Intra- and inter-observer agreement on diagnosis of Dupuytren disease, measurements of severity of contracture, and disease extent

Dieuwke C Broekstra; Rosanne Lanting; Paul M N Werker; Edwin R van den Heuvel

doi:10.1016/j.math.2015.01.010

Intra- and inter-observer agreement on diagnosis of Dupuytren disease, measurements of severity of contracture, and disease extent

Man Ther. 2015 Aug;20(4):580-6. doi: 10.1016/j.math.2015.01.010. Epub 2015 Jan 29.

Authors

Dieuwke C Broekstra¹, Rosanne Lanting², Paul M N Werker³, Edwin R van den Heuvel⁴

Affiliations

¹ University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, HPC BB81, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Electronic address: d.c.broekstra@umcg.nl.
² University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, HPC BB81, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Electronic address: r.lanting@umcg.nl.
³ University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, HPC BB81, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. Electronic address: p.m.n.werker@umcg.nl.
⁴ University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands. Electronic address: e.r.v.d.heuvel@tue.nl.

PMID: 25682557
DOI: 10.1016/j.math.2015.01.010

Abstract

Introduction: Dupuytren disease (DD) is a fibrosing disease affecting the palmar aponeurosis, and is mostly treated by surgery based on measurement of severity of flexion contracture of the fingers. Literature concerning the measurement reliability is scarce. This study aimed to determine the intra- and inter-observer agreement of four variables for diagnosing DD, determining severity of contracture, and disease extent. One of them is a new measurement on the area of nodules and cords for measuring the disease extent in early disease stages.

Methods: An agreement study (n = 54) was performed by two trained investigators. Agreement was calculated per finger, based on an intraclass correlation coefficient (ICC) using a latent variable model on subjects for diagnosis and Tubiana stage. For total passive extension deficit (TPED) and the area of nodules and cords, agreement was calculated with an ICC using a one-way random effects model with subject as random effect.

Results: Inter-observer agreement was very good for diagnosing DD (ICC: 95.5%-99.9%) and good to very good for classifying Tubiana stage (ICC: 73.5%-94.9%). Agreements for area and TPED were moderate (middle finger) to very good (ICC: 48.4%-98.6% and 45.0%-99.5%, respectively). Intra-observer agreement was slightly higher on average than inter-observer agreement.

Conclusion: Overall, the intra- and inter-observer agreement in diagnosing DD, and determining the severity of flexion contracture is high. Also, the newly introduced variable area of nodules and cords has high intra- and inter-observer agreement, indicating that it is suitable to measure disease extent.

Keywords: Articular; Dupuytren contracture; Observer variation; Range of motion; Reproducibility of results.

MeSH terms

Arthrometry, Articular / methods*
Dupuytren Contracture / diagnosis*
Female
Humans
Male
Observer Variation
Range of Motion, Articular / physiology*
Reproducibility of Results
Severity of Illness Index*