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

Preoperative Physiotherapy Effects on Hand Function and Quality of Life in Carpal Tunnel Syndrome: 3 - & 6 - month randomized controlled trial

INTRODUCTION

Carpal Tunnel Syndrome (CTS) is a prevalent upper limb mononeuropathy that often leads to delayed surgical intervention, resulting in prolonged symptoms and reduced quality of life.

AIM

To describe the effect of a three-session treatment involving nerve mechanical interface mobilization and self-mobilization combined with education in hand function, symptoms, and quality of life of pre-surgical CTS patients at 3 and 6-months follow-ups; 3) A randomized clinical trial was performed in 42 preoperative CTS patients. Patients were randomized into an experimental group, receiving a three-session intervention of education, diacutaneous fibrolysis, and self-mobilization, or a control group receiving standard care. Primary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, while secondary outcomes assessed paresthesia, mechanosensitivity of the median nerve, mechanical threshold with the Semmes Weinstein monofilament, pinch strength, and quality of life, with the short-form-36 & EuroQol-5D.

RESULTS

The cohort were predominantly severe CTS patients with associated comorbidities. Statistical improvements were shown for experimental group compared to control group in DASH at 6-month follow-up (p = 0.035; η2 = 0.12). Paraesthesia intensity, mechanosensitivity, and quality of life were also significantly improved in the experimental group compared to control group at both 3- and 6-months (p < 0.05). The same occurred for pinch strength at 6 months (p < 0.05). No significant differences were found in mechanical threshold (p > 0.05); 5) The treatment effectively improved hand function, symptoms, and quality of life in preoperative CTS patients, offering a viable alternative during delays in surgical procedures. Nerve mechanical interface treatment could not only help mild to severe CTS patients but might be relevant for severe CTS patients with associated comorbidities.

Does orthosis improve outcomes of conservative treatment in trigger fingers? A three-arm prospective randomized controlled trial

OBJECTIVE

The purpose of this trial was to evaluate whether the addition of an orthosis improved the efficacy of cortisone injection for the non-operative management of trigger finger.

DESIGN

Block-randomized controlled trial.

SETTING

Outpatient hand clinic.

PARTICIPANTS

Individuals presenting to our centre with Green severity grade 1-3 trigger finger from age 18 to 80 were eligible for inclusion. Previous treatment with either a splint or cortisone injection, trigger thumb, greater than two digits involved, grade 4 trigger or an allergy to cortisone were criteria for exclusion.

INTERVENTIONS

Patients' hands were randomized to night-time extension orthosis, cortisone injection, or combined treatment, stratified by Green severity score and comorbid diabetes. MAIN.

OUTCOME

MEASURES

Patient reported outcome measures and the number of triggering occurrences with 10 repeated grips were collected at 6-weeks, 3-, 6-, and 12-months.

RESULTS

The study includes 104 patients representing 122 trigger fingers in 115 hands, with an average follow-up of 29 months. At 6 weeks there was no significant difference in incidence of triggering, symptom relief, or PRWHE score between injection or combined treatment groups. Overall success rate with conservative treatment was high, 68.9% experience resolution or improvement of their symptoms. Grade 3 trigger fingers had a significantly higher rate of surgical release compared with lower grade trigger fingers (39.1% vs. 22.4%, p=0.05).

CONCLUSIONS

Our study shows no significant benefit to adding an orthosis to cortisone injection in all trigger grades. Overall success with conservative treatment was high (68.9%) in this cohort. Conservative management of grade 1 and 2 triggers is successful in about 75% of cases, regardless of whether treatment is an orthosis, injection or both compared to 60% success rate for grade 3.

Dynamic hand and finger load distribution patterns in the first year following surgically treated distal radius fracture

BACKGROUND

Manugraphy is a relatively young technique for assessing dynamic load distribution when gripping a cylinder. Thereby, dynamic hand grip function is objectivated, providing a more detailed insight than with other clinical assessment tools. Analysis of changes in grip patterns following a distal radius fracture provides a new perspective on documenting the recovery process of this common injury. Our aim was also to investigate the relationships between load distribution during a maximum force grip and other hand function parameters to better understand the implications for follow-up and rehabilitation.

METHODS

Assessment of the QuickDASH score, finger and wrist range of motion, grip strength as well as grip load distribution using manugraphy was performed 3, 6 and 12 months following isolated surgically treated distal radius fractures. Using special software, each finger ray as well as the thenar and hypothenar were defined on the digital pressure map and the contribution to the total force was calculated for each region.

RESULTS

After 3 months, 49 patients participated in the follow-up examinations, after 6 months 38 patients and after 12 months 35 patients. When the QuickDASH score decreased significantly, the wrist range of motion and grip strength recovered to more than 90% of the values of the uninjured side within the first year after fracture treatment. The cumulative analysis of the load distribution showed that after 3 months, the thumb and index finger exerted a greater proportion of the total grip strength than did the uninjured hand, whereas the contributions of the thenar and hypothenar were smaller. These changes diminished at 6 and 12 months, respectively. The changes in grip pattern showed significant correlations with grip strength and partly with range of motion of finger and wrist as well as the QuickDASH score.

CONCLUSIONS

The dependence between changes in load distribution and different hand function parameters implies the particular additional value and validity of this helpful technique for individual assessment and rehabilitation of hand function. Early detection of persisting imbalances of dynamic load distribution might support clinical decision-making in the postoperative course during rehabilitation.

The availability of common patient-reported outcome measures in hand surgery across Europe

Many European healthcare systems emphasize value-based care to improve outcomes and control costs. Assessing function and satisfaction in hand surgery relies on patient reported outcome measures. This study evaluates the use of these outcome measures across Europe, focusing on diversity and language validation.A comprehensive database search for hand-specific patient reported outcome measures assessed availability for all official languages in Europe focusing on transculturally adapted and validated versions of available questionnaires. The study identified 47 European countries with 41 unique languages. The Disabilities of the Arm, Shoulder and Hand Questionnaire is the most available outcome measure, translated into 41 languages. Availability of other outcome measures varied significantly by language. Gaps in the availability of hand specific patient reported outcome measures exist across Europe. To assist in translating and validating such questionnaires, an exemplary Standard Protocol Items: Recommendations for Interventional Trials checklist is provided as supplementary material.Level of evidence: IV.

Single Joint Hybrid Assistive Limb (HAL-SJ) robotic exoskeleton therapy in improving functional outcomes among workers with wrist fractures: Study protocol for a randomized controlled trial

INTRODUCTION

Robotic technologies have been developed for motor rehabilitation and such robots have shown favourable results when compared with equivalent doses of usual clinical therapy. Recently, robotic interventions have been suggested to be applied in orthopaedic rehabilitation with upper extremity disorders, especially those related to hand and wrist. This study aims to determine the effectiveness of combined conventional therapy and HAL-SJ robotic therapy in restoring the wrist functionality following the fractures as compared to the standard conventional therapy solely.

METHODS AND ANALYSIS

Workers with wrist fractures will be randomized in two groups, i.e., the control group (conventional therapy) and intervention group (combination of conventional therapy and robotic HAL-SJ intervention). All participants will receive 5-day/week therapy sessions for four weeks. Primary outcomes of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and secondary outcomes of range of motion, grip and pinch strengths, fine and gross hand dexterity as well as pain and the Lam Assessment of Stages of Employment Readiness (LASER) will be assessed at baseline assessment and upon completion of the therapy program after 4 weeks. Data from the baseline and post intervention outcome measures will be analysed using a Repeated Measures ANOVA to compare the therapy effectiveness of both control and intervention groups.

RESULTS

Participants recruitment and data collection are in progress.

DISCUSSION

Wrist fractures can produce some residual disability and pain that may impact the functionality of a person. The application of robotic technology in facilitating upper limb movement and functional recovery training is extensive and shows positive outcomes in the field of neurorehabilitation. However, there is a lacking of published evidence about the effectiveness of robotic intervention in orthopaedic rehabilitation, especially in the field of hand therapy.

CONCLUSION

Participants recruitment and data collection are still ongoing.

CLINICAL TRIAL REGISTRATION

This trial is registered with the Australian New Zealand Clinical Trials Registry (registration number: ACTRN12622000413729).

A randomized controlled trial comparing controlled active motion and early passive mobilization protocols for rehabilitation of repaired flexor tendons in zone II

BACKGROUND

Flexor tendon injuries in zone II of the hand pose serious clinical complications due to the high risk of adhesion formation and suboptimal clinical outcomes, although controlled active motion (CAM) and early passive mobilization (EPM) are standard protocols used during rehabilitation.

OBJECTIVE

This randomized trial compared functional outcomes between CAM and EPM systems after zone II flexor tendon repair.

METHODS

Forty patients with entire zone II flexor digitorum profundus and superficialis tears were randomly assigned to either the CAM or EPM protocol for 12 weeks' rehabilitation. Total active motion (TAM), grip strength, and disability of the arm, shoulder, and hand (DASH) scores were assessed in the 6th and 12th week after the repair. Two-way mixed ANOVA was used to determine the effect of the treatment regarding the type of protocol and time within and between groups, as well as, Cohen's d was used to calculate the effect size.

RESULTS

There was a significant improvement over time in both groups for all measured outcomes (p < 0.001). However, CAM showed superior results than EPM across all time points (6th and 12th week); for TAM (p < 0.05, Cohen's d =11.8 and 9.9), grip strength (p < 0.05, Cohen's d = 7.97 and 9.7), and DASH score (p < 0.05, Cohen's d = 5.8 and 5.5). By 12 weeks, 80% of CAM patients achieved an "excellent" rating according to the Strickland formula of the TAM grading compared with 55% for the EPM group.

CONCLUSION

While both CAM and EPM protocols improve functional status after zone II flexor tendon repair, CAM confers a distinct early advantage in a digital range of motion and manual function compared with EPM. These data support the preferred adoption of the CAM rehabilitation approach after area II flexor tendon surgical repair.

