Biomedical subjects

Jacques Fermanian

Publications and source records attributed to Jacques Fermanian.

At least 19 recordsLinked to original sources

PubMed2006

Expressed emotion and anorexia nervosa: the validation of the Five-Minute Speech Sample in reference to the Camberwell Family Interview.

OBJECTIVE: The goal of the current study was to test whether the Five-Minute Speech Sample (FMSS) assessments of expressed emotion (EE) in families with a daughter with anorexia nervosa (AN) are valid in comparison to the Camberwell Family Interview (CFI). METHOD: The sample included parents of hospitalized patients with AN. Assessments were conducted at the time of patients' discharge from the hospital. The participants (n = 40) were assessed individually with the FMSS and then the CFI. FMSS-EE ratings were classified as high or low for Emotional Overinvolvement (EOI), Critical EE, and Final EE (overall rating). For the CFI, average EE scores were computed on the same subscales. RESULTS: Comparisons of FMSS subgroups on the CFI mean scores revealed that parents rated high EE on the FMSS subscales (EOI and Final EE) had significantly greater mean scores on the CFI than parents rated low EE on the FMSS (EOI: p = .02; Final EE: p = .04). Furthermore, FMSS-EE ratings were positively correlated to CFI-EE ratings for EOI EE (r = .38, p = .01), Critical EE (r = .31, p = .05), and Final EE (r = .29, p = .07). CONCLUSION: The FMSS can reliably measure EE in reference to the CFI in terms of Final EE and EOI EE. For the Critical EE subgroup, further investigation is needed with a bigger sample size.

Adolescent↗

PubMed2005

Testing the Working Alliance Inventory (WAI) in a French primary care setting: predictive value and factor structure.

BACKGROUND: Working alliance has shown a predictive value of the outcome in different therapeutic settings but was not yet studied in a non-medical setting. METHODS: The predictive value and the factor structure of the Working Alliance Inventory (WAI) [36-item client version; as reported by Horvath and Greenberg (J Couns Psychol 36:223-233, 1989)] were studied in a French primary care setting on a sample of 130 adults accessing social services. RESULTS: The WAI total score completed after the first meeting was positively predictive of quality of the working alliance 4 months later. An exploratory factor analysis produced two orthogonal factors which explained 45.12% of the total variance: a first factor (23 items) labelled 'positive expectations about the usefulness of help' and a second factor (13 items) labelled 'absence of suspicion about the effects of help'. CONCLUSIONS: The WAI is shown to be applicable to primary care social work settings to measure the working alliance phenomenon and predict disruption of practitioner-client relationship.

Adolescent↗

PubMed2005

Magnetic resonance imaging of shoulders with idiopathic adhesive capsulitis: reliability of measures.

The magnetic resonance imaging (MRI) findings in idiopathic adhesive capsulitis (AC) were compared with those of contralateral healthy shoulders and the reliability of measures assessed. Twenty-six consecutive patients (26 AC and 14 healthy shoulders) were prospectively assessed. The main measurements were thickness of the joint capsule and synovial membrane in the axillary recess and rotator interval in T1-weighted spin-echo sequence enhanced with intravenous (IV) gadolinium chelate (Gd-chelate). Reliability was studied by use of the intraclass correlation coefficient (ICC). The mean thickness of the axillary recess on the coronal plane was 9.0+/-2.2 mm in AC shoulders and 0.4+/-0.7 mm in healthy shoulders. The mean thickness of the rotator interval on the sagittal plane was 8.4+/-2.8 in AC shoulders and 0.6+/-0.8 mm in healthy shoulders. Interobserver reliability was good for the axillary recess, with ICC values of 0.84 for the coronal plane, and good for the rotator interval, with ICC values of 0.80 for the sagittal plane. MRI with IV Gd-chelate injection can show, with acceptable reliability, signal and thickness abnormalities of the shoulder joint capsule and synovial membrane in AC.

Adult↗

PubMed2005

Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).

