scholarly journals Hand function and cost effectiveness after collagenase injection versus aponeurectomy for Dupuytren’s contracture: results of the CeCORD-J study

2021 ◽  
Author(s):  
Michiro Yamamoto ◽  
Hideo Yasunaga ◽  
Ryosuke Kakinoki ◽  
Naoto Tsubokawa ◽  
Akimasa Morita ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Direct Cost ◽  
Hand Function ◽  
Group Extension ◽  
Dupuytren’S Contracture ◽  
Extension Deficit ◽  
Dupuytren's Contracture ◽  
Surgery Group ◽  
Patient Reported ◽  
Pip Joint

Abstract BackgroundThis study compared hand function and the cost effectiveness of treatment between collagenase Clostridium histolyticum (CCH) injection and limited fasciectomy for patients with Dupuytren’s contracture (DC).Materials and MethodsThe CeCORD-J study is a prospective, multicenter, non-randomized controlled, observational study of two parallel groups. Participants were DC patients with multiple affected fingers, including flexion contracture of the proximal interphalangeal (PIP) joint. The primary outcome was the Hand10 score, as a patient-reported outcome measure. We set secondary outcomes of EQ-5D-5L score, degree of extension deficit, and direct cost. Propensity score adjustment was used to balance differences in patient characteristics between groups.ResultsParticipants comprised 52 patients in the Collagenase group and 26 patients in the Surgery group. Hand10 score was significantly better in the Collagenase group at 1 and 2 weeks. EQ-5D-5L score was significantly higher in the Collagenase group at 8 weeks. Mean direct cost was 248,000 yen higher in the Surgery group than in the Collagenase group. Extension deficit angle of the PIP joint was significantly larger in the Collagenase group at 26 weeks.ConclusionsCCH injection provides better short-term hand function and cost effectiveness than surgery.UMIN-CTR (UMIN000029826)

scholarly journals Collagenase clostridium histolyticum in patients with Dupuytren’s contracture: results from POINT X, an open-label study of clinical and patient-reported outcomes

2014 ◽  
Vol 40 (2) ◽  
pp. 124-132 ◽  
Author(s):  
D. Warwick ◽  
M. Arner ◽  
G. Pajardi ◽  
B. Reichert ◽  
Z. Szabo ◽  
...  
Keyword(s):  
Hand Function ◽  
Large Population ◽  
Metacarpophalangeal Joint ◽  
Patient Treatment ◽  
Dupuytren’S Contracture ◽  
Open Label ◽  
Extension Deficit ◽  
Dupuytren's Contracture ◽  
Patient Reported ◽  
The Mean

In POINT X, a study designed to reflect clinical practice and patient treatment choices, 254 European patients received open-label collagenase for Dupuytren’s contracture. The most severely affected joint was treated first in 74% of patients. In total, 52%, 41%, 7%, and 1% of patients selected the little, ring, middle, and index finger, respectively; 79% had one or two joints treated. Only 9% of patients ( n = 24) received 4 or 5 injections. The mean improvement in total passive extension deficit (TPED) was 34° on day 1, improving further by day 7 to 42°. This secondary improvement was maintained by day 90 and month 6. The mean number of injections/joint was 1.2 for the metacarpophalangeal joint and 1.25 for the proximal interphalangeal joint. Median time to recovery was 4 days; the mean improvement in hand function was clinically relevant as measured by the Unité Rhumatologique des Affections de la Main (URAM) score. In total, 87% and 86% of patients and physicians, respectively, were very satisfied or satisfied with treatment at month 6, although correlation between TPED and patient satisfaction was weak (Spearman −0.18, 95% CI −0.32 to −0.06). Collagenase was well tolerated, with 10 (3.9%) patients experiencing severe adverse events. As a real-world study, the POINT X findings can be generalized to the at-large population.

Dupuytren’s Contracture: An Audit of the Outcomes of Surgery

2006 ◽  
Vol 31 (5) ◽  
pp. 514-521 ◽  
Author(s):  
J. J. DIAS ◽  
J. BRAYBROOKE
Keyword(s):  
Audit Committee ◽  
Hand Function ◽  
Postal Questionnaire ◽  
High Rate ◽  
Dupuytren’S Contracture ◽  
Subjective Data ◽  
Dupuytren's Contracture ◽  
Patient Reported ◽  
Full Correction

This multi-centre postal questionnaire study was conducted by the Audit Committee of the BSSH to assess the outcomes of surgery for Dupuytren’s Contracture using subjective data provided by 1177 patients at a mean follow-up of 27 (SD 8) months after surgery. Surgery for Dupuytren’s contracture achieved a high rate of full, or almost full, correction in 826 patients (75%) but had a high incidence of post-operative patient-reported complications of 46%. A higher complication rate was seen in those patients with worse initial deformities. The rate of contracture recurrence or persistence was 158 of 1037 (15%). The severity of contracture correlated with the final hand function measured using the PEM score. Recurrence was more common in patients with greater initial deformity. Recurrence was less common if good correction was achieved at surgery. The relevance and limitations of this data are discussed.

