Original Communications
Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture*,**,*,**

https://doi.org/10.1053/jhsu.2000.jhsu25a0330Get rights and content

Abstract

We evaluated the responsiveness of patient questionnaires and physical testing in the assessment of recovery after distal radius fracture. Patients (n = 59) were assessed at their baseline clinic visit and again 3 and 6 months after injury. At each visit patients completed a short form-36, Disability of the Arm, Shoulder, and Hand questionnaire, and patient-rated wrist evaluation (PRWE). At 3 and 6 months grip strength, range of motion, and dexterity were analyzed. Standardized response means (SRM) and effects sizes were calculated to indicate responsiveness. The PRWE was the most responsive. Both the PRWE (SRM = 2.27) and the Disability of the Arm, Shoulder, and Hand (SRM = 2.01) questionnaire were more responsive than the short form-36 (SRM = 0.92). The physical component summary score of the short form-36 was similar to that of the physical component subscales. Questionnaires were highly responsive during the 0- to 3-month time period when physical testing could not be performed. Of the physical tests, grip strength was most responsive, followed by range of motion. Responsive patient-rating scales and physical performance evaluations can assist with outcome evaluation of patients with distal radius fracture. (J Hand Surg 2000;25A:330–340. Copyright © 2000 by the American Society for Surgery of the Hand).

Section snippets

Patient testing

Patients with wrist fractures (n = 59 for whom all questionnaires were completed at all 3 visits) were tested on 3 occasions. All patients signed consent forms approved by the local university ethics board. Primary emergency care took place either in local or outlying hospitals. The baseline orthopedic clinic visit and definitive treatment occurred within the first 10 days after fracture. Patients were assessed again at 3 and 6 months after injury. At all visits the patients completed the SF-36,

Results

Over both the 0- to 3-month and 0- to 6-month time periods, the PRWE SRM was larger (more responsive) than the DASH (ph < .001) or the SF-36 (ph < .0001) SRMs (Table 4).

. Responsiveness of Outcome Measures in Distal Radius Fracture Patients

Empty CellSRMEffect SizeEmpty CellEmpty Cell
Months0–33–60–60–33–60–6
PRWE
 Pain1.520.671.951.870.502.42
 Specific function2.470.623.625.870.447.01
 Usual function1.620.442.241.950.362.29
 Total2.270.742.953.160.503.91
DASH2.010.682.521.860.442.32
SF-36
 Physical function1.330.281.070.820.140.91
 Physical

Discussion

The results of this study demonstrate that questionnaires that were more specific to the wrist were more responsive in detecting clinical change. The largest change in outcome scores was observed between the baseline measurement and the 3-month follow-up examination. Baseline measurements can be taken immediately with questionnaires, but measures of physical performance must await fracture healing and removal of external hardware. Thus, questionnaires provide important information regarding

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    *

    No benefits in any form have been received or will be recieved from a commercial party related directly or indirectly to the subject of this article.

    **

    Reprint requests: Joy C. MacDermid, PhD, Clinical Research Laboratory, Hand and Upper Limb Centre, St Joseph's Health Centre, PO Box 5777, London, Ontario, N6A 4L6 Canada.

    *

    0363-5023/00/25A02-0008$3.00/0.

    **

    J Hand Surg 2000;25A:330–340.

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