Few studies have directly compared the clinical features of neuropathic and non-neuropathic pains. For this purpose, the French Neuropathic Pain Group developed a clinician-administered questionnaire named DN4 consisting of both sensory descriptors and signs related to bedside sensory examination. This questionnaire was used in a prospective study of 160 patients presenting with pain associated with a definite neurological or somatic lesion. The most common aetiologies of nervous lesions (n=89) were traumatic nerve injury, post herpetic neuralgia and post stroke pain. Non-neurological lesions (n=71) were represented by osteoarthritis, inflammatory arthropathies and mechanical low back pain. Each patient was seen independently by two experts in order to confirm the diagnosis of neuropathic or non-neuropathic pain. The prevalence of pain descriptors and sensory dysfunctions were systematically compared in the two groups of patients. The analysis of the psychometric properties of the DN4 questionnaire included: face validity, inter-rater reliability, factor analysis and logistic regression to identify the discriminant properties of items or combinations of items for the diagnosis of neuropathic pain. We found that a relatively small number of items are sufficient to discriminate neuropathic pain. The 10-item questionnaire developed in the present study constitutes a new diagnostic instrument, which might be helpful both in clinical research and daily practice.

Adult↗

PubMed2005

Computer-aided detection (CAD) in mammography: does it help the junior or the senior radiologist?

OBJECTIVES: To evaluate the impact of a computer-aided detection (CAD) system on the ability of a junior and senior radiologist to detect breast cancers on mammograms, and to determine the potential of CAD as a teaching tool in mammography. METHODS: Hundred biopsy-proven cancers and 100 normal mammograms were randomly analyzed by a CAD system. The sensitivity (Se) and specificity (Sp) of the CAD system were calculated. In the second phase, to simulate daily practice, 110 mammograms (97 normal or with benign lesions, and 13 cancers) were examined independently by a junior and a senior radiologist, with and without CAD. Interpretations were standardized according to BI-RADS classification. Sensitivity, Specificity, positive and negative predictive values (PPV, NPV) were calculated for each session. RESULTS: For the senior radiologist, Se slightly improved from 76.9 to 84.6% after CAD analysis (NS) (one case of clustered microcalcifications case overlooked by the senior radiologist was detected by CAD). Sp, PPV and PNV did not change significantly. For the junior radiologist, Se improved from 61.9 to 84.6% (significant change). Three cancers overlooked by the junior radiologist were detected by CAD. Sp was unchanged. CONCLUSION: CAD mammography proved more useful for the junior than for the senior radiologist, improving sensitivity. The CAD system may represent a useful educational tool for mammography.

Adult↗

PubMed2005

Quantification methods were developed for selection bias by predictability of allocations with unequal block randomization.

BACKGROUND AND OBJECTIVE: A selection of patients for a controlled clinical trial may be biased because of prior knowledge of the treatment. With randomized blocks of known or guessed lengths, some allocations can be predicted with certainty. Previously described methods determine the proportion of predictable cases for blocks of equal lengths. It may be useful to make a calculation for unequal blocks as well to find a method that reduces this predictability. STUDY DESIGN AND SETTING: Quantification methods are developed for series of two and three unequal blocks, using the probability of identifying a long block when it comes before a short one if it starts with a sequence incompatible with the content of a short block. Results are compared with the recently described maximal allocation procedure. RESULTS: Predictability is not always reduced by unequal blocks and is even worse in some cases, compared to equal blocks. Predictability is not necessarily decreased with the maximal allocation procedure. CONCLUSIONS: Before choosing an allocation method, it is important to quantify the predictability of possible options to reduce selection bias. Several practical recommendations are formulated for choosing methods, taking this risk of bias into account.

Forecasting↗

PubMed2005

A motor function measure for neuromuscular diseases. Construction and validation study.

A new scale for motor function measurement has been developed for neuromuscular diseases. The validation study included 303 patients, aged 6-62 years. Seventy-two patients had Duchenne muscular dystrophy, 32 Becker muscular dystrophy, 30 limb-girdle muscular dystrophy, 39 facio-scapulo-humeral dystrophy, 29 myotonic dystrophy, 21 congenital myopathy, 10 congenital muscular dystrophy, 35 spinal muscular atrophy and 35 hereditary neuropathy. The scale comprised 32 items, in three dimensions: standing position and transfers, axial and proximal motor function, distal motor function. Agreement coefficients for inter-rater reliability were excellent (kappa=0.81-0.94) for nine items, good (kappa=0.61-0.80) for 20 items and moderate (kappa=0.51-0.60) for three items. High correlations were found between the total score and other scores: Vignos (r=0.91) and Brooke (r=0.85) grades, Functional Independence Measure (r=0.91), the global severity of disability evaluated with visual analog scales by physicians (r=0.88) and physiotherapists (r=0.91). This scale is reliable, does not require any special equipment and is well-accepted by patients. Its sensitivity to change is being assessed to permit its use in clinical trials of neuromuscular diseases.

