Development and validation of the patient-rated ulnar nerve evaluation

Joy C MacDermid, Ruby Grewal, Joy C MacDermid, Ruby Grewal

Abstract

Background: Compression neuropathy at the elbow causes substantial pain and disability. Clinical research on this disorder is hampered by the lack of a specific outcome measure for this problem. A patient-reported outcome measure, The Patient-Rated Ulnar Nerve Evaluation (PRUNE) was developed to assess pain, symptoms and functional disability in patients with ulnar nerve compression at the elbow.

Methods: An iterative process was used to develop and test items. Content validity was addressed using patient/expert interviews and review; linking of the scale items to International Classification of Functioning, Disability, and Health (ICF) codes; and cognitive coding of the items. Psychometric analysis of data collected from 89 patients was evaluated. Patients completed a longer version of the PRUNE at baseline. Item reduction was performed using statistical analyses and patient input to obtain the final 20 item version. Score distribution, reliability, exploratory factor analysis, correlational construct validity, discriminative known group construct validity, and responsiveness to change were evaluated.

Results: Content analysis indicated items were aligned with subscale concepts of pain and sensory/motor symptoms impairments; specific upper extremity-related tasks; and that the usual function subscale provided a broad view of self-care, household tasks, major life areas and recreation/ leisure. Four subscales were demonstrated by factor analysis (pain, sensory/motor symptoms impairments, specific activity limitations, and usual activity/role restrictions). The PRUNE and its subscales had high reliability coefficients (ICCs>0.90; 0.98 for total score) and low absolute error. The minimal detectable change was 7.1 points. It was able to discriminate between clinically meaningful subgroups determined by an independent evaluation assessing work status, residual symptoms, motor recovery, sensory recovery and global improvement) p<0.01. Responsiveness was excellent (SRM=1.55).

Conclusion: The PRUNE is a brief, open-access, patient-reported outcome measure for patients with ulnar nerve compression that demonstrates strong measurement properties.

Figures

Figure 1
Figure 1
Patient-rated ulnar nerve evaluation.
Figure 2
Figure 2
Boxplots of subscale items at baseline. a: Boxplot of Pain Items. b: Boxplot of Sensory/motor Symptoms Subscale. c: Boxplot of Items in Specific Activity Subscale. d: Boxplots of Items in Usual Activity Subscale. e: Boxplot of Subscale and Total Scores of Baseline PRUNE.
Figure 3
Figure 3
PRUNE symptom score at 3 months post-op.

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