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
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Article Info
Publication History
Published online: October 20, 2022
Accepted:
August 17,
2022
Received:
August 8,
2021
Publication stage
In Press Corrected ProofFootnotes
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.