Adolescent↗

PubMed2005

[Functional disability indexes: translation difficulties and cross cultural adaptation problems].

OBJECTIVES: To summarize the difficulties involved in translating tests in Arabic and to describe the translation methods and to apply those to functional indexes. METHOD: Four functional indexes were translated and then subjected to the following test validation methods: back translation, pre-test, and review by an expert committee. RESULTS: Translation problems were underlined. These include in particular the different types of equivalence between the source language and the target language (semantics, idioms, conceptual... equivalences). Problems related to comprehensive literal words were the most observed. CONCLUSION: The current method combining translation with back translation is not sufficient and must be used with, a pre-test and a review committee.

Arabs↗

PubMed2004

Renal-transplant recipients and sun protection.

BACKGROUND: The incidence of skin carcinomas in organ-transplant recipients is high. The main factors implicated in carcinogenesis are immune suppression and ultraviolet radiation. Only the second is avoidable. We have evaluated knowledge of and compliance with sun protection measures among renal-transplant recipients (RTR). METHODS: A survey by means of a questionnaire including questions about clinical data, knowledge of, and compliance with sun protection was given. The questionnaire was given to 520 consecutive RTR followed up in a single center, and 445 (86%) answered. RESULTS: Of the responders, 91% have been informed of the need for sun protection, in 80% of cases by dermatologists. Sixty-eight percent used more protective measures abroad than at home, 63% avoided going outside during the hottest midday hours, 63% used sunscreen regularly, but 46% used one or less tube of sunscreen a year. A hat was always worn in the sun by 35% and long sleeves by 36%. Women and fair-skinned individuals complied better with protective measures. A minority of patients knew that ultraviolet radiation carries a risk of skin cancer. CONCLUSIONS: This survey shows that most RTR are aware of the need for sun protection, but only a minority take adequate protection measures. The better results observed in this study than in previous published investigations may be caused by the great involvement of dermatologists in the care of RTR in our institution. The results of this survey underline the need to inform RTR better about sun-protection measures and the importance of cooperation between transplant physicians and dermatologists.

Clothing↗

PubMed2004

Validation of the French version of the fear avoidance belief questionnaire.

STUDY DESIGN: Observational prospective study. OBJECTIVE: To assess the reliability, validity, and responsiveness of the French version of the Fear Avoidance Belief Questionnaire. SUMMARY OF BACKGROUND DATA: Fear, avoidance attitudes, and belief play pivotal roles in disability perceived by patients with chronic low back pain. The Fear Avoidance Belief Questionnaire is a two-part questionnaire assessing fear, avoidance, and beliefs about professional activity and physical activity. METHODS: The Fear Avoidance Belief Questionnaire was translated by use of the forward and backward translation procedure. Test-retest reliability was assessed in 31 patients (Group 1) with the intraclass correlation coefficient and the Bland and Altman method. Construct validity was assessed in two groups of patients (Group 2, n = 147; Group 3, n = 70) with the Spearman rank correlation coefficient and factor analysis. Responsiveness was assessed in Group 3, after they underwent a functional restoration program, by the effect size and the standardized response mean. RESULTS: Test-retest reliability was good, with an intra-class correlation coefficient value of 0.88 and 0.72 for fear, avoidance, and beliefs about professional activity and physical activity, respectively. Use of the Bland and Altman method produced a homogeneous distribution of the differences, with no systematic trend observed. The expected divergent validity was observed in Groups 2 and 3. Factor analysis extracted four factors in Group 2 and the two original factors of the English Fear Avoidance Belief Questionnaire in Group 3. The lowest effect size and standardized response mean values (0.30 and 0.31, respectively) were observed with the fear, avoidance, and beliefs about professional activity. CONCLUSIONS: The psychometric properties (test-retest reliability, construct validity, and responsiveness) of the French version of the Fear Avoidance Belief Questionnaire are acceptable, and fear, avoidance, and belief can now be assessed in French-speaking patients with low back pain.

Adaptation, Psychological↗

PubMed2004

The ability to change of three questionnaires for neck pain.

