What Do Patients Want? Outcome Measures in a Diverse World

Area of Science:

• Orthopedics and Sports Medicine
• Patient-Reported Outcome Measures
• Global Health

Background:

• Traditional hand surgery outcome quantification relied on objective measures like range of motion and pinch strength.
• Patient-centered care has led to the development of numerous pathology-specific, closed-ended patient-reported outcome measures (PROMs).
• Existing PROMs, often Western-originated, may not fully capture the diverse values and priorities of global patient populations.

Purpose of the Study:

• To evaluate the breadth of patient experiences and treatment goals across cultures for common hand conditions.
• To assess the utility of an open-ended PROM, the Patient-Specific Functional Scale (PSFS), in capturing diverse patient-reported functional impacts.
• To compare the comprehensiveness of the PSFS with standardized, closed-ended PROMs for carpal tunnel syndrome (CTS) and trigger finger (TF).

Main Methods:

• A multi-institutional, international study involving patients diagnosed with carpal tunnel syndrome (CTS) and trigger finger (TF).
• Patient-reported functional difficulties and goals were collected using the open-ended Patient-Specific Functional Scale (PSFS).
• Qualitative data analysis using template analysis was performed on 225 PSFS responses from three continents and five countries.

Main Results:

• Patient responses revealed diverse functional impacts of CTS and TF, categorized using the International Classification of Functioning.
• Significant variations in the representation of functional domains were observed across different countries, indicating cultural influences.
• Standardized PROMs (QuickDASH, Boston Carpal Tunnel Score, PROMIS) did not fully capture the country-specific priorities identified by patients via PSFS.

Conclusions:

• Patient priorities regarding hand function are diverse and significantly influenced by cultural context.
• Open-ended assessment tools like the PSFS are crucial for capturing the richness of individual patient goals and experiences.
• Standardized, closed-ended PROMs may overlook cross-cultural differences and a broader range of patient concerns, hindering accurate outcome evaluation.