268
An important consideration for patients with hand OA is the length of the PROM,
and method of administration. It may not be appropriate, or indeed possible, for a
patient with hand OA to fi ll in a paper questionnaire for 20 min. Where possible, it
is recommended that shorter PROMs are utilized to reduce the functional burden on
the patient. If clinicians wish to use a longer PROM, they should consider using an
electronic version (e.g., tablet/touchscreen) to facilitate easier completion.
In selecting PROMs for use in patients with hand OA, clinicians should be aware
that the literature is not as advanced as for knee and hip OA measures. We present
information on two hand OA-specifi c PROMs, a PROM intended for hand OA or
rheumatoid arthritis, and one PROM developed for rheumatoid arthritis that has
been validated for patients with hand OA (Table 10.3 ). In contrast to knee and hip
OA measures, their measurement properties for use in hand OA is less well estab-
lished, as summarized in Table 10.1.
Patient-Reported Outcome Measures Specifi c for Hand
Osteoarthritis
Australian Canadian Osteoarthritis Hand Index (AUSCAN)
The AUSCAN was developed for patients with hand OA, by the same group who
developed WOMAC. AUSCAN resembles WOMAC in style and format. It com-
prises 15 items evaluating the same domains as WOMAC: pain, stiffness, and func-
tion in ADL. Clinicians can choose to use the Likert or VAS version, and administer
as a patient-completed questionnaire or via interview. Patients recall the previous
48 hours when responding to items, and typically take 3–7 min to complete. Scoring
takes approximately 5 min, via manual or computer calculation (sum of all items in
each subscale). It is unclear how to handle missing items, although assumed that
guidelines are provided in the user manual that can be purchased with the license for
use. Higher scores represent worse outcome. Although the developers suggested
that an overall score can be calculated by summing the three subscale scores [ 51 ],
subsequent analysis found that the pain, stiffness, and function subscales represent
three separate constructs, and recommended that they should not be combined in a
total score [ 52 ]. Clinicians can use population-based normative data as a compari-
son for individual patient scores [ 53 ].
There is evidence that the AUSCAN subscales measure what they intend to mea-
sure. Because patients with hand OA were involved in development, the AUSCAN
can be considered to have content that is relevant for patients with hand OA (content
validity). However, as with WOMAC, there is a high correlation between the pain
and function subscales [ 54 ], likely due to the pain items asking about pain during
particular functional activities. Clinicians should therefore consider that the pain
subscale is more a measure of pain during ADL and may wish to use an additional
measure of the impact of pain on other areas of life (e.g., pain VAS). It is also pos-
sible that some of the items in the pain and function subscales are redundant.
N.J. Collins and E.M. Roos