OBJECTIVE: To assess the sensitivity to change of three algofunctional scales for neck pain. METHODS: Observational, prospective study. Patients with neck disorders were included. Pain and patients' perceived handicap assessed on visual analogue scales (VAS Pain, VAS Handicap), and functional disability measures (Neck Disability Index, Neck Pain and Disability Scale, Northwick Park Neck Pain Questionnaire) were recorded twice, at baseline and at an 11-month follow-up assessment. Sensitivity to change was assessed using the effect size (ES) and the standardised response mean (SRM), and the non-parametric Spearman's rank correlation coefficient (r) was used to assess the correlation between quantitative variable changes and patients' overall opinion. Analysis of variance (ANOVA) followed by a Tukey-test was performed to determine if the scales distinguished improved, stable, and deteriorated patients. RESULTS: Seventy-one patients (43 women, mean age 49 years) were included and evaluated twice at an interval of 11 +/- 2 months. The three scales showed good sensitivity to change. The ANOVA showed a group effect, and individual changes in the scales scores were statistically different in two-by-two comparisons (improved, stable or deteriorated patients). Changes in NPDS scores had the highest correlation with patient's overall assessment (r = 0.592). CONCLUSION: The three scales can detect changes in patients with neck disorders. Changes in NPDS score had the best correlation with patients' overall opinion concerning their neck disorder and this questionnaire should be given preference in clinical trials.

Adolescent↗

PubMed2004

Disability induced by hand osteoarthritis: are patients with more symptoms at digits 2-5 interphalangeal joints different from those with more symptoms at the base of the thumb?

BACKGROUND: The contribution of osteoarthritis (OA) at the base of the thumb (BT) and digits 2-5 interphalangeal joints (IP) to disability in the hand has never been assessed. OBJECTIVES: To evaluate and compare disability in patients with clinical hand OA and more severe symptoms at BT or IP. DESIGN: Observational, prospective, correlational. SETTING: Rheumatology and rehabilitation departments in two tertiary care teaching hospitals. PARTICIPANTS: One hundred and sixteen patients (107 women, mean age 62+/-7 years) fulfilling the American College of Rheumatology criteria for OA in the hand, with more symptomatic BT (67 patients) or IP (49 patients). MAIN OUTCOME MEASURE: Disability assessment with Cochin hand functional scale (CHFS) was the primary outcome. Assessment of impairment by the visual analog scale of pain (VAS pain), Ritchie articular index (RAI), modified Kapandji index (mKI), Kallman radiological classification and handicap assessment with visual analog scale (VASHd) was the secondary outcome. Group comparisons were assessed by use of Student's t-test for quantitative variables and Chi-square test for categorical variables. Results of the CHFS analysis were assessed by factorial analysis followed by Varimax rotation. Correlation between scores of disability, impairment, and handicap measures were calculated with use of Spearman rank correlation coefficient. RESULTS: Demographic data, disease duration, and level of global pain were similar between the BT and IP groups. The BT and IP groups did not differ significantly according to disability and handicap level (P=0.42 and P=0.94 for CHFS total score and VASHd, respectively). Factor analysis of the CHFS revealed similar results for the two groups of patients, especially for the first extracted factor. Disability scores correlated best with global hand pain (r=0.65) in the BT group and with RAI scores (r=0.71) in the IP group. CONCLUSIONS: Disability and perceived handicap levels are comparable in clinical hand OA patients with more symptomatic BT or IP. These two groups should not be considered different during trials assessing treatments for hand OA when the primary outcome measure assesses disability.

Aged↗

PubMed2004

Translation, adaptation and validation of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for an Arab population: the Sfax modified WOMAC.

OBJECTIVE: To translate into Arabic and validate the Western Ontario and McMaster Universities (WOMAC) index. METHOD: Arabic translation was obtained with use of the forward and backward translation method. Adaptations were made after a pilot study. Patients with symptomatic knee OA fulfilling the revised criteria of the American College of Rheumatology were included. Impairment outcome measures (pain as measured on a visual analog scale, the maximum distance walked, Kellgren's radiological score), Lequesne index score and Beck depression scale score were recorded. Each item was analyzed. Test-retest reliability was assessed with use of the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with use of Spearman's rank correlation coefficient, and a factor analysis was performed. RESULTS: One hundred and three patients were included in the study. Eight questions of the WOMAC physical function subscale (PF) had insufficient psychometric properties and were excluded. Although test-retest reliability of the questionnaire was good (0.84, 0.84, and 0.92 for pain, stiffness, and modified PF subscales respectively), construct validity could not be demonstrated. Factor analysis of the modified form of the WOMAC extracted four factors, which differed from the a priori triple stratification. However, factor analysis of the modified PF subscales extracted two factors, which accounted for 68.4% of the total variance and could be clinically characterized (disability during activities requiring knee flexion within the first 90 degrees and activities requiring knee flexion over more than 90 degrees ). CONCLUSION: We translated and adapted the WOMAC index into Arabic to suit Tunisian people. The translated questionnaire is reliable but not valid in its original form. We propose the use of a modified version of PF subscale of the WOMAC, although the psychometric properties of this instrument must be examined in a larger population.

