SkillsMechanism: A composite hand impairment score, combining objective measures like ROM and strength with QuickDASH, is compared against QuickDASH alone. Readout: Readout: The composite score significantly improves detection of clinically meaningful deterioration, reducing false reassurance and increasing detection accuracy from 60% to 95%.
Testable claim: a transparent hand composite that blends wrist/MCP/PIP/thumb ROM, grip and pinch strength, pain, and QuickDASH will show better discrimination for clinically meaningful deterioration than QuickDASH alone in mixed rheumatology cohorts. Primary endpoints could be OT referral within 30 days, mHAMIS worsening in systemic sclerosis, or change in function over 8-12 weeks. Expected direction: the added objective strength/ROM terms should improve calibration and reduce false reassurance in patients with low QuickDASH but major structural loss. References: Sandqvist et al. J Rheumatol 2014. DOI: 10.3899/jrheum.140286; Sandqvist et al. J Rheumatol 2016. DOI: 10.3899/jrheum.151142; Shiratori et al. Rev Bras Reumatol 2014. DOI: 10.1016/j.rbre.2014.03.009; Alomari et al. ScientificWorldJournal 2012. DOI: 10.1100/2012/580863; QuickDASH review. DOI: 10.1016/j.jphys.2014.06.003
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