A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy for Dupuytren’s disease

2012 ◽  
Vol 37 (8) ◽  
pp. 733-737 ◽  
Author(s):  
M. A. Kemler ◽  
P. Houpt ◽  
C.M.A.M. van der Horst
Keyword(s):  
Primary Outcome Measure ◽  
Flexion Contracture ◽  
Dupuytren’S Contracture ◽  
Hand Therapy ◽  
Extension Deficit ◽  
Intention To Treat ◽  
Flexion Contractures ◽  
Dupuytren's Contracture ◽  
Pip Joint ◽  
Postoperative Flexion

Before surgery for Dupuytren’s contracture, 54 patients with a proximal interphalangeal (PIP) joint flexion contractures of at least 30° were randomized to receive either a 3-month splinting protocol together with hand therapy under the direct supervision of hand therapists, or the same hand therapy alone. Extension deficit of the PIP joint (primary outcome measure), global perceived effect, pain intensity, comfort and complications were assessed at baseline and 1 year after surgery. In an intention-to-treat analysis, the group assigned to splint-plus-hand therapy had a mean reduction of 21° in flexion contracture after 1 year, compared with 29° in the group receiving hand therapy alone ( p = 0.1). There was no difference between the groups regarding other parameters. After operative release of a Dupuytren’s contracture, a postoperative protocol using a splint and hand therapy was no better than hand therapy alone in minimizing postoperative flexion contractures.

Validation of a Handprint for Clinical Evaluation of Dupuytren’s Contracture

2021 ◽  
Author(s):  
Takashi Ajiki ◽  
Akira Murayama ◽  
Yukinori Hayashi ◽  
Katsushi Takeshita
Keyword(s):  
Clinical Evaluation ◽  
High Reliability ◽  
Flexion Contracture ◽  
Dupuytren’S Contracture ◽  
Therapeutic Effects ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
Palmar Surface ◽  
Patient Reported ◽  
Quick Dash

Abstract Objective We have developed a handprint-based method for visualizing and quantifying the palmar contact of patients with Dupuytren’s contracture. The purpose of this study was to examine whether the generated handprint was useful for assessing the severity of flexion contracture of the fingers and for evaluating the therapeutic effects of collagenase clostridium histolyticum (CCH) injection for Dupuytren’s contracture. Methods The handprint was created by applying medical-grade ethanol-containing hand sanitizer over the entire palmar surface of the affected hand and then pressing it on thermal paper for word processors. The reliability of the handprint was evaluated through test–retest of 10 healthy volunteers at an interval of 10 days, and the validity of the handprint was assessed using a flexion contracture model in which the little finger was fixed in an Alfence splint. In addition, we obtained handprints of the affected hand in 33 patients with unilateral Dupuytren’s contracture both before CCH injection and at the final observation after injection to investigate the contact area of the hand (CAH) and the length of the hand (LH). The relationships between CAH, LH, total extension deficit angle (TEDA), and patient-reported outcome measures (Japanese Society for Surgery of the Hand Version of the Quick Disability of Arm, Shoulder, and Hand Questionnaire [Quick DASH-JSSH] and Hand20) were examined. Results The test–retest correlation coefficient was 0.9187 (p < 0.001) for CAH and 0.9052 (p < 0.001) for LH, indicating high reliability of the handprint. The ratios of CAH and LH decreased gradually as the contracture angle of the splinted finger increased. The handprint revealed a marked improvement of palmar contact after CCH injection for Dupuytren’s contracture. Furthermore, the ratios of CAH and LH were strongly correlated with TEDA, Quick DASH-JSSH, and Hand20 before treatment. Conclusion Our handprint-based assessment method was extremely useful for clinical evaluation of CCH treatment for Dupuytren’s contracture. Type of Study/Level of Evidence Therapeutic.

