Measuring Outcomes Over Time in Distal Radius Fractures: A Comparison of Generic, Upper Extremity-Specific and Wrist-Specific Outcome Measures

Amarpal S Cheema, Peter J O'Brien, Henry M Broekhuyse, Kelly A Lefaivre, Amarpal S Cheema, Peter J O'Brien, Henry M Broekhuyse, Kelly A Lefaivre

Abstract

Purpose: This study compared the responsiveness of a generic (Short Form-36 [SF-36]), an upper extremity-specific (Disabilities of the Arm, Shoulder, and Hand [DASH]) and a wrist-specific (Patient-Rated Wrist Evaluation [PRWE]) outcome score when evaluating distal radius fractures over time.

Methods: We observed 235 patients who met the inclusion criteria of an isolated distal radius fracture treated surgically or nonsurgically and greater than age 50 years for 12 months in this prospective study. Standardized assessments were performed at baseline and at 6 and 12 months. Exclusion criteria included subjects with concomitant injuries in the ipsilateral limb and follow-up of less than 1 year. Responsiveness was evaluated through the standardized response mean and the proportion who met a minimal clinically important difference. Floor and ceiling effects were also calculated.

Results: The standardized response mean was significantly greatest for the DASH between baseline and 6 months (P < .001), and the PRWE between both baseline and 6 months (P < .01) and 6 and 12 months (P < .01) compared with the SF-36. The proportion of patients who met a minimal clinically important difference between baseline and 6 months was greater in the PRWE, but it did not meet statistical significance (P = .12). The PRWE demonstrated a high ceiling effect at baseline (76.6%) but less so at 12 months (16.9%). The DASH demonstrated similar ceiling effects at baseline (62.9%) and 12 months (18.6%). The SF-36 had no ceiling effect.

Conclusions: In the first 6 months, both the DASH and PRWE have greater responsiveness in assessing change over the SF-36 in distal radius fractures. From 6 to 12 months, the wrist-specific PRWE has greater responsiveness over both the DASH and SF-36. This supports the use of the anatomy- and injury-specific outcome measures over the generic outcome measure in detecting change over a patient's early recovery. However, as the time from injury increases, the absence of a ceiling effect from the generic outcome measure may become more useful.

Clinical relevance: This study demonstrates the responsiveness of the DASH, PRWE, and SF36 in assessing distal radius fractures treated in patients greater than age 50 in the first year. In establishing the most responsive measure, respondent burden can be decreased in future research.

Keywords: Disabilities of the Arm, Shoulder, and Hand; Distal radius; Fracture; Functional outcome scores; Patient-Rated Wrist Evaluation.

© 2020 THE AUTHORS. Published by Elsevier Inc. on behalf of The American Society for Surgery of the Hand.

Figures

Figure 1
Figure 1
Distribution of scores at each time point.
Figure 2
Figure 2
Comparison of magnitude of SRM for SF-36, PRWE, and DASH. 1The mean improvements are all negative from baseline to 6 months and positive from 6 months to 12 months. ∗ P<0.01; ∗∗P<0.001; ∗∗∗P<0.04.
Figure 3
Figure 3
Percentage of patients achieving MCID between time points for SF-36, PRWE, and DASH.

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