Do patients with minimally displaced distal radial fractures need a plaster cast?

Traditionally, patients with a fracture of the distal radius are treated in a cast if they do not require surgery. If the fracture requires manipulation, the cast is moulded to hold the reduction and maintain normal anatomical alignment during healing. However, is a cast necessary for patients whose fracture does not require manipulation? Removable splints are an alternative treatment option. Such splints have the advantage that they can be adjusted to improve fit around the wrist as swelling reduces, and can be removed and reapplied for the purpose of washing or, in some cases, exercise. However, evidence for their safety and effectiveness in the management of distal radius fractures is lacking. DRAFT3 is a multicentre randomized non-inferiority trial and economic analysis designed to determine the safety and effectiveness of removable splints as an alternative to casts in the treatment of distal radius fractures that do not require manipulation.

tREatment of trIaNgular FibrOcaRtilage ComplEx Ruptures (REINFORCER): protocol for randomised, controlled, blinded, efficacy trial of triangular fibrocartilage complex tears

INTRODUCTION

Triangular fibrocartilage complex (TFCC) tear is often considered to be the cause of ulnar wrist pain. The primary treatment typically involves non-operative methods; however, in cases of persistent symptoms, operative intervention has been proposed as a viable option. Depending on the tear's morphology, treatment may involve debridement (central or radial tear) or repair (peripheral tear). Efficacy of operative treatment has not been studied in a randomised controlled trial.

METHODS AND ANALYSIS

This is a prospective, randomised, controlled, blinded multicentre trial, with two randomisation stratums. The first stratum includes central or radial TFCC tears, while the second stratum comprises peripheral TFCC tears. Each stratum consists of two parallel 1:1 arms, comparing the efficacy of (1) debridement of central or radial tear with placebo surgery and (2) repair of peripheral tear with physiotherapy. Participants are recruited from secondary and tertiary referral hospitals in Denmark, Finland and Sweden.Primary outcome is the Patient-Rated Wrist Evaluation (PRWE) at 1 year. Secondary outcomes include subjective and objective outcome measures at 6 months, 1, 2, 5 and 10 years follow-ups.

ETHICS AND DISSEMINATION

The trial was approved by the Pirkanmaa Hospital District Institutional Review Board in March 2020. All participants will be asked to give a written informed consent. The results of the trial will be disseminated as published articles in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04576169.

Validation of DASH and QuickDASH for Outcome Assessment of Anatomic Total Shoulder Arthroplasty for Treatment of Advanced Glenohumeral Osteoarthritis

BACKGROUND

The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and its abbreviated version, QuickDASH, are commonly used patient-reported outcome measures (PROMs) for the assessment of an upper-extremity disability. Theoretically, they can be used to compare the treatment outcomes of different upper-extremity conditions. Despite increasingly widespread use for some shoulder conditions, these questionnaires have not been rigorously validated for use to assess the outcomes of patients undergoing anatomic total shoulder arthroplasty (aTSA). The objective of this study was to validate the DASH and QuickDASH scores for a longitudinal outcome assessment of patients undergoing aTSA to treat advanced glenohumeral osteoarthritis (GHOA).

METHODS

In this study, 450 patients with a median age of 70.3 years (interquartile range [IQR] width, 11.7 years) were included; 52.4% of the patients were female. The DASH and QuickDASH questionnaires, the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and the EuroQol-5 Dimensions (EQ-5D) questionnaire were completed preoperatively and at follow-ups of 3 months, 6 to 12 months, and a minimum of 2 years by patients undergoing aTSA. The criterion validity, construct validity, reliability, and responsiveness of the DASH and QuickDASH were assessed.

RESULTS

The DASH and QuickDASH scores demonstrated moderate to very strong correlations with the ASES scores (ρ = -0.83 to -0.62), SST scores (ρ = -0.73 to -0.55), and EQ-5D scores (ρ = -0.72 to -0.57); minimal floor or ceiling effects; internal consistency (Cronbach alpha > 0.80); and large Cohen d and standardized response means (<1.6) at all time points. Very strong positive correlations were observed between the DASH and QuickDASH scores at all time points (ρ = 0.96 to 0.97).

CONCLUSIONS

The DASH and QuickDASH scores, which are region-specific rather than shoulder-specific, are valid, reliable, and responsive PROMs for the evaluation of patients with advanced GHOA treated with aTSA. Therefore, the DASH and QuickDASH scores can be used to compare the outcomes of aTSA for the treatment of advanced GHOA with the outcomes of treatment of other upper-extremity disorders, potentially facilitating comparative cost-effectiveness and value analysis studies.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparative Analysis of Radial Corrective Osteotomy and Sauvé-Kapandji Procedure for Malunited Distal Radius Fractures in Older Adults

PURPOSE

Malunited distal radius fractures frequently occur in the older population, posing a dilemma in selecting ideal management for symptomatic patients. Radial corrective osteotomy (RCO) and the Sauvé-Kapandji procedure (SK) have been used to treat this challenging condition. However, it remains unknown which approach is better for the older population. The objective of this study was to compare the outcomes of RCO with those of SK for the treatment of symptomatic distal radius malunion in older adults.

METHODS

Thirty-three patients aged ≥60 years, with malunited distal radius fractures, were randomized to be treated with either RCO or SK and followed for a minimum of 2 years. The primary evaluation parameter was grip strength, and secondary outcome parameters were surgical time, range of motion of the wrist, exercise-related wrist pain assessment using visual analog scale scores, radiographic results, patient-reported outcomes evaluated using the Disability of the Arm, Shoulder, and Hand (DASH), and Patient-Related Wrist Evaluation (PRWE) scores.

RESULTS

The average follow-up duration was 36.7 ± 10.2 months. The grip strength was significantly higher in the RCO group. The surgical time was shorter in the SK group than in the RCO group. The postoperative wrist range of motion and visual analog scale scores for exercise-related pain alleviation were similar in both groups. The ulnar variance decreased in both groups and was similar when compared with the postoperative images. The DASH and PRWE scores were similar between the RCO and SK groups.

CONCLUSIONS

Radial corrective osteotomy and SK surgeries have similar clinical and functional outcomes in patients aged ≥60 years. Grip strength is higher in the RCO group than in the SK group. However, the operating time to accomplish SK is shorter than RCO.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic II.

Distal Radius Fracture Rehabilitation

Distal radius fracture (DRF) is arguably the most common upper extremity fracture resulting from a fall accident. These clinical practice guidelines (CPG) were developed to guide all aspects of the management of DRF by physical therapists and other rehabilitation practitioners, such as certified hand therapists. This CPG employed a systematic review methodology to locate, appraise, and synthesize contemporary evidence while developing practice recommendations for determining the prognosis of outcomes, examination, and interventions while managing individuals with DRF. The quality of the primary studies found in the literature search was appraised using standardized tools. The strength of the available evidence for a particular practice domain (e.g., prognosis or intervention) was graded as strong, moderate, weak, or conflicting, where such gradings guided the level of obligation for each practice recommendation. Lastly, the CPG also provided the gaps in the evidence pool for the rehabilitation of DRF that future research efforts can address. J Orthop Sports Phys Ther 2024;54(9):CPG1-CPG78. doi:10.2519/jospt.2024.0301.

Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options

Purpose  This systematic review summarizes the existing evidence on treatment options and outcomes for partial scapholunate interosseous ligament (pSLIL) injuries. Methods  A systematic electronic search of Medline, Embase, and CINAHL was performed from inception through to February 13, 2022. All primary research articles addressing the treatment of pSLIL tears were eligible for inclusion regardless of timing of surgery, surgical technique, or rehabilitation. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics and forest plots are presented. Results  A total of 14 studies with 342 patients were included for analysis. Treatments were categorized into four groups: electrothermal shrinkage (ES), arthroscopic capsuloplasty (AC), open capsulodesis (OC), and no treatment (NT). There were five studies in the ES group ( N  = 69, mean age = 34.3 ± 3.3 years), three studies in the AC group ( N  = 138, mean age = 32.2 ± 3.8 years), five studies in the OC group ( N  = 123, mean age of 30.7 ± 7.8 years), and one study in the NT group ( N  = 12, mean age = 43 years, range = 28-67 years). The average postintervention visual analog scale pain score for the ES group was 1.4 ± 0.5 (from 5.7 ± 1.8), for the AC group was 3.2 ± 1.3 (from 6.6 ± 0), for the OC group was 2.3 ± 2.1 (from 5.6 ± 1.6), and for the NT group was 3.2 (from 7.6). The wrist extension range of motion improved postoperatively for all intervention groups (ES = 66.3°-70.7°; AC = 67°-74.5°; and OC = 48.9°-63.5°), whereas it remained unchanged for the NT group (46°-45°). Grip strength also improved in all intervention groups (ES = 17.9-29.9 kg; AC = 24.0-32.2 kg; and OC = 15.8-26.6 kg), while the NT group remained unchanged (25-24 kg). The radiographic scapholunate gap improved postoperatively in all groups that reported pre- and postintervention (ES = 2.2-1.9 mm; OC = 2.5-1.8 mm) and slightly worsened in the NT group (2.5-2.7 mm). In the ES group, there were three complications (11.5%, no major complications), in the AC group there was one major complication (0.9%, complex regional pain syndrome [CRPS]), and in the OC group there were six complications (15.4%, four major complications-CRPS). Conclusion  All interventional treatment options (ES, AC, and OC) provided significant improvements in patient-reported pain, range of motion, grip strength, and radiographic parameters, with low complication rates. In comparison, no improvement in range of motion or grip strength was noted in the NT group. Therefore, surgical management of pSLIL injuries is an effective and relatively safe treatment option. Further studies comparing the outcomes of specific surgical treatments are warranted to further elucidate the optimal management option for pSLIL tears. Level of Evidence  Level III, systematic review of Level III-IV studies.