Novel patient-specific visual analogue survey (PVS) is validated in patients treated with collagenase injection for Dupuytren’s disease

2019 ◽  
Vol 5 (1) ◽  
pp. 3-9
Author(s):  
Stephen L Lyman ◽  
Jayme Burket Kotsov ◽  
Chisa Hidaka ◽  
Quynh Tran ◽  
Naomi Roselaar ◽  
...  
Keyword(s):  
Effect Size ◽  
External Validation ◽  
Patient Specific ◽  
Dupuytren’S Contracture ◽  
Post Injection ◽  
Retest Reliability ◽  
Dupuytren's Contracture ◽  
Number Of Patients ◽  
Patient Reported ◽  
Test Retest Reliability

ObjectivesWe developed and validated an electronically administered patient-specific visual analogue survey (PVS) to evaluate changes in hand function after treatment with injectable collagenase clostridium histolyticum (CCH) in Dupuytren’s contracture. The items in the PVS were authored and ranked in importance by the patients.MethodsIn an open-label trial for patients with Dupuytren’s contracture receiving CCH injection, 109 patients completed the PVS on the day of injection, day of manipulation and 30-day follow-up. For external validation, patients also completed standard patient-reported outcome measures, the Overall Treatment Effects Scale and QuickDASH, and underwent physician assessment of contracture via goniometry and the table top test.ResultsResponses were highly individualised with no single activity being chosen as important by more than 8% of patients. Sports-related activities were mentioned most often (23%). The PVS was highly responsive to changes in patients’ conditions with CCH injection (effect size=1.49), much more so than the QuickDASH (effect size=0.50). Additionally, the PVS had no floor or ceiling effects, whereas the QuickDASH ceiling approached 20% post-injection. The PVS had excellent internal consistency (Cronbach’s α=0.95) and correlated strongly with the QuickDASH post-injection (Spearman’s=−0.67). PVS scores were significantly higher for patients reporting their condition had improved versus those reporting no change after injection. The test–retest reliability of the PVS was poor to fair, in part due to allowing patients to choose different activities at test and retest. However, test–retest reliability was good (intraclass correlation coefficient >0.7) and better than QuickDASH among patients who rated the same activities at test and retest.ConclusionsThe PVS is simple to administer and enables individualised assessment in a large number of patients. It is also readily adaptable for use in other diseases, particularly within musculoskeletal medicine.Level of evidenceTherapeutic II: Prospective cohort.

Percutaneous needle fasciotomy for primary Dupuytren’s contracture

2011 ◽  
Vol 36 (7) ◽  
pp. 548-552 ◽  
Author(s):  
L. Rahr ◽  
P. Søndergaard ◽  
T. Bisgaard ◽  
T. Baad-Hansen
Keyword(s):  
Open Surgery ◽  
Tendon Rupture ◽  
Sensory Nerves ◽  
Dupuytren’S Contracture ◽  
Extension Deficit ◽  
Joint Contractures ◽  
Dupuytren's Contracture ◽  
Rehabilitation Period ◽  
Severe Comorbidity ◽  
The Individual

This study evaluated the effect of percutaneous needle fasciotomy on primary Dupuytren’s contracture in 149 patients (213 rays) admitted to our clinic in 2007. Ninety-two patients (130 rays) were followed up for 2 years to compare the change in total passive extension deficit and the passive extension deficit across the individual joint and to note side effects. No tendon rupture or damage to sensory nerves was observed and the rehabilitation period was short (mean, 0.6 days). We found a significant change ( p < 0.001) in total passive extension deficit after 2 years, but the effect of the treatment was greater in Tubiana I and II stages and our best results were in correction of MCP joint contractures. Percutaneous needle fasciotomy is an alternative treatment for elderly patients with severe comorbidity or for those patients who do not want open surgery.

scholarly journals Cost-Effectiveness and Patient Outcomes of Injectable Collagenase to Treat Dupuytren’s Contracture

Cureus ◽  
2021 ◽  
Author(s):  
Rajpreet S Sahemey ◽  
Govind S Dhillon ◽  
Karanjeet S Sagoo ◽  
Kuntrapaka Srinivas
Keyword(s):  
Cost Effectiveness ◽  
Patient Outcomes ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Contracture

The Long-Term Results of Closed Palmar Fasciotomy in the Management of Dupuytren’s Contracture

1988 ◽  
Vol 13 (3) ◽  
pp. 254-256
Author(s):  
A S. BRYAN ◽  
M. S. GHORBAL
Keyword(s):  
Long Term Results ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Contracture ◽  
Pip Joint ◽  
Term Benefit

Twenty-three patients were reviewed an average of 5.3 years after a closed palmar fasciotomy for the correction of Dupuytren’s contracture. Results suggest that this procedure is best suited to those whose contracture is mainly at the MP joint and that approximately 55% of such patients can expect the correction to be maintained for at least five years. In those patients with severe deformity affecting the PIP joint in addition to the MP joint, this may be a useful preliminary procedure, but is unlikely to be of any long term benefit.

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