We thank Knobloch et al for their comments about the development and validation of the URAM scale for Dupuytren's disease. The URAM scale is indeed a tool to assess patient-reported functional outcome in Dupuytren's disease and we agree that assessing disability is of key importance in Dupuytren's disease. However, we would like to respond to a few points made by Knobloch et al. We emphasize that the validation of a scale for a specific condition has to be done in the disease being considered and not another disease. Specificity here is a question of what disease from which the scale has been developed and in which it has been validated, and of functional limitation due to the considered condition; it is not only a question of side (right hand or left hand). Validation means studying the reliability, the construct validity, and the responsiveness as has been done for the URAM scale. To our knowledge, neither the DASH nor the MHQ have been validated in such a way for Dupuytren's disease. Our opinion is that nonvalidated scales should not be recommended and used to assess disability in Dupuytren's disease.
Nonetheless, we are grateful to Knobloch et al for their German translation of the URAM scale. We compliment them for using the French language version and translating it into the German language version using sound methodology. We encourage using the URAM scale in patients with Dupuytren's disease, including German patients. Indeed, assessment of the disease should not be limited to the flexion contracture. A patient's subjective perception of their own difficulties in daily living is pertinent in current practice and recommended in clinical trials (1, 2). The URAM scale is the only scale developed and validated to assess disability in Dupuytren's disease. Therefore, the URAM scale should be part of the assessment of Dupuytren's disease in current practice and in future clinical trials.
Finally, we agree with Knobloch et al that the recurrence rate is also of key importance for assessing effectiveness of treatments in Dupuytren's disease and that a consensus definition of recurrence is needed. Several definitions have previously been proposed and used, including reappearance of cords, nodules, or contracture requiring further operation with followup of a few months to several years (3). A consensus definition of recurrence should therefore include the criteria for recurrence and the time of its assessment.