2.8 Wrist/Hand - General

2.8.1 Rationale and aims

• Baseline group for consistent post-op outcomes for patients diagnosed with a hand pathology not suitable for any of the other cohorts.
• Reduce the chance of missing patients post-operatively.
• Auditing of all patients entering the registry. Any patients not designated to a specific cohort (not from lack of diagnosis), will be placed in the 'Hand General' protocol.

2.8.2 Patient Flow

Inclusion criteria

• All patients presenting with wrist pathology for the first time to Geelong Orthopaedics.
• Wrist pathology includes the following structures
  • Distal Radius
  • Distal Ulna
  • Triangular Fibrocartilage Complex (TFCC)
  • Carpus (proximal) (scaphoid, lunate, triquetrum), and
  • any ligament associated with any of the osseous structures listed

Exclusion criteria

• Patient is unable to return patient-reported outcome measures.

2.8.3 Cohort Outcome Measures

EuroQol 5-Dimension (EQ-5D 5L): The EQ-5D 5L is a generic tool for measuring quality of life, describing health in terms of five dimensions: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression (Conner-Spady et al. 2015). Patients respond to each item on a 5 level range of severity, following the format of "no problems", "slight problems", "moderate problems", "severe problems", and "unable to or extreme problems". The EQ-5D 5L has been shown to have good validity and discriminatory power in a range of pathologies (Janssen et al. 2013).

MODEMs Expectation Scale: The MODEMS expectations scale is a 6-item instrument developed as part of the MODEMS project (AAOS) as per Tashjian et al (2007). It has demonstrated good internal consistency and re-test reliability. Each item is scored from 1 (lowest level of expectations) to 5 (highest level of expectations), and a mean score for the 6 items is calculated (Zywiel et al. 2013; Dunn et al. 2016).

Return to activity (work or sport): This will be addressed using Patient History and follow-up window in Socrates with 8 questions for return to work and 7 questions for return to sport.

Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH): The QuickDASH is the 11-item shortened version of a questionnaire assessing activity limitations and symptoms in people with musculoskeletal disorders of the upper limb (Beaton et al. 2005), which has similar measurement properties to the full 30-item DASH (Gummeson et al. 2006), particularly for patients undergoing RCR (MacDermid et al. 2014). A minimum of 10 out of 11 items are required for calculation of a QuickDash score, which ranges from 0 (no disability) to 100 (most severe disability). The MCID score for the QuickDASH is 15.9 points (Franchignoni et al. 2014).

2.8.4 Core dataset and protocol

The core dataset includes;

• Clinical data
• Patient-reported outcomes
• Imaging
• Functional - Biomechanics
• Surgical/treatment
• Complications