Objective Improvements, Subjective Uncertainty: Surgical Outcomes and the Role of PROMIS in Severe PIP Contractures.

Abstract

Severe proximal interphalangeal (PIP) contractures in Dupuytren disease significantly impair hand function and quality of life. Surgical correction is common, but the relationship between improved joint mobility and patient-reported outcomes remains unclear. This study evaluated surgical outcomes for severe PIP contractures and assessed patient-reported function using Patient-Reported Outcomes Measurement Information System (PROMIS). A retrospective chart review included patients with severe PIP contractures treated surgically. Contractures were categorized by severity: group 1 (<29°), group 2 (30°-59°), group 3 (60°-89°), and group 4 (>90°). Objective outcomes were measured as contracture reduction at multiple time points (preoperative, immediate postoperative, and final follow-up) using a goniometer. The PROMIS scores for pain intensity, daily activity interference, and upper extremity function were collected preoperatively and at final follow-up. Statistical analyses included descriptive statistics, paired <i>t</i> tests, and analysis of variance with post hoc Tukey tests (<i>P</i> < .05). The study included 60 digits from 48 patients. Significant contracture reductions were observed across all groups, averaging more than 60%. However, PROMIS scores did not consistently reflect improvements in pain, activity interference, or upper extremity function. A significant decrease in upper extremity function was noted in group 3 (60°-89°). No operative complications or reoperations occurred. Surgical correction markedly improves joint contracture but does not consistently enhance PROMIS-reported outcomes. These results question PROMIS applicability in this context and highlight the need for alternative assessment tools to better address functional recovery in patients with severe PIP contractures.