271All three subscales of the AUSCAN are able to detect improvements with anti-
infl ammatory drug intervention up to 8 weeks, with larger effects seen in the pain
and function subscales. No studies have investigated the responsiveness of the
AUSCAN to other interventions, or whether there are fl oor or ceiling effects associ-
ated with the AUSCAN subscales.
Clinicians should be aware that there are limitations with test–retest reliability.
The pain and stiffness subscales do not show adequate reliability for use in indi-
vidual patients, whereas the function subscale shows mixed results. Clinicians
should keep this in mind when interpreting change scores for an individual patient,
as observed changes may represent error in the measure rather than real change. The
stiffness subscale is also not suffi ciently reliable for use in groups, whereas there are
mixed fi ndings for the pain and function subscales. At this time, there are no guide-
lines as to the minimum value that clinicians can use to represent a real change in
the patient’s condition. Additional questions can be used alongside AUSCAN to
ascertain whether scores represent real change (e.g., VAS for global change).
The AUSCAN is available in multiple language versions. However, as for
WOMAC, the AUSCAN is copyright-protected and may be associated with a fee
for clinical use. This limits its accessibility to all patients with hand OA. Clinicians
should enquire via the Website provided in Table 10.3 regarding permission to use
AUSCAN and associated costs.
Functional Index for Hand Osteoarthritis (FIHOA)
The FIHOA was developed in 1995 to ev aluate hand function in patients with hand
OA. Although intended to be clinician-administered, it can be completed by the
patient. The FIHOA is freely available in four language versions and is quick to use
in clinical settings. It consists of ten items scored on 4-point Likert scales and can
be completed in 2–3 min. Clinicians can calculate a single score in approximately
3 min by manually summing all items, to give a score from 0 to 30. Higher scores
indicate worse function. There are no instructions on how to handle missing items.
Because patients were not involved in the development of the FIHOA, content
validity cannot be assumed. Item 7 is split based on more traditional gender roles.
Men respond to “are you able to use a screwdriver?” while women answer “are you
able to sew?” Clinicians should consider that it is likely that these roles will not fi t
all patients, especially younger patients. It may be more appropriate to have patients
choose the task most relevant for them. However, clinicians should be aware that the
measurement properties of the FIHOA have been established with this item in its
original format, and therefore these cannot be assumed to carry over to a modifi ed
version. There may also be cultural considerations with item 10 (“would you accept
a handshake without reluctance?”).
The FIHOA consistently demonstrates adequate reliability for use in individual
patients and groups of patients with hand OA. Clinicians can consider that an indi-
vidual patient’s change score that exceeds 5.55 points represents a real change
(SDD) [ 55 ]. Studies also support its construct validity, meaning that the FIHOA
10 PROMs for Osteoarthritis