The hand-foot impairment score as a tool for evaluating prevention of disability activities in leprosy: an exploration in patients treated with corticosteroids

The hand-foot (HF) impairment score in leprosy patients is the sum of the W HO disability grades for hands and feet. This retrospective study explored the possibility of using the HF score for evaluation of the effectiveness o f corticosteroid treatment programmes for nerve function impairment (NFI). Changes in the score were compared with changes in sensory testing (ST) and voluntary muscle testing (VMT) for 42 leprosy patients who received cortic osteroid treatment. The WHO grade did not change in 30/60 (50%) of extremit ies gaining, and in 4/10 (40%) extremities losing sensation and/or muscle s trength. However, 18/24 (75%) patients with a definite gain in function imp roved in HF score, while the HF score remained unchanged in 10/11 (91%) pat ients with no change in nerve function. Five patients with impairment in mu ltiple extremities showed both gain and loss of sensation and/or muscle str ength in the same or different extremities. Overall, improvement, deteriora tion and absence of change in NFI, as indicated by changes in ST and VMT we re reflected correctly by the HF score in 28 (76%) of the remaining 37 pati ents. It was also shown that the MF score does not give appropriate informa tion on the extent of the effect of corticosteroid treatment. This study il lustrates that the HF score can not be used to support management of cortic osteroid treatment of individual patients, but indicates this score to be a promising device for the evaluation of the effectiveness of corticosteroid treatment programmes. This study used the HF score because information on (changes in) eye impairment was not considered reliable. However, in princi ple, we consider the EHF score, which is the sum of the WHO disability grad es for hands, feet and eyes, preferable for evaluation purposes. We strongl y recommend further validation of the EHF score as a tool for evaluation of corticosteroid treatment programmes for patient groups with different dist ributions of NFI through prospective studies.