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• Satisfaction of Dupuytren's disease with treatment with collagenase
  Francisco Javier Carrera-Hueso, Rafael Sanjuan-Cerveró and Pedro Vaue-Ferreiro
  Published on: 7 April 2017

• Published on: 7 April 2017

  Satisfaction of Dupuytren's disease with treatment with collagenase

  • Francisco Javier Carrera-Hueso, Pharmacist Pharmacy Servicie. Hospital Dr Moliner. Valencia (Spain)
  • Other Contributors:
    • Rafael Sanjuan-Cerveró, MD Traumatologist.
    • Pedro Vaue-Ferreiro, MD Ophtalmologist

  Dear Editor,
  Recently published in your journal, Lauritzson & Atroshi1 used a dichotomic question for the assessment of patient satisfaction in Dupuytren Disease (DD) treated with collagenase Clostridium hystolyticum (CCH). This satisfaction was correlated with the 11-item disabilities of the arm, shoulder and hand (QuickDASH) scale. Follow up was made initially at 5 weeks and at 2 years, answering the patients to both questionnaires.
  This way of proceeding is adequate. To contemplate the level of satisfaction of patients with their clinical results achieved or about the therapeutic process applied must be done2. However the way to measure satisfaction is not the best. Satisfaction is a multidimensional concept and it is not possible to valuate only with a dichotomic question. The expectation that the patient has about the care, staff or hospital in which he or she has been treated is a fundamental element to know this satisfaction. It has long been considered that satisfaction has between three to ten dimensions, mainly: cognitive (quantity, type and quality of information given by the doctor); affective (interest and understanding that shows); and behavioral (on the abilities and clinical competences of the physician).
  Measurement satisfaction in this article has important bias of selection and information. There may be both a Hawthorne bias (by questions asked directly by a therapist) as well as a recall bias (by the time elapsed and the advanced a...

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  Dear Editor,
  Recently published in your journal, Lauritzson & Atroshi1 used a dichotomic question for the assessment of patient satisfaction in Dupuytren Disease (DD) treated with collagenase Clostridium hystolyticum (CCH). This satisfaction was correlated with the 11-item disabilities of the arm, shoulder and hand (QuickDASH) scale. Follow up was made initially at 5 weeks and at 2 years, answering the patients to both questionnaires.
  This way of proceeding is adequate. To contemplate the level of satisfaction of patients with their clinical results achieved or about the therapeutic process applied must be done2. However the way to measure satisfaction is not the best. Satisfaction is a multidimensional concept and it is not possible to valuate only with a dichotomic question. The expectation that the patient has about the care, staff or hospital in which he or she has been treated is a fundamental element to know this satisfaction. It has long been considered that satisfaction has between three to ten dimensions, mainly: cognitive (quantity, type and quality of information given by the doctor); affective (interest and understanding that shows); and behavioral (on the abilities and clinical competences of the physician).
  Measurement satisfaction in this article has important bias of selection and information. There may be both a Hawthorne bias (by questions asked directly by a therapist) as well as a recall bias (by the time elapsed and the advanced age of the patients).
  There are currently validated and reliable instruments to measure patient satisfaction of the health care received. For DD is frequently used a subscale of The Michigan Hand Outcome Questionnaire3. It is sensitive, reliable and validated for this population. The inclusion of patient satisfaction in the assessment of treatment with CCH, especially those who had not reached the Primary End Point established in the studies CORD4, is based in the Witthaut´ study5 on the same cohort of patients. In this study patient satisfaction is measured in a five points scale at one month follow up and a Linkert scale at 90 days with seven items.
  In conclusion, despite the reported limitations by the authors in the study, we believe that their results should be reviewed in terms of patient satisfaction and their relationship to the quality of life measured with QuickDASH, as it may be skewed and spurious.

  REFERENCES
  1. Lauritzson A, Atroshi I. Collagenase injections for Dupuytren’s disease: prospective cohort study assessing 2-year treatment effect durability. BMJ Open [Internet]. 2017 [cited 2017 Apr 4];7(3):e012943. Available from: http://bmjopen.bmj.com.ezproxy.u-pec.fr/content/7/3/e012943.abstract
  2. Hall JA, Dornan MC. What patients like about their medical care and how often they are asked: a meta-analysis of the satisfaction literature. Soc Sci Med 1982. 1988;27(9):935–9.
  3. Ball C, Pratt AL, Nanchahal J. Optimal functional outcome measures for assessing treatment for Dupuytren’s disease: a systematic review and recommendations for future practice. BMC Musculoskelet Disord [Internet]. 2013 Apr 10 [cited 2015 Jan 14];14:131. Available from: http://www-ncbi-nlm-nih-gov.ezproxy.u-pec.fr/pmc/articles/PMC3637830/
  4. Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FTD, Meals RA, et al. Injectable Collagenase Clostridium Histolyticum for Dupuytren’s Contracture. N Engl J Med [Internet]. 2009 Sep 3 [cited 2015 Jan 9];361(10):968–79. Available from: http://dx.doi.org.ezproxy.u-pec.fr/10.1056/NEJMoa0810866
  5. Witthaut J, Bushmakin AG, Gerber RA, Cappelleri JC, Le Graverand-Gastineau M-PH. Determining clinically important changes in range of motion in patients with Dupuytren’s Contracture: secondary analysis of the randomized, double-blind, placebo-controlled CORD I study. Clin Drug Investig. 2011 Nov 1;31(11):791–8.

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  Conflict of Interest:
  None declared.

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