Quantifying the results of medical interventions has evolved over time but challenges remain. Initially, hand surgeons used concrete assessments like range of motion and/or pinch strength. With a shift towards patient-centered care, numerous pathology-specific patient-reported outcome measures with standardized closed ended questions were developed mostly in the western English-speaking countries. Much of the language in these tools has been validated cross-culturally, but the question remains “how well these specific items capture patients’ values across different cultures”? Therefore, we used an open-ended PROM the Patient Specific Functional Scale (PSFS) to assess patients’ priorities for two common hand diagnoses: carpal tunnel and trigger finger. This allowed us to evaluate the breadth of variation of experiences and treatment goals across cultures.

We conducted a multi-institutional, international study on patients with diagnosis of carpal tunnel and trigger finger. Patient desires were recorded using the PSFS and the qualitative methodology of template analysis was undertaken on their responses.

Patient responses from 225 PSFS scores from 3 continents and 5 countries were evaluated. Patients provided diverse functional impacts from trigger and carpal tunnel, which were categorized according to the International Classification of Functioning. There were diverse patient responses with variations in the proportion of domains represented in each country. There was variation in the types of household chores each country listed. Writing and typing were universally important, but prioritization varied across countries. All countries, but the United States listed driving and/or riding a motorcycle as an important goal. Another activity that all countries except the United States listed as important was doing dishes. Regarding quality of life, respondents mentioned aspects like numbness, pain, sleep, reading, sports and walking. Qatar was the only country to list prayer as a surgical goal, while Austrians were the only country to list reading and book-holding as a central goal. Sleeping was valued in all countries except the USA.

PROMS are used to gauge the success and value of medical interventions and often use closed questions about specific functions. However, codifying functional impact becomes problematic when designed in a specific population and then universally implemented. This study highlights the diversity of functions patients hope to improve and that this varies across cultures.

Standardized tools, which are primarily Western-oriented, miss the richness of the individuals’ goals and overlook cross-cultural differences, hindering accurate outcome evaluation and intercultural comparisons. Achieving truly patient-focused care necessitates more open and inclusive assessment tools.