OPerative versus non-opERAtive management of isolated ULNAr diaphyseal fractures (OPERA-Ulna): protocol for a randomized controlled trial

Aims

Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give rise to complications, such as nonunion, limited forearm pronation and supination, restricted elbow range of motion, radioulnar synostosis, and prolonged pain. Treatment options for this injury remain a topic of debate, with limited research available and no consensus on the optimal approach. Therefore, this trial aims to compare clinical, radiological, and functional outcomes of two treatment methods: open reduction and internal fixation (ORIF) versus nonoperative treatment in patients with isolated ulnar diaphyseal fractures.

Methods

This will be a multicentre, open-label, parallel randomized clinical trial (under National Clinical Trial number NCT01123447), accompanied by a parallel prospective cohort group for patients who meet the inclusion criteria, but decline randomization. Eligible patients will be randomized to one of the two treatment groups: 1) nonoperative treatment with closed reduction and below-elbow casting; or 2) surgical treatment with ORIF utilizing a limited contact dynamic compression plate and screw construct. The primary outcome measured will be the Disabilities of the Arm, Shoulder and Hand questionnaire score at 12 months post-injury. Additionally, functional outcomes will be assessed using the 36-Item Short Form Health Survey and pain visual analogue scale, allowing for a comparison of outcomes between groups. Secondary outcome measures will encompass clinical outcomes such as range of motion and grip strength, radiological parameters including time to union, as well as economic outcomes assessed from enrolment to 12 months post-injury.

Ethics and dissemination

This trial has been approved by the lead site Conjoint Health Research Ethics Board (CHREB; REB14-2004) and local ethics boards at each participating site. Findings from the trial will be disseminated through presentations at regional, national, and international scientific conferences and public forums. The primary results and secondary findings will be submitted for peer-reviewed publication.

Characterization of functioning in breast cancer survivors: an interpretive descriptive analysis study based on the International Classification of Functioning, Disability, and Health (ICF) and the Item-Perspective Classification Framework

PURPOSE

Breast cancer survivors may experience a variety of disabilities that could potentially compromise their independent functioning. This study aimed to examine their perspectives and experts on their functioning and interpret concepts with the International Classification of Functioning, Disability, and Health (ICF) and the Item-Perspective Classification Framework (IPF).

METHODS

Interpretive descriptive methods were used with in-depth interviewing with 16 breast cancer survivors and 22 experts using a semi-structured interview guide. The interviews were recorded, transcribed, and qualitatively analyzed using thematic analysis. The extracted data were linked to the ICF Core Set for Breast cancer and were interpreted by the IPF.

RESULTS

Four main themes emerged to define the functioning of breast cancer survivors: body functioning, physical functioning, social functioning, and mental functioning. Three other factors were also categorized as modifiers of functioning personal, emotional, and environmental. The 592 extracted meaningful concepts were linked to 38 (47%) categories from the ICF: 16 Body Functions, 14 Activities and Participation, and 8 Environmental Factors. The IPF classified all the extracted concepts, and most rational appraisals fell in the biological (B) domain. The concepts that required emotional appraisal were classified in Psychology (P).

CONCLUSION

Psychological and emotional factors were pivotal in defining functioning in patients with BC.

Impact of chronic wrist hypermobility on proprioception, strength, and functional performance in young adults

BACKGROUND

Chronic joint hypermobility has been attributed to repetitive ligamentous microtrauma, benign joint hypermobility syndrome (BJHS), or genetic connective tissue disorders that lead to pain and functional impairment, especially among females. Chronic wrist hypermobility (CWH) prevalence, etiology, and effects on proprioception, strength, and function have yet to be established.

PURPOSE

This pilot study aimed to determine the CWH prevalence among adults; its effects on proprioception, strength, and function; and whether these effects are gender based.

STUDY DESIGN

This was a quasi-experimental cross-sectional study.

METHODS

Ninety wrists (55 participants, mean age 27.46 years) with no wrist range of motion (ROM) restrictions or previous trauma for ≥6 months were screened for CWH based on an exploratory set of diagnostic criteria. Fifty-eight wrists (34 adults) were allocated to a CWH group, and 32 wrists (21 adults) were allocated to a healthy control group. Twenty-five CWH and 25 healthy control matched (gender, age, and handedness) participants were compared. Assessment included the active wrist joint position sense test, hand-held dynamometry for wrist extension and grip strength, and the patient-rated wrist evaluation for function. Testers were blinded to group allocation.

RESULTS

A 64.4% CWH prevalence existed among CWH participants, who were mostly asymptomatic females (74%). Frequent etiologic factors were midcarpal (96.5%) and scapholunate (39%) instabilities and BJHS (37%), which was higher among females (30%) than males (8%). Independent t-tests showed statistically significant (p < 0.05) group differences in wrist proprioception, wrist isometric extension, grip strength, and function with moderate-high (0.41-0.75) effect size. No significant gender differences existed in proprioception and function.

CONCLUSIONS

CWH is very prevalent among functional independent young adults with atraumatic midcarpal and intercarpal ligamentous laxities and BJHS. CWH prevails among women and adversely affects wrist proprioception, strength, and function. The study's specific CWH diagnostic criteria may be useful for clinicians to identify and timely manage impacted individuals by CWH.

Relation between the dash score and radiographic evaluation of the wrist in patients with wrist fracture

Traditionally, the assessment of distal radius fracture outcomes has been based on radiological measurements and self-evaluation scores. However, there is uncertainty regarding how accurately these measurements reflect the patient's perception of their outcome. In this study, we examined the correlation between radiological measurements and patient-perceived outcomes using the Disabilities of the Arm, Shoulder, and Hand outcome (DASH) score. 140 individuals who had recovered from a distal radius fracture. and had been treated with DVR, Kapandji, percutaneous pinning or closed reduction were included in the study. The retrospective assessment included 78 females and 62 males, with a mean DASH score of 3.54 points.Except for the ulnar variance, the study found little to no significant association between the DASH score and the final radiological measurement.In summary, the DASH score did not always indicate that a superior radiological result translated into a better patient-perceived outcome.

The effectiveness of therapeutic craft-making activities in treating lower-third forearm fracture: study protocol for a randomized controlled trial

BACKGROUND

Occupational Therapists use craft-making activities as therapeutic interventions to improve physical and psychological functioning of injured people. Despite the therapeutic effects, craft-making is not routinely used in hand rehabilitation as an intervention for patients with upper limb fractures. These patients often experience physical and psychosocial issues; however, without supportive evidence, therapists hesitate to integrate craft-making into upper limb rehabilitation.

PURPOSE

This study aims to determine the effect of a conventional therapy combined with therapeutic craft-making on disability, post-traumatic stress, and physical performance in patients with lower-third forearm fractures.

METHODS

Priori analysis determined that 38 patients will be needed for this superiority randomized controlled trial to be conducted in a hand and upper limb rehabilitation center. Eligible participants must comprehend English, be diagnosed with lower-third forearm fracture(s) stabilized by open reduction internal fixation, and referred to therapy within 2-4 weeks of surgery. Following the CONSORT guidelines, participants will be randomly assigned to a Control (conventional therapy) group or an Intervention (conventional therapy and craft) group. Twice weekly for 6 weeks, Therapist A will provide both groups with 1-h of conventional therapy while the Intervention group will also receive 15 min of craft-making supervised by the Researcher. The primary outcome of disability will be measured with the Quick-Disabilities of Arm, Shoulder and Hand. The secondary outcome measurements include the Patient-Rated-Wrist-Evaluation; Impact of Event Scale-revised and physical performance, i.e., the Purdue Pegboard Test, AROM, and grip strength. All outcome measures will be obtained by Therapist B prior to the 1st therapy visit and after the 12th visit. Descriptive analysis will be done for the categorical and continuous data and a mixed model ANOVA for analysis of the initial and final assessment scores within and between groups.

RESULTS

This study is ongoing.

DISCUSSION

The intent of this study is to determine if therapeutic crafts have value as an intervention when used in combination with conventional therapy for patients with lower-third forearm fractures. If the value of crafts is supported, this evidence may reduce hesitancy of therapists to implement craft-making with patients referred to hand therapy after upper limb fracture.

CONCLUSION

This study is ongoing.

TRIAL REGISTRATION

ANZCTR, ACTRN12622000150741. Retrospectively registered on 28 January 2022 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382676&isReview=true ..

The association of ICUC trauma score and quick DASH in a distal radius fracture cohort

BACKGROUND

This study evaluates the association between ICUC trauma and short-form Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick DASH) scores among patients who underwent surgery for distal radius fractures.

METHODS

This research gathered patient-reported outcomes (PROs) from patients registered in the ICUC database at a single trauma center. The study involved 76 adult patients who underwent surgical treatment for distal radius fractures before 2023. These patients received a volar locking plate for their distal radius fracture. The research utilized two different PROs to evaluate the patients' conditions. The ICUC trauma score measures functional impairment and pain through two 5-point scale questions, allowing patients to self-assess these aspects. The Quick DASH, comprising 11 questions, was used to evaluate symptoms and functionality of the upper extremity.

RESULTS

For patients aged 55.9 ± 15.3 years and 4.6 ± 3.9 years post-op follow-up, the ICUC trauma score was 0.70 ± 0.95, and Quick DASH was 6.07 ± 10.35. A strong correlation between ICUC and Quick DASH was identified (r = 0.71, P < 0.01). The interaction between the ICUC trauma score and age at the surgery to Quick DASH revealed a significant unstandardized partial regression coefficient of 0.19 (95% confidence interval 0.08-0.31; P < 0.01).

CONCLUSION

This study demonstrated a strong correlation between the ICUC trauma score and the Quick DASH among patients, especially the elderly. It was noted that an elevation in the ICUC trauma score is linked to a more marked increase in the Quick DASH score, particularly in older patients. Given its simplicity and efficacy, the ICUC trauma score may be a viable alternative to the Quick DASH for assessing the patient's clinical outcomes.