Aged↗

PubMed2004

Development and validation of the Neuropathic Pain Symptom Inventory.

This study describes the development and validation of the Neuropathic Pain Symptom Inventory (NPSI), a new self-questionnaire specifically designed to evaluate the different symptoms of neuropathic pain. Following a development phase and a pilot study, we generated a list of descriptors reflecting spontaneous ongoing or paroxysmal pain, evoked pain (i.e. mechanical and thermal allodynia/hyperalgesia) and dysesthesia/paresthesia. Each of these items was quantified on a (0-10) numerical scale. The validation procedure was performed in 176 consecutive patients with neuropathic pain of peripheral (n = 120) or central (n = 56) origin, recruited in five pain centers in France and Belgium. It included: (i) assessment of the test-retest reliability of each item, (ii) determination of the factorial structure of the questionnaire and analysis of convergent and divergent validities (i.e. construct validity), and (iii) evaluation of the ability of the NPSI to detect the effects of treatment (i.e. sensitivity to change). The final version of the NPSI includes 10 descriptors (plus two temporal items) that allow discrimination and quantification of five distinct clinically relevant dimensions of neuropathic pain syndromes and that are sensitive to treatment. The psychometric properties of the NPSI suggest that it might be used to characterize subgroups of neuropathic pain patients and verify whether they respond differentially to various pharmacological agents or other therapeutic interventions.

Adult↗

PubMed2004

Clinical profile of responders to buprenorphine as a substitution treatment in heroin addicts: results of a multicenter study of 73 patients.

In France, high-dosage buprenorphine (HDB) is the main substitution treatment for narcotic addiction. Few data have been published concerning clinical factors predicting a good response to this treatment in a daily practice. A hospital-based multicenter clinical research program (PHRC) was undertaken in heroin-addicted patients, diagnosed according to DSM-III-R, to detect clinical criteria susceptible of predicting a good response to HDB administered during a 3-month treatment period. At the inclusion time in the study, a diagnostic structured interview (DIGS) was performed, and the Addiction Severity Index (ASI), Zuckerman scale, depression scale from Jouvent, and CGI were scored. MMPI was also administered. Good response was defined as an ongoing participation in the study, with absence of opiate detected in 75% of urine collected during the last month of treatment. Only subjects treated for at least 1 month were eligible for analyses. One hundred fifteen patients were recruited and 73 were analyzed. Patients received 8.5+/-2.6 mg (m+/-S.D.) of buprenorphine for 1 to 3 months. A forward stepwise logistic regression showed that six clinical parameters may predict a good response to treatment: probability to respond to buprenorphine was higher in subjects having a high psychopathology (ASI) subscore, low disinhibition and boredom susceptibility factor scores (Zuckerman scale), no alcohol dependence, no family history of addiction or mood disorder, and duration of opiate dependence less than 10 years. Only the MMPI D subscale was a psychological pattern correlated to a good response to substitution treatment. These findings are important to consider when making the decision to prescribe HDB substitution treatment in opiate addiction.

Buprenorphine↗

PubMed2004

Assessment of the test-retest reliability and construct validity of a modified WOMAC index in knee osteoarthritis.

