand function and satisfaction. The questionnaire was posted to all patients who had PNF over the study period (n=68) along with a stamped addressed envelope and participant information sheet.
Results
68 patients had PNF surgery on 73 hands. Completed questionnaires were returned from 46 patients (51 hands), a response rate of 70%. Mean follow-up was 15 months (SD +/− 10), range 5-36 months. Wilcoxon Signed Ranks Test showed that change in ‘function of hand’ over time was statistically significant (z = 5.82, n-ties = 50, p < 0.001). Spearman's test showed a significant correlation between any residual contracture and total score on the PEM (rs = 0.540, N=51, p <0 .001, two tailed). Multiple linear regression revealed that the correction achieved at time of surgery was a significant predictor of subjective hand function (p= 0.001). Most of the patients were satisfied with their surgery and its outcome, a cumulative mean score of 4.80 with SD +- 2.58.
Conclusion
Significant improvement in contracture and deformity and good patient satisfaction can be achieved by percutaneous needle fasciotomy. Hand function measured using this tool (PEM Score) was strongly correlated with final deformity at follow-up.
