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measures what it is intended to measure. Although the FIHOA is able to detect
changes with pharmacological interventions of up to 8 weeks duration, it tends to be
less responsive than the function subscale of the AUSCAN. The responsiveness of
the FIHOA to other interventions, as well as fl oor and ceiling effects, have not been
evaluated.
Patient-Reported Outcome Measures Specifi c for Hand Arthritis
Cochin Hand Function Scale
The Cochin Hand Function Scale was intended to measure hand function in people
with rheumatoid arthritis and has since been validated for patients with hand OA
[ 56 ]. It is also known by other names, including the Duruoz Hand Index and the
Hand Function Disability Scale. While it was designed to be administered by an
interviewer, it can be self-completed by the patient. The Cochin Scale contains 18
items relating to hand function, including kitchen, dressing, hygiene, offi ce, and
other tasks, and does not specify a recall period. When interviewer-administered, it
takes approximately 3–5 min to complete. Scoring is performed manually by sum-
ming items and takes less than 5 min. Subscale scores can be calculated, along with
a single score (0–90), with higher scores indicating worse hand function. The Cochin
Scale is free to use, with French and English versions available in the original publi-
cation [ 57 ]. An Italian translation has been used in studies on scleroderma.
Clinicians should consider whether the items contained within the Cochin Scale
are relevant for their patient with hand OA. Because the Cochin Scale was developed
with input from patients with rheumatoid arthritis, content validity for patients with
hand OA cannot be assumed. Furthermore, included items may need updating to
refl ect more modern daily upper limb tasks, such as computer and smartphone use.
The Cochin Scale has evidence of adequate reliability for use in individual
patients and groups of patients with hand OA. It is able to detect deterioration in
hand function over 6 months and can discriminate between patients with hand OA
who improve or deteriorate [ 56 ]. However, there is no evidence regarding measure-
ment error, fl oor or ceiling effects, missing items, or responsiveness to treatment.
This limits the ability to recommend the Cochin Scale for use in patients with hand
OA at this time.
Score for Assessment and Quantifi cation of Chronic Rheumatic Affections
of the Hands (SACRAH)
The SACRAH is a measure of pain, stiffness, and function that was developed as a
patient-completed PROM for patients with hand OA or rheumatoid arthritis. The
original version consists of 23 items, each scored on a VAS [ 58 ], and takes 3–5 min
N.J. Collins and E.M. Roos