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A threshold disability score corresponds with an estimated diagnosis of clinical depression in patients with upper extremity disease

  • Therapy Articles
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HAND

Abstract

Background

The purpose of this study was to assess whether there is a threshold Disability of Arm, Shoulder and Hand (DASH) score among patients with common hand diagnoses that corresponds with an estimated diagnosis of clinical depression.

Methods

Two hundred sixty-nine patients with one of five common upper extremity disorders completed a measure of upper extremity-specific disability (QuickDASH or DASH) and a questionnaire assessing depressive symptoms (Patient Health Questionnaire (PHQ) or Center for Epidemiologic Studies Depression scale (CES-D). A receiver operating characteristic (ROC) analysis of the discriminatory value of a threshold DASH score for an estimated diagnosis of clinical depression was assessed. The threshold DASH score with the highest positive predictive value for an estimated diagnosis of clinical depression was selected. In bivariate analysis, the association between demographic factors, disease factors, and an estimated diagnosis of clinical depression was examined.

Results

The area under the ROC curve for a threshold DASH value diagnostic of an estimated diagnosis of clinical depression was 0.75, indicating clinical usefulness for a threshold DASH score as a screening test for depression. The highest positive predictive value of 72 % occurred at a threshold QuickDASH/DASH score of 55. In bivariate analysis, only diagnosis and years of education were significantly different between patients with and without an estimated diagnosis of clinical depression.

Conclusion

A DASH score of 55 or greater in patients with common upper extremity disorders has an acceptable area under the curve and positive predictive value for an estimated diagnosis of clinical depression.

Level of Evidence: Level 3, diagnostic study

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Acknowledgments

Conflict of Interest

David Ring has received consultancy fees from Wright Medical and Skeletal Dynamics. David Ring has received a speaker honorarium from AO North America and AO International. David Ring has received royalties from Wright Medical. David Ring owns stock in Illuminos. Stein J. Janssen received research grants from Stichting Anna fonds and Stichting Michael van Vloten fonds, both not related to the submitted work. Jeroen Molleman declares that he has no conflict of interest. Celeste L. Overbeek declares that she has no conflict of interest.

Statement of Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 [5].

Statement of Informed Consent

The study was approved by our institutional review board and a waiver of informed consent was obtained.

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Authors and Affiliations

  1. Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA

    Jeroen Molleman, Stein J. Janssen, Celeste L. Overbeek & David Ring

Authors
  1. Jeroen Molleman
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  2. Stein J. Janssen
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  3. Celeste L. Overbeek
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  4. David Ring
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Corresponding author

Correspondence to David Ring.

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Molleman, J., Janssen, S.J., Overbeek, C.L. et al. A threshold disability score corresponds with an estimated diagnosis of clinical depression in patients with upper extremity disease. HAND 10, 168–172 (2015). https://doi.org/10.1007/s11552-014-9686-y

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  • DOI: https://doi.org/10.1007/s11552-014-9686-y

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