Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable?

Kleinlugtenbelt, Y. V.; Krol, R. G.; Bhandari, M.; Goslings, J. C.; Poolman, R. W.; Scholtes, V. A. B.

doi:10.1302/2046-3758.71.BJR-2017-0081.R1

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Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable?

research-article

Author(s): Y. V. Kleinlugtenbelt , MD, PhD ¹ ^, , R. G. Krol , MD ² , M. Bhandari , MD, PhD ³ , J. C. Goslings , MD, PhD ⁴ , R. W. Poolman , MD, PhD ² , V. A. B. Scholtes , PhD ²

Publication date (Electronic): 8 February 2018

Journal: Bone & Joint Research

Keywords: Patient-rated wrist evaluation (PRWE), Disabilities of the Arm Shoulder and Hand (DASH) questionnaire, Distal radial fracture, Validity, Reliability

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Abstract

Objectives

The patient-rated wrist evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are patient-reported outcome measures (PROMs) used for clinical and research purposes. Methodological high-quality clinimetric studies that determine the measurement properties of these PROMs when used in patients with a distal radial fracture are lacking. This study aimed to validate the PRWE and DASH in Dutch patients with a displaced distal radial fracture (DRF).

Methods

The intraclass correlation coefficient (ICC) was used for test-retest reliability, between PROMs completed twice with a two-week interval at six to eight months after DRF. Internal consistency was determined using Cronbach’s α for the dimensions found in the factor analysis. The measurement error was expressed by the smallest detectable change (SDC). A semi-structured interview was conducted between eight and 12 weeks after DRF to assess the content validity.

Results

A total of 119 patients (mean age 58 years ( sd 15)), 74% female, completed PROMs at a mean time of six months ( sd 1) post-fracture. One overall meaningful dimension was found for the PRWE and the DASH. Internal consistency was excellent for both PROMs (Cronbach’s α 0.96 (PRWE) and 0.97 (DASH)). Test-retest reliability was good for the PRWE (ICC 0.87) and excellent for the DASH (ICC 0.91). The SDC was 20 for the PRWE and 14 for the DASH. No floor or ceiling effects were found. The content validity was good for both questionnaires.

Conclusion

The PRWE and DASH are valid and reliable PROMs in assessing function and disability in Dutch patients with a displaced DRF. However, due to the high SDC, the PRWE and DASH are less useful for individual patients with a distal radial fracture in clinical practice.

Cite this article: Y. V. Kleinlugtenbelt, R. G. Krol, M. Bhandari, J. C. Goslings, R. W. Poolman, V. A. B. Scholtes. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? Bone Joint Res 2018;7:36–45. DOI: 10.1302/2046-3758.71.BJR-2017-0081.R1.

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Psychometric theory.

J.C. NUNNALLY, I.H. Bernstein, J Nunnally … (1994)

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Individual-patient monitoring in clinical practice: are available health status surveys adequate?

C A McHorney, A. Tarlov (1995)

Interest has increased in recent years in incorporating health status measures into clinical practice for use at the individual-patient level. We propose six measurement standards for individual-patient applications: (1) practical features, (2) breadth of health measured, (3) depth of health measured, (4) precision for cross-sectional assessment, (5) precision for longitudinal monitoring and (6) validity. We evaluate five health status surveys (Functional Status Questionnaire, Dartmouth COOP Poster Charts, Nottingham Health Profile, Duke Health Profile, and SF-36 Health Survey) that have been proposed for use in clinical practice. We conducted an analytical literature review to evaluate the six measurement standards for individual-patient applications across the five surveys. The most problematic feature of the five surveys was their lack of precision for individual-patient applications. Across all scales, reliability standards for individual assessment and monitoring were not satisfied, and the 95% CIs were very wide. There was little evidence of the validity of the five surveys for screening, diagnosing, or monitoring individual patients. The health status surveys examined in this paper may not be suitable for monitoring the health and treatment status of individual patients. Clinical usefulness of existing measures might be demonstrated as clinical experience is broadened. At this time, however, it seems that new instruments, or adaptation of existing measures and scaling methods, are needed for individual-patient assessment and monitoring.

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The purpose of this new classification compendium is to republish the Orthopaedic Trauma Association's (OTA) classification. The OTA classification was originally published in a compendium of the Journal of Orthopaedic Trauma in 1996. It adopted The Comprehensive Classification of the Long Bones developed by Müller and colleagues and classified the remaining bones. In this compendium, the introductory chapter reviews new scientific information about classifying fractures that has been published in the last 11 years. The classification is presented in a revised format that is easier to follow. The OTA and AO classification will now have a unified alpha-numeric code eliminating the differences that have existed between the 2 codes. The code was significantly revised for the clavicle and scapula, foot and hand, and patella. Dislocations have been expanded on an anatomic basis and for most joints will be coded separately. This publication should stimulate new developments and interest in a unified language to code and classify fractures. Further improvements in classification will result in better patient care and clinical research.

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Author and article information

Contributors

Y. V. Kleinlugtenbelt: Role: Orthipaedic Surgeon

R. G. Krol: Role: Resident Radiologist

M. Bhandari: Role: Orthopaedic Surgeon and Professor of Surgery

J. C. Goslings: Role: Trauma Surgeon and Professor of Surgery

R. W. Poolman: Role: Orthopaedic Surgeon

V. A. B. Scholtes: Role: Program Manager

Journal

Journal ID (nlm-ta): Bone Joint Res

Title: Bone & Joint Research

ISSN (Electronic): 2046-3758

Publication date Collection: January 2018

Publication date (Electronic): 8 February 2018

Volume: 7

Issue: 1

Pages: 36-45

Affiliations

[1 ]Department of Orthopaedic and Trauma Surgery, Joint Research OLVG Oost, PO Box 95500, 1090 HM, Amsterdam, the Netherlands; Department of Orthopaedic and Trauma Surgery, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, the Netherlands; and Division of Ortopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St, Hamilton, Ontario L8N 3Z5, Canada

[2 ]Department of Orthopaedic and Trauma Surgery, Joint Research OLVG Oost, PO Box 95500, 1090 HM, Amsterdam, The Netherlands

[3 ]Division of Orthopaedic Surgery, McMaster University, 1200 Main St. West, Room 4E17, Hamilton, Ontario L8N 3Z5, Canada

[4 ]Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

Author notes

[*]Y. V. Kleinlugtenbelt; email: ijdoklb@ 123456hotmail.com

Article

Publisher ID: 10.1302_2046-3758.71.BJR-2017-0081.R1

DOI: 10.1302/2046-3758.71.BJR-2017-0081.R1

PMC ID: 5805831

PubMed ID: 29330342

SO-VID: d76e187c-95c4-4ee7-87e2-761cc1f218fe

License:

This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY-NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.

Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable?

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Abstract

Objectives

Methods

Results

Conclusion

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Most cited references 26

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Individual-patient monitoring in clinical practice: are available health status surveys adequate?

Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.

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