ICF-Based Biopsychosocial Assessment With AI-Assisted Profile Prediction: Trapeziometacarpal Osteoarthritis Model

Pain Intensity

Measured using a Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate greater pain intensity.

Baseline (single assessment at enrollment)

Pain Duration

Total duration of thumb pain reported by the participant.

Baseline (single assessment at enrollment)

Radiographic Severity (Eaton-Littler Stage)

Evaluation of the trapeziometacarpal joint osteoarthritis stage based on the Eaton-Littler classification (Stages I through IV).

Baseline (single assessment at enrollment)

Radial Subluxation Ratio

Radiographic measurement of the radial subluxation of the metacarpal base on the trapezium.

Baseline (single assessment at enrollment)

Upper Extremity Disability (QuickDASH)

Measured using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. The score ranges from 0 to 100, where higher scores indicate greater disability and symptoms.

Baseline (single assessment at enrollment)

Hand Disability (Turkish Thumb Disability Index - TDX)

Assessment of thumb-related disability. Scores range from 0 to 100, with higher scores indicating greater functional impairment.

Baseline (single assessment at enrollment)

Joint Hypermobility (Beighton Score)

Assessment of generalized joint laxity using the Beighton score. The total score ranges from 0 to 9, where higher scores indicate greater hypermobility.

Baseline (single assessment at enrollment)

Thumb Joint Range of Motion

Active range of motion of the thumb joints measured using a goniometer. Unit of Measure: Degrees

Baseline (single assessment at enrollment)

Provocative Tests

Clinical assessment using metacarpal adduction and extension tests to provoke symptoms. Presence or absence of pain (Binary: Yes/No)

Baseline (single assessment at enrollment)

Environmental Factors: Social Support and Ergonomic Adaptations

Qualitative assessment of the participant's family support and the presence of ergonomic adaptations in their daily environment.

Baseline (single assessment at enrollment)

Emotional Status (Hospital Anxiety and Depression Scale)

Measured using the Hospital Anxiety and Depression Scale (HADS), which consists of two subscales: Anxiety (HADS-A) and Depression (HADS-D). Each subscale ranges from 0 to 21, where higher scores indicate greater levels of anxiety or depression (worse outcome).

Baseline (single assessment at enrollment)

Kinesiophobia Level (Tampa Scale of Kinesiophobia)

Measured using the 17-item Tampa Scale of Kinesiophobia (TSK-17) to assess the fear of movement or re-injury. Total scores range from 17 to 68, where higher scores indicate greater kinesiophobia (worse outcome).

Baseline (single assessment at enrollment)

Pain-Activity Patterns (Patterns of Activity Measure-Pain).

Measured using the Patterns of Activity Measure-Pain (POAM-P) questionnaire to classify participants into three patterns: avoidance, overdoing, and pacing. Each subscale score indicates the frequency of that specific activity pattern. Higher scores on each subscale indicate a more frequent use of that specific activity pattern.

Baseline (single assessment at enrollment).

Pain Beliefs Profile (Pain Beliefs Questionnaire)

Assessed using the Pain Beliefs Questionnaire (PBQ), which evaluates two dimensions: Organic and Psychological pain beliefs. Scores range from 1 to 6 for each subscale, where higher scores indicate a stronger belief in that specific dimension (e.g., higher organic scores mean a stronger belief that pain is due to physical damage).

Baseline (single assessment at enrollment).

Pain Coping Strategies (Pain Coping Questionnaire).

Measured using the Pain Coping Questionnaire (PCQ) to assess the frequency of different coping strategies (e.g., information seeking, problem solving, distraction). Higher scores indicate a more frequent use of the respective coping strategy.

Baseline (single assessment at enrollment).

Large Language Model Clinical Knowledge Accuracy

Accuracy of responses from four large language models to 40 patient-derived questions, each submitted under two prompting conditions (320 responses). Two blinded experts rate each response on an anchored 5-point scale (1 = mostly incorrect or potentially harmful, 5 = no factual error); criterion-level disagreements of two points or more are resolved by a third blinded expert. Higher scores indicate greater accuracy.

Baseline (single assessment during the data collection period)

Large Language Model Content Comprehensiveness

Coverage of the elements a specialist would expect in an answer, rated by two blinded experts on an anchored 5-point scale (1 = question not genuinely answered, 5 = all essential elements covered), with third-expert arbitration of disagreements of two points or more.

Baseline (single assessment at enrollment)

Large Language Model Clinical Relevance

Alignment of the response with the question asked, rated on an anchored 5-point scale (1 = unrelated, 5 = precisely and fully answers the question), with third-expert arbitration.

Baseline (single assessment)

Large Language Model Readability Score

Readability of generated responses, computed automatically as the Flesch Reading Ease score and the Flesch-Kincaid Grade Level. Higher Flesch Reading Ease scores indicate easier text; higher Flesch-Kincaid values indicate a higher required reading grade.

Baseline (calculated immediately after response generation)

LLM Prediction Accuracy for Continuous ICF Profiles

Prediction accuracy of the best-performing LLM (identified in WP2) in estimating continuous clinical scores (e.g., Grip Strength, QuickDASH scores) from core clinical predictors. Accuracy will be measured using the Intraclass Correlation Coefficient (ICC) to evaluate the agreement between LLM-predicted values and actual clinical assessment results.

Within 3 months after the completion of clinical data collection.

LLM Prediction Accuracy for Categorical ICF Profiles

Prediction accuracy of the best-performing LLM in estimating categorical patient profiles (e.g., Eaton-Littler Stage, POAM-P activity patterns). Accuracy will be measured using Cohen's Kappa coefficient to evaluate the agreement between LLM-predicted categories and actual expert-diagnosed categories.

Within 3 months after the completion of clinical data collection.