Purpose
To examine agreement on Dupuytren disease (DD) treatment recommendations in an international
sample of hand surgeons.
Methods
A survey was developed to determine expertise in needle aponeurotomy, surgery, and
collagenase injection to treat DD and to examine treatment recommendations for 16
case scenarios. Case scenarios were predeveloped using expert input. Each case represented
a unique combination of 4 dichotomous variables including cord thickness, contracture
severity, patient age, and joint involvement. Interrater reliability statistics were
calculated and multinomial logistic regression modeling and analysis of variance were
used to examine the impact of surgeon- and case-related variables on treatment recommendations.
Results
A total of 36 hand surgeons from 9 countries (mean experience, 17 years) participated.
Average pairwise percent agreement and Krippendorff’s alpha were 26% and .012, respectively.
Predictors of a recommendation for surgery over multiple options were a total contracture
of greater than 70°, a thick precentral cord, involvement of the metacarpophalangeal
and proximal interphalangeal joints, and greater years in practice. A greater number
of years in practice predicted recommendation for collagenase injection and the presence
of a thick precentral cord predicted a recommendation for needle aponeurotomy.
Conclusions
Little agreement exists on treatment recommendations for common presentations of DD
in this sample.
Clinical relevance
Further investigation into the sources of potential widespread discrepancies in the
management of DD may improve the capacity to make evidence-based recommendations.
Key words
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Article info
Publication history
Published online: September 23, 2017
Accepted:
August 22,
2017
Received:
December 14,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
