Development of a Core Outcome Measurement Set for the Evaluation of Scars in the Hand & Wrist (COSSH)

Scar pain, hypersensitivity and functional interference are commonly reported adverse outcomes following hand injury and hand surgery. There are no diagnostic criteria for scar hypersensitivity, terminology and evaluation techniques are not standardised and there is no universally accepted clinician-completed nor patient-reported outcome measure (PROM) for evaluating scars in the hand and wrist. The robust evaluation of hand scar outcomes requires a core outcome measurement set (COS), an agreed minimum set of outcomes that should be measured and reported in clinical trials. A hand and wrist scar COS will inform future clinical trials and underpin advances in evidence-based clinical care.


Develop a patient and clinician informed core outcome measurement set (COS) for scars in the hand and wrist


Principal Investigator:
Dr Donna Kennedy
Hand Therapist; Senior Clinical Academic for Occupational Therapy, Imperial College Healthcare NHS Trust
Postdoctoral Research Fellow, Human Performance Group, Imperial College London

Prof Dominic Furniss DM MA MBBCh FRCS(Plast)
Associate Professor, University of Oxford

Dr Tracy Chism-Balangue, OTD, CHT
Senior Hand Therapist, Cedars-Sinai Medical Center

Further Study Information

Current Stage: Ongoing
Date: January 2020 - 2024
Funding source(s): NIHR Imperial Biomedical Research Centre Postdoctoral Fellowship

Health Area

Disease Category: Skin

Disease Name: Scar

Target Population

Age Range: 6 - 120

Sex: Either

Nature of Intervention: Any

Stakeholders Involved

- Charities
- Clinical experts
- Conference participants
- Consumers (caregivers)
- Consumers (patients)
- Families
- Researchers
- Service providers
- Service users

Study Type

- COS for clinical trials or clinical research
- COS for practice


- Delphi process
- Focus group(s)
- Literature review
- Survey

• A state-of-the art literature review identifying clinician and patient-reported hand and wrist scar outcomes has been completed and published open access: Kennedy, D.L., Chism-Balangue, T. & Furniss, D. Reporting of scar outcomes in the hand and wrist; a state-of-the-art literature review. BMC Musculoskelet Disord 24, 249 (2023).

• Results of our survey of international clinicians and researchers, identifying relevant, potential COS domains can be found here: Donna L. Kennedy, Tracy Chism-Balangue, Lucy Dereham, Dominic Furniss. What outcomes are important when evaluating people with hand scars? Results of an international clinician and researcher survey. medRxiv 2023.04.25.23289079; doi:

• Focus groups with people with experience of scarring.

• Electronic Delphi Study in patients and international clinical experts defining scope and domains of hand and wrist scar COS

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