Adjuvant Arthroscopy Does Not Improve the Functional Outcome of Volar Locking Plate for Distal Radius Fractures: A Randomized Clinical Trial

PURPOSE

To evaluate the outcomes of adding arthroscopy to osteosynthesis of distal radius fractures (DRF) with volar locking plate (VLP), by Patient-Rated Wrist Evaluation (PRWE) 1 year after surgery.

METHODS

In total, 186 functionally independent adult patients who met the inclusion criteria (DRF and a clinical decision for surgery with a VLP) were randomized to arthroscopic assistance or not. Primary outcome was PRWE questionnaire results 1 year after surgery. For the main variable, PRWE, we obtained the minimal clinically important difference based on a distribution-based method. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand and 12-Item Short Form Health Survey questionnaires, range of motion, strength, radiographic measures, and presence of joint step-offs by computed tomography. Data were collected preoperatively and at +1 and +4 weeks, +3 and +6 months, and +1 year after surgery. Complications were recorded throughout the study.

RESULTS

In total, 180 patients (mean age: 59.0 ± 14.9 years; 76% women) were analyzed by modified intention to treat. A total of 82% of the fractures were intra-articular (AO type C). No significant difference between arthroscopic (AG) and control (CG) groups in median PRWE was found at +1 year (median AG: 5.0, median CG: 7.5, difference in medians 2.5; 95% confidence interval [CI] -2.0, 7.0, P = .328). The proportion of patients who exceeded the minimal clinically important difference of 12.81 points in the AG and CG was 86.4% vs 85.1%, P = .819, respectively. Percentage of associated injuries and step-offs reduction maneuvers was greater with arthroscopy (mean differences: 17.1 95% CI -0.1, 26.1, P < .001) and 17.4 (95% CI 5.0, 29.7, P = .007). The difference in percentage of residual joint step-offs at the postsurgical computed tomography in radioulnar, radioscaphoid, and radiolunate joints was not significant (P = .990, P = .538, and P = .063). Complications were similar between groups (16.9% vs 20.9%, P = .842).

CONCLUSIONS

Adjuvant arthroscopy did not significantly improve PRWE score +1 year after surgery for DRF with VLP, although the statistical power of the study is below the initially estimated to detect the expected difference.

LEVEL OF EVIDENCE

Level I, randomized controlled trial.

How to Deal With an Unreconstructable Distal Radius Fracture

The most prevalent long bone fracture is that of the distal radius, and it affects all age groups. These fractures can present after low-energy or high-energy trauma, and their configuration often varies depending on the mechanism of injury. Their management can be operative or non-operative, and the scientific literature is abundant in studies comparing these two treatment modalities. There is also a healthy scientific debate as to the indications that should guide surgery for these injuries. A male patient sustained a high-energy fracture to his distal radius and presented to our unit soon after the injury. His fracture presented significant surgical challenges due to its complexity. It was stabilised surgically, and the patient recovered good function after rehabilitation. This case aims to demonstrate a surgical treatment protocol and the relevant surgical considerations when dealing with significant injuries, such as the one presented in this paper, where traditional fixation techniques may not yield a satisfactory outcome.

Comparison of patient preferences and responsiveness among common patient-reported outcome measures for hand/wrist injuries or disorders

BACKGROUND

Patient-reported outcome measures (PROMs) were developed to examine patients' perceptions of functional health. Most studies compare the responsiveness of each type of questionnaire. However, reports of patient preferences among PROMs commonly used with patients with hand/wrist injuries or disorders are limited. This study aimed to compare patient preferences, factors associated with those preferences and responsiveness among the Disability of the Arm, Shoulder, and Hand (DASH), Michigan Hand Outcomes Questionnaire (MHQ), Patient-Rated Wrist/Hand Evaluation (PRWHE) and EQ-5D in patients with hand/wrist injuries or disorders.

MATERIAL AND METHODS

This retrospective cohort study collected data on 183 patients with hand/wrist injuries or diseases who had visited a hand/wrist outpatient clinic or were hospitalized for surgery between 2017 and 2020. Patients had to be at least 18 years old and able to complete the four questionnaires included in the study. The four PROMs (DASH, MHQ, PRWHE and EQ-5D) were administered to the patients prior to treatment. After completing the questionnaires, patients were asked to answer two open-ended questions regarding their preferences. Multinomial logistic regression was used to identify factors related to patient preferences. Results are presented as the relative risk ratio (RRR). The standardized response mean (SRM) was used to evaluate questionnaire responsiveness.

RESULTS

Of the 183 patients, most preferred the PRWHE questionnaire (n = 74, 41%), with the main reasons cited being "specific to injuries/diseases and reflects hand/wrist function (n = 23, 31%)" and "easy to complete (n = 22, 30%)." Sex was found to be associated with patient preference after adjusting for demographic data and reasons for choosing a PROM as confounders (RRR = 0.46, P value = 0.049). The PRWHE had the highest SRM, followed by DASH (0.92 and 0.88, respectively).

CONCLUSIONS

The PRWHE is the most preferred by patients and is the most responsive questionnaire. It is recommended for use in clinical practice in situations where a clinician would like to use only one PROM for evaluating patients with various types of hand/wrist problems.

LEVEL OF EVIDENCE

Prognostic III.

Do Surgeons Accurately Predict Level of Activity in Patients With Distal Radius Fractures?

PURPOSE

One factor influencing the management of distal radius fractures is the functional status of the patient. The purpose of this study was to assess the agreement between patient and surgeon assessments of patient activity level in patients sustaining a distal radius fracture.

METHODS

Ninety-seven patients were included, with a mean age of 58.5 years (range, 18-92 years). Patients completed the International Physical Activity Questionnaire, a validated survey that provides a score of low, moderate, or high activity levels. Treating surgeons provided an independent assessment using the same scale. Agreement between patient and surgeon assessments was evaluated using a weighted kappa-statistic, with a secondary analysis using logistic regression models to assess odds of surgical treatment.

RESULTS

Interrater agreement between surgeons and patients demonstrated only "fair" agreement, with a kappa-statistic of 0.33. Predictive models showed that surgeons accurately identified 73% of "high activity" patients but failed to correctly identify more than 41% of patients rated as "moderate activity" or "low activity." There was a correlation between surgical intervention and increasing physical activity status as assessed by the surgeon; however, the magnitude of this effect was unclear (odds ratio, 2.14; 95% confidence interval, 1.07-4.30). This relationship was no longer significant after adjusting for age, Charlson comorbidity index, and fracture class. There was no association between surgical intervention and physical activity status when using the status provided by the patient.

CONCLUSIONS

Surgeon assessment of patient activity level does not have strong agreement with patients' independent assessment. Surgeons are most accurate at identifying "high activity level" patients but lack the ability to identify "moderate activity level" or "low activity level" patients.

CLINICAL RELEVANCE

Recognition of surgeon assessment of patient activity level as flawed can stimulate improved dialog between patients and physicians, ultimately improving the shared decision-making process.

Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial

BACKGROUND

This study aimed to compare functional outcomes of a volar plate osteosynthesis for distal radius fractures (DRF) performed with either a standard volar approach (SVA), which required detachment of the pronator quadratus muscle, or a pronator-sparing approach (PqSA).

MATERIALS AND METHODS

This prospective randomized controlled study included 106 patients scheduled for volar plate osteosyntheses. Patients were allocated to either the SVA group (n = 53) or the PqSA group (n = 53). Patients were blinded to treatment until completion of the study. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcome parameters were the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Modified Mayo Wrist Score (MMWS). Follow-up examinations were performed at 8 weeks and 3, 6, and 12 months postoperatively.

RESULTS

Overall, 91 patients were included in the final analysis: 48 in the SVA group and 43 in the PqSA group. The two cohorts were not significantly different in demographic characteristics, including age, sex, injuries on the dominant side, type of injury, and fracture classification. We found significant differences between groups at 6 months in the mean PRWE (SVA: 12.3 ± 10.4, PqSA: 18.9 ± 14.11 points) and in the mean DASH score (SVA: 12.3 ± 11.9, PqSA: 19.3 ± 16.7 points), which favoured the SVA. We found no significant differences between groups in the MMWS or in the PRWE and DASH scores at any other time points.

CONCLUSIONS

This randomized comparative clinical trial failed to demonstrate that a volar plate osteosynthesis performed with a PqSA could improve the outcome, compared to the SVA, in patients with DRF.

LEVEL OF EVIDENCE

II Trial registration Comparison of Two Volar Plating Systems for Distal Radius Fractures, ClinicalTrials.gov (NCT03474445), registered 22 March 2018, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03474445?cond=radius&cntry=AT&draw=2&rank=1.

Can we safely place the distal volar locking plate screws into the subchondral zone of a distal radius fracture using a 45° supination oblique view under fluoroscopic guidance?

INTRODUCTION

Careful distal locking screw insertion into the subchondral zone is necessary to obtain proper mechanical strength of unstable distal radius fractures using volar locking plating. However, subchondral zone screw insertion increases the risk of intra-articular screw penetration, which may remain unrecognized during surgery due to complex distal radial anatomy. The purpose of this study was to evaluate the role of fluoroscopic guidance with a 45° supination oblique view technique for placing distal screws into the subchondral zone during volar locking plating for unstable distal radius fractures and to explore the factors associated with poor screw placement.

METHODS

We retrospectively analyzed 171 wrists of 169 patients treated with variable-angle volar locking plates for unstable radius fractures. The subchondral zone was defined as the metaphyseal area within 4 mm of the articular margin of the distal radius. The location of the distal locking screws and radiographic parameters, including the teardrop angle, were measured using computed tomography scans and X-rays. Clinical and radiographic factors were examined to determine their possible associations with screw placement failure.

RESULTS

Of 581 distal screws inserted, 559 screws (96.2%) were inserted into the subchondral zone and 17 screws into the metaphyseal zone (2.9%). Five screws (0.7%) in three wrists showed intra-articular placement: four screws were placed into the lunate fossa and one into the scaphoid fossa. These three wrists also exhibited significantly reduced teardrop angles. The distal screws were significantly closer to the joint line in the lunate fossa than the scaphoid fossa (1.9 ± 0.9 mm vs. 2.8 ± 1 mm, P < 0.000).

CONCLUSION

The 45° supination oblique view technique is a useful fluoroscopic guiding technique for accurate and safe distal screw placement in the subchondral zone in volar locking plate fixation for distal radial fractures. However, a decreased teardrop angle or extended lunate fossa should be corrected before distal screw insertion to avoid intra-articular screw placement.

Application of Nursing Intervention Based on Nel Noddings Care Theory for School-Aged Asthmatic Children

Objectives: The objective of this study was to examine the effect of nursing intervention based on Nel Noddings care theory on self-management behavior and symptomatic improvement in school-age asthmatic children in China. Methods: In this study, a sample of 100 school-aged children suffering from asthma was chosen, and divided into two groups: observation group and control group. Both groups received routine nursing but the observation group was combined with nursing intervention based on Nel Noddings theory.Results:The total scores of social psychologies, daily life, disease medicine and self-management in the observation group before intervention were similar to those in the control group. The self-management scores of the observation group after intervention were higher than those of the control group. The improvement time of wheezing and cough in the observation group was shorter than that in the control group. The total number of complete compliance and partial compliance in the observation group was higher than that in the control group. Conclusion: The application of nursing intervention based on Nel Noddings care theory to the nursing of school-age asthmatic children can improve the self-management ability of children, promote the recovery of cough, wheezing and other symptoms, and is of great significance to improve the compliance and nursing effect of children, with high popularization and application value.

A Systematic Review of Satisfaction Measures in Hand and Wrist Surgery

PURPOSE

Patient-reported experience measures (quantifying satisfaction, trust, perceived clinician empathy, and communication effectiveness) may not be developed with the same rigor as patient-reported outcome measures (quantifying comfort and capability). We systematically reviewed the use of measures used to evaluate satisfaction with hand surgery by comparing recent (2017-2019) and remote (2000-2002) publications to assess the use of satisfaction measures and areas for potential improvement.

METHODS

An initial search yielded 6,159 studies, 278 of which met the eligibility criteria. We compared the 2 time periods and recorded the method of satisfaction assessment (dichotomous, categorical, and ordinal) and the results. Because they are measures of research usage potentially representative of rigor in instrument development, we evaluated aspects of score distribution, including discernment (the threshold set at >80% of top scores) and skewness, as well as the differentiation between the satisfaction with outcome and experience.

RESULTS

Dichotomous ratings of satisfaction were the most common (171 [62%] of 278 studies), followed by categorical (83 [30%] of 278 studies) and ordinal ( 66 [24%] of 278 studies). All 3 score types had limited discernment (86% dichotomous, 77% categorical, and 64% ordinal ratings) and non-Gaussian distributions (negative skew near 1 or greater), with no differences between the remote and recent time periods. Ninety-seven percent of studies made no distinction between satisfaction with outcome and experience.

CONCLUSIONS

Measurements of satisfaction with hand surgery have remained unchanged over the last 20 years. They are associated with nonnormal distributions, a notable proportion of top scores, and routine failure to distinguish between experience and outcomes of care.

CLINICAL RELEVANCE

Patient-reported experience measures developed with the rigor comparable to the development of patient-reported outcome measures have the potential for either of the following: (1) specificity, variation, and responsiveness sufficient to guide experience improvement efforts or (2) verification of notable ceiling effects that may limit their use.

Clinical and functional analysis of closed reduction-plastering and volar locking plate methods in distal radius fractures in patients over 60 years of age

Aim: Many different methods have been described in the treatment of distal radius fractures (DRF) in the elderly population, and which one is the better method is a matter of debate among orthopedic surgeons. The aim of this study was to compare the results of closed reduction and plastering (CRP) and volar locking plate (VLP), which are used in the treatment of DRF in the elderly population. Materials and Methods: Between January 2019 and December 2020, 36 patients with DRF aged > 60 years were evaluated retrospectively. There were 19 patients in the CRP group and 17 patients in the VLP group. Wrist flexion, extension, pronation, supination, ulnar deviation, and radial deviation degrees and grip strength were measured in the first year of their treatment. The patients were evaluated functionally by patient-rated wrist evaluation (PRWE), modified Green and O'Brien score (MGOS), and resting and stress visual analogue scale (VAS). Results: In both groups, similar ROM values were obtained and no significant difference was observed. While the PRWE score was 17.5 ± 5.5 in the CRP group and 12.5 ± 4.8 in the VLP group, the MGOS score was 83.0 ± 7.4 in the CRP group and 86.8 ± 12.6 in the VLP group, and the scores were not significantly different (p = 0.802, p = 0.315). While there was almost no pain in both groups at rest, more pain was felt in the VKP group under stress. While grip strength was 20.9 ± 6.4 kg in the CRP group, it was 22.2 ± 6.8 kg in the VLP group, and there was no significant difference compared to the contralateral wrist. Conclusion: There is no clinical and functional difference between CRP and VLP in the one-year period after DRF treatment in the patient population aged > 60 years. Treatment should be planned according to the functional capacity of the patient.

Outcome Metrics in the Treatment of Distal Radius Fractures in Patients Aged Above 50 Years: A Systematic Review

BACKGROUND

The inclusion of patient-reported outcome measures (PROMs) serves to better quantify aspects of patient outcomes missed with objective measures, including radiographic indices and physical examination findings. We hypothesize that PROMs are inconsistently and heterogeneously captured in the treatment of distal radius fractures.

METHODS

We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of all level I and II randomized controlled trials (RCTs) of distal radius fracture treatment of any modality for those older than 50 years of age from January 2008 to January 2018. A total of 23 studies were included in the final analysis. The metrics used by each study to assess outcomes were collected, compared, and described.

RESULTS

Physical examination findings and radiographic measures were reported in 70% and 74% of studies, respectively. Patient-reported outcomes measures were used to assess outcomes in 74% of studies. Only the Disabilities of the Arm, Shoulder, and Hand was used in greater than half of the studies (57%). Pain scores were assessed in 39% of studies and complications in only 26%.

CONCLUSIONS

There is substantial heterogeneity and lack of standardization in the collection of both objective outcome measures and PROMs in level I and II RCTs for the treatment of distal radius fractures. The ability to compare between studies or aggregate data among studies is therefore limited. Radiographic and physical examination findings remain frequently reported despite known limitations of these metrics. The routine collection of PROMs after the treatment of distal radius fractures can ensure care is directed toward improving what is most important to patients.

Cast-OFF Trial: One Versus 4 to 5 Weeks of Plaster Cast Immobilization for Nonreduced Distal Radius Fractures: A Randomized Clinical Feasibility Trial

BACKGROUND

Distal radius fracture is a common fracture of which the incidence appears to be increasing worldwide. This pilot study investigated whether 1 week of plaster cast is feasible for nonreduced (stable fractures including nondisplaced and displaced fractures) distal radius fractures.

METHODS

The study was a multicenter randomized clinical feasibility trial including patients from regional acute care providers. Patients with a nonreduced distal radius fracture were included in the study. Nonreduced fractures meant intra-articular or extra-articular fractures and including nondisplaced and minimal displaced fractures (dorsal angulation less than 5°-10°, maximum radial shortening of 2 mm, and maximum radial shift of 2 mm) not needing a reduction. Forty Patients were included and randomized. After 1 week of plaster cast, patients were randomized to 1 of the 2 treatment groups: plaster cast removed (intervention group) versus 4 to 5 weeks of plaster cast (control group).

RESULTS

The analysis shows no significant differences between the 2 groups in having less pain, better function after 6 weeks, and better overall patient satisfaction. No difference was shown in secondary displacement between the 2 groups (control 1 vs intervention 0).

CONCLUSION

One week of plaster cast treatment for nonreduced distal radius fracture is feasible, preferred by patients, with at least the same functional outcome and pain scores.

LEVEL OF EVIDENCE

According to the Oxford 2011 level of evidence, the level of evidence of this study is 2.

Cross-cultural adaptation of the Taiwan Chinese version of the Falls Efficacy Scale-International for community-dwelling elderly individuals

Background

The Falls Efficacy Scale-International (FES-I) is a commonly used questionnaire to evaluate concerns about falling. We adapted a Taiwan Chinese version (FES-ITC) and evaluated its reliability and validity in community-dwelling elderly individuals. The discriminative validity was tested in relation to several known risk factors for fear of falling (FOF).

Methods

The questionnaire was adapted through translation, back-translation, and expert review processes. A convenience sample of 135 community-dwelling elderly individuals (at least 60 years old) completed the adapted questionnaire, and 31 of them had a retest within 7–10 days. Cronbach’s α and an intraclass correlation coefficient (ICC) were used to evaluate the internal consistency and test–retest reliability. Principal component factor analysis was performed to assess the factor-construct validity. The discriminative validity was tested in relation to demographic features, fall-related history and performances on three functional tests: timed up and go, four-stage balance and 30-s chair stand tests. Effect sizes were computed. Correlation coefficients between physical functional performance and FES-ITC scores were computed. Receiver operating characteristic curves were used to determine the cutoff point for the score to differentiate high and low concern of falling.

Results

The FES-ITC questionnaire had high internal consistency (Cronbach’s α = 0.94) and excellent test–retest reliability (ICC = 0.94). Principal component factor analysis yielded a two-factor model, with several items requiring high demand on postural control loading on factor 2. FES-ITC scores discriminated individuals with different ages, reporting FOF, reporting falls in the past year and using walking aids. However, FES-ITC scores did not differ between the participants who were at risk of falling and those who were not at risk based on functional test performance and there was no correlation found between them.

Conclusion

The FES-ITC was highly reliable and had adequate construct and discriminative validity. The lack of correlation between FES-ITC scores and functional test performance implied the presence of FOF even in individuals with good functional performance. Further follow up studies are warranted to verify the predictive validity of the FES-ITC.

Psychometric qualities of the patient rated Wrist/Hand evaluation (PRWHE) in dutch primary care patients with wrist complaints

Background

Knowledge on the course, disability and functionality of wrist complaints is still compendious in primary care guidelines, despite the high prevalence in primary care. Valid questionnaires can facilitate the monitoring of patients in primary care and research initiatives. In this study, we aimed to study the psychometric qualities of the Dutch version of the Patient Rated Wrist/Hand Evaluation (PRWHE-DLV) among adults with (sub)acute wrist complaints in primary care.

Methods

An observational cohort of 35 adults with (sub)acute wrist complaints in Dutch primary care was established. The content validity of the PRWHE-DLV was validated by assessing the floor and ceiling effects at baseline (T0). Reproducibility was assessed by the test-retest reliability between T0 and T1 (2–5 days after T0), using the Intra-class Correlation Coefficient. The construct validity was assessed based on the correlation between the PRWHE-DLV and the Quick-DASH, Physical Component Score (SF-12), VAS-function, Physical Functioning (SF-12), VAS-pain and Bodily Pain (SF-12) at T0. Responsiveness was defined as the ability of the PRWHE-DLV to measure change 3 weeks after T0 (internal) and the relation of these changes to clinically important outcomes (external).

Results

Psychometric qualities of the PRWHE-DLV demonstrated high content validity with no floor or ceiling effects, excellent reliability (Intra-class correlation coefficient = 0.90; 95% CI 0.80–0.95), high construct validity with the validated Quick-DASH and VAS score (r = 0.85 with Quick-DASH, r = 0.75 with VAS-function and r = 0.78 with VAS-pain) and high responsiveness.

Conclusion

The PRWHE-DLV provided reliable and adequate information for primary care clinical practice.

A systematic review and meta-analysis of Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE) measurement properties, translation, and/ or cross-cultural adaptation

PURPOSE

To critically appraise, summarize, and synthesize the evidence on the psychometric, translation and/or cross-cultural adaptation properties of the Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE).

MATERIALS AND METHODS

Four electronic databases were searched from 1998 to February 2021. Studies addressing psychometric, translation and/or cross-cultural adaptation properties were included. Two independent reviewers extracted data and assessed methodological quality of the studies using the COSMIN checklist. Where possible, meta-analysis was conducted to pool the estimates of each measurement property. Otherwise, qualitative synthesis was conducted. The overall quality of evidence on each measurement property was provided using GRADE principles.

RESULTS

Forty-four studies were eligible for data extraction. The PRWE/PRWHE has been translated into 21 languages. The best factor structure was a one-dimensional construct with three unidimensional subscales. High-quality evidence supports very good structural and cross-cultural validity, internal consistency, test-retest reliability, measurement error, and hypothesis testing for construct validity against DASH in wrist and hand injuries. However, low-quality evidence supports acceptable responsiveness property. The minimal clinically important difference for the PRWE/PRWHE was 24 points for patient-level comparisons and 17 for groups.

CONCLUSION

High-quality evidence supports the use of PRWE/PRWHE as a reliable, valid, and structurally sound questionnaire to assess pain and disability in patients with various wrist and hand injuries. Registration code: CRD42020180250IMPLICATION FOR REHABILITATIONSThe PRWE/PRWHE is a reliable and valid anatomical region-specific measure to assess pain and disability in patients with wrist and hand injuries.Each individual subscale of the PRWE/PRHWE (pain, specific activities, and usual activities) can be used separately as a measure of pain and disability.Change scores less than 9/100 in the total score, should be considered as measurement error, not ‎real change. Changes in the total score between 17 and 24/100 could be assumed as the minimal ‎clinically important change in the condition of patients over time. ‎The PRWE/PRWHE is available in 21 different languages and has been successfully adapted into highly diverse cultures. This point could be considered as one of the merits of using PRWE/PRWHE in clinical settings in multi-lingual and multi-cultural countries, when clinicians need a psychometrically sound ‎patient reported wrist/hand measure.‎.

Functional outcome and patient satisfaction with a ‘self-care’ protocol for minimally displaced distal radius fractures

Aims

We introduced a self-care pathway for minimally displaced distal radius fractures, which involved the patient being discharged from a Virtual Fracture Clinic (VFC) without a physical review and being provided with written instructions on how to remove their own cast or splint at home, plus advice on exercises and return to function.

Methods

All patients managed via this protocol between March and October 2020 were contacted by a medical secretary at a minimum of six months post-injury. The patients were asked to complete the Patient-Rated Wrist Evaluation (PRWE), a satisfaction questionnaire, advise if they had required surgery and/or contacted any health professional, and were also asked for any recommendations on how to improve the service. A review with a hand surgeon was organized if required, and a cost analysis was also conducted.

Results

Overall 71/101 patients completed the telephone consultation; no patients required surgery, and the mean and median PRWE scores were 23.9/100 (SD 24.9) and 17.0/100 (interquartile range (IQR) 0 to 40), respectively. Mean patient satisfaction with treatment was 34.3/40 (SD 9.2), and 65 patients (92%) were satisfied or highly satisfied. In total there were 16 contact calls, 12 requests for a consultant review, no formal complaints, and 15 minor adjustment suggestions to improve patient experience. A relationship was found between intra-articular injuries and lower patient satisfaction scores (p = 0.025), however no relationship was found between PRWE scores and the nature of the fracture. Also, no relationship was found between the type of immobilization and the functional outcome or patient satisfaction. Cost analysis of the self-care pathway V traditional pathway showed a cost savings of over £13,500 per year with the new self-care model compared to the traditional model.

Conclusion

Our study supports a VFC self-care pathway for patients with minimally displaced distal radius fractures. The pathway provides a good level of patient satisfaction and function. To improve the service, we will make minor amendments to our patient information sheet.

Cite this article: Bone Jt Open 2022;3(9):726–732.

Moulded cast compared with K-wire fixation after manipulation of an acute dorsally displaced distal radius fracture: the DRAFFT 2 RCT

BACKGROUND

Patients with a displaced fracture of the distal radius are frequently offered surgical fixation. Manipulation of the fracture and moulded plaster casting is an alternative treatment that avoids metal implants, but evidence of its effectiveness is lacking.

OBJECTIVE

To compare functional outcomes, quality-of-life outcomes, complications and resource use among patients with a dorsally displaced fracture of the distal radius treated with manipulation and surgical fixation with Kirschner wires (K-wires) and those treated with manipulation and moulded cast.

DESIGN

Pragmatic, superiority, multicentre, randomised controlled trial with a health economic evaluation.

SETTING

A total of 36 orthopaedic trauma centres in the UK NHS.

PARTICIPANTS

Patients (aged ≥ 16 years) treated for an acute dorsally displaced fracture of the distal radius were potentially eligible. Patients were excluded if their injury had occurred > 2 weeks previously, if the fracture was open, if it extended > 3 cm from the radiocarpal joint or if it required open reduction, or if the participant was unable to complete questionnaires.

INTERVENTIONS

Participants were randomly assigned in theatre (1 : 1) to receive a moulded cast (i.e. the cast group) or surgical fixation with K-wires (i.e. the K-wire group) after fracture manipulation.

MAIN OUTCOME MEASURES

The primary outcome measure was the Patient-Rated Wrist Evaluation score at 12 months, analysed on an intention-to-treat basis. Health-related quality of life was recorded using the EuroQol-5 Dimensions, five-level version, and resource use was recorded from a health and personal social care perspective.

RESULTS

Between January 2017 and March 2019, 500 participants (mean age 60 years, 83% women) were randomly allocated to receive a moulded cast (n = 255) or surgical fixation with K-wire (n = 245) following a manipulation of their fracture. A total of 395 (80%) participants were included in the primary analysis at 12 months. There was no difference in the Patient-Rated Wrist Evaluation score at 1 year post randomisation [cast group: n = 200, mean score 21.2 (standard deviation 23.1); K-wire group: n = 195, mean score 20.7 (standard deviation 22.3); adjusted mean difference -0.34 (95% confidence interval -4.33 to 3.66); p = 0.87]. A total of 33 (13%) participants in the cast group required surgical fixation for loss of fracture position in the first 6 weeks, compared with one participant in the K-wire group (odds ratio 0.02, 95% confidence interval 0.001 to 0.10). The base-case cost-effectiveness analysis showed that manipulation and surgical fixation with K-wires had a higher mean cost than manipulation and a moulded cast, despite similar mean effectiveness. The use of K-wires is unlikely to be cost-effective, and sensitivity analyses found this result to be robust.

LIMITATIONS

Because the interventions were identifiable, neither patients nor clinicians could be blind to their treatment.

CONCLUSIONS

Surgical fixation with K-wires was not found to be superior to moulded casting following manipulation of a dorsally displaced fracture of the distal radius, as measured by Patient-Rated Wrist Evaluation score. However, one in eight participants treated in a moulded cast required surgery for loss of fracture reduction in the first 6 weeks. After a successful closed reduction, clinicians may consider a moulded cast as a safe and cost-effective alternative to surgical fixation with K-wires.

FUTURE WORK

Further research should focus on optimal techniques for immobilisation and manipulation of this type of fracture, including optimal analgesia, and for rehabilitation of the patient after immobilisation.

TRIAL REGISTRATION

This trial is registered as ISRCTN11980540 and UKCRN Portfolio 208830.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 11. See the NIHR Journals Library website for further project information.

Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial

OBJECTIVE

To assess wrist function, quality of life, and complications in adult patients with a dorsally displaced fracture of the distal radius, treated with either a moulded cast or surgical fixation with K-wires.

DESIGN

Multicentre randomised clinical superiority trial, SETTING: 36 hospitals in the UK National Health Service (NHS).

PARTICIPANTS

500 adults aged 16 or over with a dorsally displaced fracture of the distal radius, randomised after manipulation of their fracture (255 to moulded cast; 245 to surgical fixation).

INTERVENTIONS

Manipulation and moulded cast was compared with manipulation and surgical fixation with K-wires plus cast. Details of the application of the cast and the insertion of the K-wires were at the discretion of the treating surgeon, according to their normal clinical practice.

MAIN OUTCOME MEASURES

The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) score at 12 months (five questions about pain and 10 about function and disability; overall score out of 100 (best score=0 and worst score=100)). Secondary outcomes were PRWE score at three and six months, quality of life, and complications, including the need for surgery due to loss of fracture position in the first six weeks.

RESULTS

The mean age of participants was 60 years and 417 (83%) were women; 395 (79%) completed follow-up. No statistically significant difference in the PRWE score was seen at 12 months (cast group (n=200), mean 21.2 (SD 23.1); K-wire group (n=195), mean 20.7 (22.3); adjusted mean difference -0.34 (95% confidence interval -4.33 to 3.66), P=0.87). No difference was seen at earlier time points. In the cast group, 33 (13%) of participants needed surgical fixation for loss of fracture position in the first six weeks compared with one revision surgery in the K-wire group (odds ratio 0.02, 95% confidence interval 0.001 to 0.10).

CONCLUSIONS

Among patients with a dorsally displaced distal radius fracture that needed manipulation, surgical fixation with K-wires did not improve patients' wrist function at 12 months compared with a cast.

TRIAL REGISTRATION

ISRCTN registry ISRCTN11980540.

Can Generic Outcome Questionnaires Replace QuickDASH in Monitoring Clinical Outcome Following Surgical Treatment of Distal Radius Fractures?

PURPOSE

In contrast to region-specific patient-reported outcome measures (PROMs), generic PROMs can be argued to have an added benefit of enabling cost-utility analyses and allowing for comparisons to be made across different conditions. The aim of this study was to assess the responsiveness and strength of the association between region-specific and generic PROMs in patients treated operatively for a displaced intra-articular distal radius fracture.

METHODS

Over a 4-year period, 166 patients aged 18-70 years with a displaced intra-articular fracture of the distal radius were treated with either a volar locking plate or external fixation augmented by K-wires and followed-up prospectively for 2 years. The main outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, but EuroQol-5D (EQ-5D) and 36-Item Short Form Survey (SF-36) were also employed. The associations between the QuickDASH score and EQ-5D and between the QuickDASH score and SF-36 were assessed using a linear mixed model.

RESULTS

There was a significant positive association between the QuickDASH score and EQ-5D and between the QuickDASH score and SF-36 throughout the follow-up period, although wide dispersion existed for the outcome measures at an individual level. However, the association between the QuickDASH score and SF-36 was significantly weaker at 6 weeks and 3 months than that at baseline, indicating that EQ-5D more closely mirrors changes in the QuickDASH score in the early postoperative period.

CONCLUSIONS

The study demonstrates that the QuickDASH score and EQ-5D correlate well on a group level, but large individual variations exist. The SF-36 had decreased sensitivity for the changes in the QuickDASH score at 6 weeks and 3 months.

CLINICAL RELEVANCE

Our findings indicate that generic PROMs cannot fully replace the region-specific QuickDASH score when evaluating the outcomes of distal radius fractures.

Measurement of value in rotator cuff repair: patient-level value analysis for the 1-year episode of care

BACKGROUND

Rotator cuff repair (RCR) is one of the most common elective orthopedic procedures, with predictable indications, techniques, and outcomes. As a result, this surgical procedure is an ideal choice for studying value. The purpose of this study was to perform patient-level value analysis (PLVA) within the setting of RCR over the 1-year episode of care.

METHODS

Included patients (N = 396) underwent RCR between 2009 and 2016 at a single outpatient orthopedic surgery center. The episode of care was defined as 1-year following surgery. The Western Ontario Rotator Cuff index was collected at both the initial preoperative baseline assessment and the 1-year postoperative mark. The total cost of care was determined using time-driven activity-based costing (TDABC). Both PLVA and provider-level value analysis were performed.

RESULTS

The average TDABC cost of care was derived at $5413.78 ± $727.41 (95% confidence interval, $5341.92-$5485.64). At the patient level, arthroscopic isolated supraspinatus tears yielded the highest value coefficient (0.82; analysis-of-variance F test, P = .01). There was a poor correlation between the change in the 1-year Western Ontario Rotator Cuff score and the TDABC cost of care (r² = 0.03). Provider-level value analysis demonstrated significant variation between the 8 providers evaluated (P < .01).

CONCLUSION

RCR is one of the most common orthopedic procedures, yet the correlations between cost of care and patient outcomes are unknown. PLVA quantifies the ratio of functional improvement to the TDABC-estimated cost of care at the patient level. This is the first study to apply PLVA over the first-year episode of care. With health care transitioning toward value-based delivery, PLVA offers a quantitative tool to measure the value of individual patient care delivery over the entire episode of care.

Arthroscopic Lunate Excision Provides Excellent Outcomes for Low-Demand Patients with Advanced Kienböck's Disease

Purpose

To examine the clinical outcomes of arthroscopic lunate excisions for advanced Kienböck's disease.

Methods

Fifteen patients (six men and nine women; mean age: 65 years; range: 48-83 years) with advanced Kienböck's disease, who underwent arthroscopic lunate resection between April 2008 and March 2016, were reviewed clinically and radiographically after a follow-up of >2 years (mean: 29 months; range: 24-60 months). Clinical parameters, such as wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and patient-rated wrist evaluation (PRWE) score were evaluated. Radiographic parameters included radioscaphoid angle, scaphocapitate angle, carpal height ratio, ulnar-triquetrum distance, and the scaphoid-triquetrum distance. Wilcoxon's signed-rank test was used to compare measurement results.

Results

During the final follow-up, patients exhibited significant improvements, such as 42.9° in wrist range of motion (P = .009), 24.5% of the contralateral side in grip strength (P = .001), 26.2 points in DASH score (P = .002), and 37.8 points in PRWE score (P < .001), compared with the preoperative values. The radioscaphoid and scaphocapitate angles significantly increased by 4.8° (P = .0027) and 3.7° (P = .0012), respectively. The carpal height ratio, ulnar-triquetrum distance, and scaphoid-triquetrum distance significantly decreased by 0.05 (P < .001), 2.6 mm (P < .001), and 1.3 mm (P = .0012), respectively.

Conclusions

Our results suggest that arthroscopic lunate excisions provided excellent postoperative pain relief and functional recovery within 2 years of follow-up. Changes in carpal alignment and stress concentration on the radial side of the carpal bones could occur in the long term; however, arthroscopic lunate excision can be a good surgical option for treating low-demand patients with advanced Kienböck's disease.

Level of Evidence

Level IV, therapeutic case series.

Evaluating FIML and multiple imputation in joint ordinal-continuous measurements models with missing data

Missing data is a common occurrence in confirmatory factor analysis (CFA). Much work had evaluated the performance of different techniques when all observed variables were either continuous or ordinal. However, few have investigated these techniques when observed variables are a mix of continuous and ordinal variables. This study investigated the performance of four approaches to handling missing data in these models: a joint ordinal-continuous full information maximum likelihood (FIML) approach and three multiple imputation approaches (fully conditional specification, fully conditional specification with latent variable formulation, and expectation-maximization with bootstrapping) combined with the weighted least squares with mean and variance adjustment (WLSMV) estimator. In a Monte-Carlo simulation, the FIML approach produced unbiased estimations of factor loadings and standard errors in almost all conditions. Fully conditional specification combined with WLSMV was second best, producing accurate estimates when the sample size was large. However, FIML encountered slight non-convergence issues when certain ordinal categories have extremely low frequencies, which is typical of skewed data. If the sample is large, fully conditional specification combined with weighted least squares is recommended when the FIML approach is not feasible (e.g., non-convergence, impractical computation durations, and variables that predict missingness are not of interest to the analysis).

Efficacy of wrist robot-aided orthopedic rehabilitation: a randomized controlled trial

Background

In recent years, many studies focused on the use of robotic devices for both the assessment and the neuro-motor reeducation of upper limb in subjects after stroke, spinal cord injuries or affected by neurological disorders. Contrarily, it is still hard to find examples of robot-aided assessment and rehabilitation after traumatic injuries in the orthopedic field. However, those benefits related to the use of robotic devices are expected also in orthopedic functional reeducation.

Methods

After a wrist injury occurred at their workplace, wrist functionality of twenty-three subjects was evaluated through a robot-based assessment and clinical measures (Patient Rated Wrist Evaluation, Jebsen-Taylor and Jamar Test), before and after a 3-week long rehabilitative treatment. Subjects were randomized in two groups: while the control group (n = 13) underwent a traditional rehabilitative protocol, the experimental group (n = 10) was treated replacing traditional exercises with robot-aided ones.

Results

Functionality, assessed through the function subscale of PRWE scale, improved in both groups (experimental p = 0.016; control p < 0.001) and was comparable between groups, both pre (U = 45.5, p = 0.355) and post (U = 47, p = 0.597) treatment. Additionally, even though groups’ performance during the robotic assessment was comparable before the treatment (U = 36, p = 0.077), after rehabilitation the experimental group presented better results than the control one (U = 26, p = 0.015).

Conclusions

This work can be considered a starting point for introducing the use of robotic devices in the orthopedic field. The robot-aided rehabilitative treatment was effective and comparable to the traditional one. Preserving efficacy and safety conditions, a systematic use of these devices could lead to decrease human therapists’ effort, increase repeatability and accuracy of assessments, and promote subject’s engagement and voluntary participation. Trial Registration ClinicalTrial.gov ID: NCT04739644. Registered on February 4, 2021—Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/study/NCT04739644.