OBJECTIVE: To assess the test-retest reliability and the construct validity of a modified version of the French-Canadian version of the WOMAC index. METHODS: Open prospective study conducted in departments of Rheumatology, Rehabilitation and Orthopedic surgery of a tertiary care teaching hospital. Eighty-eight patients with symptomatic knee osteoarthritis (OA) fulfilling the revised criteria of the American College of Rheumatology were included. The French-Canadian version of the WOMAC index was completed twice at a 3-h interval. Impairment outcome measures, patients' perceived discomfort in walking and handicap were recorded. An item-by-item analysis was performed. Test-retest reliability was assessed using the intra-class correlation coefficient (ICC) and the Bland and Altman method. Construct validity was investigated using the Spearman rank correlation coefficient and a factor analysis was performed. RESULTS: Eight questions assessing function (section C) and the two questions assessing stiffness (section B) had insufficient psychometric properties and were excluded. Although test-retest reliability of the questionnaire was fair to good (0.82, 0.85, for the WOMAC section A, and modified section C, respectively), construct validity could not be demonstrated. Factor analysis of the modified form of the WOMAC extracted four factors, which differed from the a priori stratification. However, factor analysis of the modified section C extracted two factors explaining 68.4% of the variance, which could be clinically characterized. CONCLUSION: Despite its good test-retest reliability, the modified WOMAC index is not valid for assessing pain and disability induced by knee OA in a French population. Section A and modified section C could be used separately to assess, respectively, pain and function.

Adult↗

PubMed2003

Anxiety disorders in subjects seeking treatment for eating disorders: a DSM-IV controlled study.

Women who were referred with an eating disorder (ED) were compared with a matched normal control group to answer the following questions: What are the frequencies of anxiety disorders in cases of anorexia and bulimia nervosa diagnosed according to DSM-IV criteria? Are anxiety disorders significantly more frequent among women with an eating disorder than among women from the community? We assessed the frequencies of six specific anxiety disorders among 271 women with a current diagnosis of anorexia or bulimia nervosa and 271 controls, using the Mini-International Neuropsychiatric Interview, French DSM-IV version. A lifetime comorbidity with at least one anxiety disorder was found in 71% of both the anorexic and the bulimic subjects, significantly higher than the percentage of controls with an anxiety disorder. The prevalence was significantly higher in the eating disorder groups than in controls for most types of anxiety disorder, and between 41.8 and 53.3% of comorbid cases had an anxiety disorder preceding the onset of the eating disorder. Anxiety disorders are significantly more frequent in subjects with eating disorders than in volunteers from the community, a finding that has important etiological and therapeutic implications.

Adolescent↗

PubMed2003

Reliability, validity, and responsiveness of the modified Kapandji index for assessment of functional mobility of the rheumatoid hand.

OBJECTIVE: To determine the reliability, validity, and responsiveness of the modified Kapandji index (MKI). DESIGN: Prospective study. A cohort of patients planned for surgery of the wrist and/or fingers was evaluated within 48 hours before surgery and at least 6 months after surgery. SETTING: Patients were in hospitalized or private care in France. PARTICIPANTS: Patients with rheumatoid arthritis according to criteria of the American College of Rheumatology. Forty-two patients (36 women; mean age, 57.5y; range, 22-80y) were included in the reliability study. Fifty patients (42 women; mean age, 54.18y; range, 19-77y) were included in the validity study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical outcome measures included the MKI, the overall mobility score of the wrist and fingers, the finger mobility score, a visual analog scale (VAS) of pain in the hands and wrists, morning stiffness duration, total score of tenderness, total score of swelling, grip and pinch strength, the Hand Functional Index (HFI), and the Cochin rheumatoid hand disability scale. Reliability was studied with the intraclass correlation coefficient (ICC) and the Bland and Altman method. Convergent and divergent validity were assessed with the Spearman correlation coefficient. Responsiveness was assessed by the paired t test, the effect size, and the standardized response mean (SRM). RESULTS: Interobserver reliability was good with an ICC of.90, and the Bland and Altman analysis showed homogeneous distribution of the differences, with no systematic trend. The MKI correlated well with the other mobility measures (HFI, the finger mobility score measured with the finger goniometer), indicating a good convergent validity, and the expected divergent validity with the other outcome measures (grip and pinch strength, total score of swelling, total score of Ritchie Articular Index, Cochin scale, VAS of pain) was observed. The 50 patients in the validity study were evaluated twice, before and after surgery, at a mean interval +/- standard deviation of 7.16+/-2.10 months (range, 6-15mo). Thirty-six patients (72%) were very satisfied or satisfied with the results of surgery, 7 (14%) were not satisfied or dissatisfied, and 7 (14%) were dissatisfied or very dissatisfied. The SRM and effect size values of the MKI were -.19 and -.10, respectively. Individual changes in the score had the best correlation (r(s)=.51) with overall patient satisfaction. CONCLUSIONS: The MKI has excellent validity and reliability. Individual changes in the score are clinically relevant. This index can be used in clinical practice and in therapeutic trials; it needs further study concerning its use for hand surgery.

Activities of Daily Living↗