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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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ZASH: The Zurich appearance score for hands. A validated instrument to assess appearance of hands with and without malformations. Preliminary results

Meeting Abstract

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  • presenting/speaker Daniel Weber - University Children's Hospital, Division of Hand Surgery, Zurich, Switzerland
  • Rafael Koss - Dimensional - 3D and VFX Solutions, Aeugst, Switzerland
  • Helene Werner - University Children's Hospital, Division of Psychology, Zurich, Switzerland

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-897

doi: 10.3205/19ifssh0519, urn:nbn:de:0183-19ifssh05193

Published: February 6, 2020

© 2020 Weber et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Surgical corrections of hand malformations modify function and appearance, with the latter often being the main indication for surgery. Outcome measurements must therefore include quantitative assessment of hand appearance with patient and parent related outcomes (PRO) to appreciate the effectiveness of therapy. The aim of this study was to develop and validate an instrument for assessing hand appearance in children with hand malformations.

Methods: An instrument, called the Zurich Appearance Score for Hands (ZASH), was developed based on previous literature and expert meetings. It is the sum score of 5 questions with items regarding overall appearance, skin and scarring, proportions, number of digits and distortion of fingers. Items were rated on a 5-point-Likert scale ranging from 'not good at all' to 'very good' and added to a sum score. 3D photorealistic images of 18 hands with and without hand malformations were developed with Maxon Cinema 4D for validation of the instrument. Three standard views of each hand, including the palm, the back of the hand and a lateral view, were embedded in the questionnaire and presented to participants on a tablet computer. Up to now, these images have been rated by 267 healthy lay persons (14-78 years).

Results: The ZASH had good internal consistency (alpha=0.69) and was most strongly correlated with "overall impression", followed by "skin and scarring", "number of fingers", "distortion of fingers" and "proportion of individual parts". Furthermore, statistical analysis of the ZASH revealed good interrater reliability (interclass correlation 0.59 to 0.76) and good stability over 2-4 weeks (mean r = 0.47). No gender effects were found, while age effects were present, with older participants rating the appearance of hands more favorable than younger participants.

Conclusions: The ZASH is the first validated instrument for quantitatively assessing hand appearance. It is suitable for parents and proxies to assess children's hands and as a PRO for older patients with congenital malformations. Further testing among age groups and professionals is ongoing to finalize the instrument.

The ZASH has the potential to be useful to assess the appearance of adult hands with other conditions as well. However, specific validation for these conditions must be performed before it can be recommended more universally.