Recurrence of Dupuytren's contracture: A consensus-based definition

• Published in: PloS one Vol. 12; no. 5; p. e0164849
• Main Authors: Kan, Hester J, Verrijp, Frank W, Hovius, Steven E R, van Nieuwenhoven, Christianne A, Selles, Ruud W
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15-05-2017; Public Library of Science (PLoS)
• Subjects: Agreements; Biology and Life Sciences; Bone surgery; Care and treatment; Clinical Decision-Making; Clinical trials; Collagen; Collagenase; Columns (process); Columns (structural); Continents; Delphi method; Disease control; Disease Management; Documents; Downloading; Dupuytren Contracture - diagnosis; Dupuytren Contracture - pathology; Dupuytren Contracture - therapy; Dupuytren's contracture; Engineering and Technology; Expert Testimony; Experts; Feedback; Finger; Fingers; Format; Grafts; Guidelines; Hand (anatomy); Hand surgery; Humans; Information dissemination; Injection; Inspection; Joint surgery; Literature reviews; Mail; Medical services; Medicine and Health Sciences; Nodules; Patients; Plastic surgery; Plastics; Polls & surveys; Recurrence; Recurrence (Disease); Rehabilitation; Reliability; Research and Analysis Methods; Retirement; Surgery; Surveys; Treatment Outcome; Visual perception
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0164849

One of the major determinants of Dupyutren disease (DD) treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence.
To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren's research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. We defined consensus when at least 70% of the experts agreed on a topic.
Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as "more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment". In addition, "recurrence should be reported individually for every treated joint" and afterwards measurements should be repeated and reported yearly.
This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives.