Purpose
The appearance of the hand is relevant to individual activity and participation. Improving
appearance is often one of the essential goals of hand surgery. The aim of this study
was to describe and validate an instrument for quantitatively assessing hand appearance
in congenital upper limb differences (CULD).
Methods
The Zurich Appearance Score for Hands (ZASH) was developed as a summed score of 6
items: 1 for overall appearance and 5 specific items for the skin, proportions of
the hand, the number of digits, the shape of fingers and the thumb, and the position
of the thumb. Each item can be rated on an 11-point Likert scale. Here, 448 participants
(age, 14–83 years) were asked to rate the images of 17 hands, including standardized
3-dimensional photorealistic computer graphics and photographs of children’s hands
with or without CULDs, some after surgical correction. The sociodemographic characteristics
of the participants were measured using a short questionnaire.
Results
The ZASH score for all CULDs was significantly lower than the ZASH score for normal
hands. Correlations for overall appearance and the ZASH score were high (r = 0.77–0.87).
The internal consistency of all ZASH scores was good to excellent (Cronbach α = 0.82–0.94).
The test-retest reliability in a subgroup of 54 participants was good (r = 0.53–0.79).
The interrater reliability of the ZASH score was moderate (intraclass correlation =
0.47).
Conclusions
The ZASH is a valid and moderately reliable instrument for assessing hand appearance
in children with CULDs.
Clinical relevance
Achieving the best possible appearance is the one of the most relevant goals of hand
surgery. Assessment with validated instruments provides evidence on how to approach
this goal. Further studies may clarify whether the ZASH can be recommended for all
hand conditions and to what extent observers’ sociocultural and professional backgrounds
affect perception.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- World Health Organization International Classification of Functioning, Disability, and Health (ICF).https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-healthDate accessed: October 1, 2019
- Reasons why rheumatoid arthritis patients seek surgical treatment for hand deformities.J Hand Surg Am. 2006; 31: 289-294
- Caring for children with congenital upper extremity differences.J Hand Surg Am. 2021; 46: 1105-1111
- Postoperative patient - and parent-reported outcomes for children with congenital hand differences: a systematic review.Plast Reconstr Surg. 2017; 139: 1422-1429
- Participation and quality of life in children and adolescents with congenital limb deficiencies: a narrative review.Prosthet Orthot Int. 2010; 34: 351-361
- Low impact of congenital hand differences on health-related quality of life.Arch Phys Med Rehabil. 2012; 93: 351-357
- The psychosocial impact of congenital hand and upper limb differences on children: a qualitative study.J Hand Surg Eur Vol. 2021; 46: 391-397
- Children with surgically corrected hand deformities and upper limb deficiencies: self-concept and psychological well-being.J Hand Surg Eur Vol. 2011; 36: 795-801
- The DASH(Disability of Arm-Shoulder-Hand) Questionnaire--a new instrument for evaluating upper extremity treatment outcome.Handchir Mikrochir Plast Chir. 1999; 31: 149-152
- Functional and outcome evaluation of the hand and wrist.Hand Clin. 2003; 19: 361-369
- The importance of hand appearance as a patient-reported outcome in hand surgery.Plast Reconstr Surg Glob Open. 2015; 3: e552
- Measuring outcomes in hand surgery.Clin Plast Surg. 2008; 35: 239-250
- Measurement scales in clinical research of the upper extremity, part 1: general principles, measures of general health, pain, and patient satisfaction.J Hand Surg Am. 2013; 38 (quiz 406): 401-406
- Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.J Hand Surg Am. 1998; 23: 575-587
- Complex syndactyly: aesthetic and objective outcomes.J Hand Surg Am. 2012; 37: 2068-2073
- Central ray deficiency: subjective and objective outcome of cleft reconstruction.J Hand Surg Am. 2008; 33: 1579-1588
- The modified Patient and Observer Scar Assessment Scale: a novel approach to defining pathologic and nonpathologic scarring.Plast Reconstr Surg. 2011; 127: 242-247
- The Penile Perception Score: an instrument enabling evaluation by surgeons and patient self-assessment after hypospadias repair.J Urol. 2013; 189: 189-193
- Defining the basic aesthetics of the hand.Aesthetic Plast Surg. 2005; 29: 546-551
- The ageing hand. A study to evaluate the chronological ageing process of the hand.J Plast Reconstr Aesthet Surg. 2008; 61: 681-686
- Significance of prenatal, perinatal and postnatal factors in the development of AGA preterm infants at five to seven years.Dev Med Child Neurol. 1989; 31: 440-456
- Use your words carefully: what is a chronic disease?.Front Public Health. 2016; 4: 159
- The Psychology of Attitudes and Attitude Change.2nd ed. Sage, 2015
- Gender, gender role, and physical appearance.J Psychol. 1987; 121: 51-56
- A global assessment of the gender gap in self-reported health with survey data from 59 countries.BMC Public Health. 2016; 16: 675
- Gender differences in personality across the ten aspects of the big five.Front Psychol. 2011; 2: 178
Article info
Publication history
Published online: October 20, 2022
Accepted:
August 17,
2022
Received:
August 8,
2021
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
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
