Variation in Range of Movement Reporting in Dupuytren Disease

PICOS analysis

Definition

Participants

Dupuytren Disease of the hand

Intervention

Surgical treatment/percutaneous fasciotomy/collagenase injection for DD

Comparisons

Not applicable (systematic review)

Outcomes

Reported range of movement

Study design

Included: RCTs, non-randomised CCTs and case series

Excluded: case studies, reviews and conference papers

Publications were suitable for inclusion if the participants had received a surgical treatment, percutaneous fasciotomy or collagenase injection for Dupuytren Disease, if the ROM data was able to be analysed and if articles were published in English within the last 20 years.

29.3 Results

A total of 638 publication titles were screened following removal of duplicates. Relevant abstracts were assessed using a screening tool resulting in 548 publications being excluded. Full text was obtained for the remaining 90 studies.

All 90 studies were reviewed and the method of ROM methodology was extracted and tabulated on a graph. A variation of 24 ROM descriptors was identified with percentage change being the most frequently used as illustrated in Fig. 29.1.

Fig. 29.1

Variation of measures used by description (n = 24)

Further analysis revealed that 8 of these 24 ROM descriptors were potentially describing the same measure, extension deficit:

Flexion contracture
Joint contracture
Joint extension deficit
Extension deficit
Extension contracture
Flexion deformity
Contracture
Extension of a joint

This was confirmed when the 8 categories were scrutinised revealing that each measure was used only once in each publication.

Although the majority of studies reported ROM measurements in degrees, it was not always clear if a goniometer had been used to assess ROM objectively. Furthermore, there was ambiguity whether measurement had been taken actively or passively as both measures are relevant to Dupuytren Disease.

Goniometry was specified as being used in 43 of the 90 studies. On closer evaluation of these studies, only 16 (Anwar et al. 2007; Beyermann et al. 2004; Budd et al. 2011; Donaldson et al. 2010; Engstrand et al. 2009; Gilpin et al. 2010; Herweijer et al. 2007; Hurst et al. 2009; Jerosch-Herold et al. 2011; Johnston et al. 2008; Midgley 2010; Misra et al. 2007; Pess et al. 2012; Skirven et al. 2013; Witthaut et al. 2013; Zyluk and Jagielski 2007) described how measurement was assessed in a way that would permit replication for comparison purposes. This included one study that unusually defined a fully extended joint as 180° on the goniometer (Witthaut et al. 2013). However, as the method was fully described, comparison with other studies, using zero as full extension, was possible.

Only two studies (Donaldson et al. 2010; Skirven et al. 2013) reported testing for intrinsic tightness affecting the PIP joint. Assessing the extended PIP joint with MCP held in flexion enables a true representation of the PIP joint capability.