A psychometric comparison of patient-reported outcome measures used in pediatric hand therapy

STUDY DESIGN

Retrospective case series.

INTRODUCTION

Patient-reported outcome measures are important for research and also for informing clinical practice. The Pediatric Outcomes Data Collection Instrument (PODCI) and the Canadian Occupational Performance Measure (COPM) are commonly used in pediatric hand therapy. Both are validated in research, but no data exist regarding their relative merits for clinical practice.

PURPOSE OF THE STUDY

This study compares the psychometric properties of the PODCI and COPM in children receiving hand therapy to examine their relative utility in clinical practice.

METHODS

We assessed the psychometric properties of the PODCI and COPM in 75 children receiving hand therapy. Treatment outcomes were assessed simultaneously with the PODCI (Upper Extremity Function and Pain and Comfort scales), COPM (Performance and Satisfaction scales) at baseline and posttreatment time points. Interim scores were included for a subset of patients. Each scale was assessed for responsiveness, ceiling effect, and concurrent and discriminate validity.

RESULTS

All scales, except PODCI/Pain from interim to completion, were able to detect changes over the course of therapy. However, both COPM scales demonstrated greater responsiveness and less severe ceiling effects than both PODCI scales at all time points. All scales had weak concurrent validity and limited discriminate validity.

CONCLUSIONS

The COPM is more responsive to changes during treatment and less hindered by a ceiling effect than the PODCI. Weak concurrent validity between the PODCI and COPM suggests that they measure different things in this population.

Improvement of disability in neurogenic thoracic outlet syndrome by robotic first rib resection

BACKGROUND

Robotic transthoracic first rib resection (R-FRR) has advantages over traditional approaches however its impact on post-operative nTOS outcomes is unknown. Our primary objective was to determine improvement of patient-reported outcome measures (PROMs) of pain and disability following R-FRR in neurogenic thoracic outlet syndrome (nTOS). Our secondary objective was to compare improvement of patient-reported pain between R-FRR and supraclavicular FRR (SC-FRR) in nTOS.

METHODS

We queried a prospectively-maintained, single surgeon, single institution database for nTOS patients undergoing R-FRR or SC-FRR with available pre-operative and post-operative PROMs. PROMs included the Disability of the Arm, Hand, and Shoulder (DASH) questionnaire and Visual Analog Scale (VAS) for pain.

RESULTS

Cohort 1 included 37 patients undergoing 40 R-FRRs and was comprised of 32 females, aged 36 years on average. Pre-operative VAS and DASH (6.0 and 64.2, respectively) improved significantly at the first (2.8 and 35.0, P<0.001 for both) and second post-operative visits (1.4 and 30.2, P<0.01 for both) which occurred at 2.6 and 15.3 weeks, respectively. Cohort 2 included 57 R-FRR performed in 53 patients, and 35 SC-FRRs performed in 34 patients. R-FRR and SC-FRR groups did not significantly differ in sex, age, hand dominance, TOS laterality, or pre-operative VAS. At first post-operative visit (2.4 weeks), R-FRR was associated with lower VAS scores (P=0.023) and greater VAS improvement than SC-FRR (53% and 27% decrease, respectively, P=0.008).

CONCLUSIONS

R-FRR results in significant improvement in disability and pain in nTOS and may have a greater impact on patient-reported pain than SC-FRR in the early postoperative period.

Cross-Cultural Adaptation and Validation of the Translated Patient-Rated Wrist Evaluation Score

Introduction  The purpose of this study is to perform a cross-cultural adaptation and validation of the translated Patient-Rated Wrist Evaluation (PRWE) score exclusively for pathologies of the wrist. Materials and Methods  A methodological study of cross-cultural validation of clinical scores was performed through a test-retest reliability analysis, internal consistency, response to change, and criterion validity assessment. Results  The test was applied to 57 patients with 139 surveys. Stability evaluated through Lin's concordance correlation coefficient was 0.98, with 95% confidence interval (CI) = 0.97-0.99; Cronbach's alpha was > 0.91; the difference in score was 24.26 (standard deviation: 26.59); the standardized response mean was 0.912; the effect size was 0.924; the Spearman's coefficient between the differences of PRWE and DASH-Disabilities of the Arm, Shoulder, and Hand-scores was r  = 0.899, with 95% CI = 0.811-0.947; Spearman's nonparametric correlation test between PRWE and DASH was 0.82, with 95% CI = 0.711-0.890. Conclusions  We successfully validated the Spanish translation of the PRWE scale. It showed valid and reliable interpretation of functional status and response to treatment after distal radius fracture, for Colombian population. Level of Evidence  This is a level II, methodological study for scale validation.

The Michigan Hand Outcomes Questionnaire (MHQ-Swe) in patients with distal radius fractures-cross-cultural adaptation to Swedish, validation and reliability

Background

The Michigan Hand Outcomes Questionnaire—MHQ—is a well-known self-assessment questionnaire, where patients’ own perception in terms of recovery, pain and the ability to return to activities of daily living is assessed. The purpose of the study was to translate and culturally adapt the Michigan Hand Outcomes Questionnaire to Swedish and to test the validity and reliability in patients with surgically treated distal radius fractures.

Methods

The cross-cultural adaptation and the translation process were conducted according to predefined guidelines. Seventy-eight patients with surgically treated distal radius fractures completed the translated version of the questionnaire on their six-week follow-up visit.

Results

The translation and cross-cultural adaptation process revealed no major linguistic or cultural issues. The internal consistency of the MHQ-Swe ranged from 0.77 to 0.94 at test 1 and from 0.81 to 0.96 at test 2 for all subscales, which indicates good internal consistency in the subscales. The hand function subscale revealed the lowest results and work performance the highest. The ICCs showed excellent test-retest reliability, ranging from 0.77 to 0.90 on all MHQ subscales and 0.92 on total score. The highest results for the ICC were seen in the satisfaction subscale (ICC = 0.90), while the lowest were seen in the aesthetic subscale (ICC = 0.77). The correlation analysis between the MHQ-Swe, PRWE and VAS showed a generally moderate to high correlation for all the subscales.

Conclusions

The Swedish version of the MHQ, the MHQ-Swe, showed good validity and reliability and it is therefore an appropriate and relevant questionnaire for use in patients with surgically treated distal radius fractures.

Trial registration

FoU i VGR, Projectnumber: 208491, registered December 9, 2015.

No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial

Purpose

For displaced distal radius fracture, this trial aimed to compare an above-elbow (AE) and below-elbow (BE) cast at the end of a 24-week follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a primary outcome.

Methods

This is a clinical trial with parallel groups (1:1) and a blinded evaluator. There are two non-surgical interventions: AE and BE. A total of 128 adult patients with acute (up to 7 days) displaced distal radius fracture of type A2-3, C1-3 by the AO classification were included. The follow-up was 24 weeks. The primary outcome was the DASH questionnaire at 24 weeks. Secondary outcomes were the maintenance of reduction by the evaluation of radiographic parameters, pain measured by VAS, PRWE, objective functional evaluation and rate of adverse effects.

Results

The difference between the two groups in the DASH score at 24 weeks was not significant, with the mean (95% CI) DASH score being AE: 9.44 (2.70 to 16.17) vs. BE: 9.88 (3.19 to 16.57) (p = 0.895). The above-elbow group had a significantly greater worsening of the mean DASH score from baseline to 2 weeks (p < 0.001). No statistically significant differences were found between the 2 groups in any of the other follow-up assessments. Objective functional evaluation, PRWE, radiographical measures and rates of reduction loss were similar between groups. Above-elbow casting resulted in more adverse effects (mostly shoulder pain; 19 events vs. 9 events); RR = 0.39 (0.19–0.94); p = 0.033 at the end of six-month follow-up.

Conclusions

This study did not demonstrate a difference between above-elbow and below-elbow cast in terms of DASH outcome at 6 months in non-surgical treatment of deviated distal radius fractures. However, below-elbow casting is less debilitating during the treatment period, has comparable performance in maintaining the reduction, and is related to fewer minor adverse effects than above-elbow casting.

Measurement Properties of Outcome Measures Used to Assess Physical Impairments in Patients After Distal Radius Fracture: A Systematic Review

OBJECTIVES

Individuals with distal radius fractures (DRF) may experience difficulty with gripping an object, painful wrist movements, sensorimotor difficulties, and swelling around the wrist and hand. A comprehensive review of the existing evidence concerning the measurement properties of common physical impairment measures can provide a valuable resource to guide hand therapy practice while managing DRF. The primary objective was to locate and assess the quality of literature on the measurement properties for the measures of physical impairment used in individuals with DRF.

METHODS

Two reviewers searched PubMed, CINAHL, and EMBASE. A combination of DRF, measurement properties, and physical impairments were used as keywords, and articles were independently assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments critical appraisal tool. Primary studies were included if they examined at least 1 of the following: reliability, validity, responsiveness, or indices of true and meaningful changes for measures of physical impairment in the DRF sample. A total of 19 articles were included in this review. The quality of the studies ranged from 46% to 92%. This review suggests that measures such as assessment of grip strength and supination and pronation range of motion (ROM), using various goniometric devices, showed good intrarater and interrater reliability, construct validity, and responsiveness in individuals with DRF.

CONCLUSION

Acceptable reliability and responsiveness were reported in grip and wrist ROM assessments for measuring changes in wrist and hand function after DRF; however, wrist ROM assessed using traditional goniometric techniques were less reliable in individuals with DRF.

IMPACT

This study provides insight into which objective tools might be better suited for measuring outcomes related to DRF.

Outcome Measurement for Distal Radius Fractures

Distal radius fractures (DRFs) are among the most common upper extremity injuries. Multiple medical conditions now are evaluated by standardized outcome sets that enable comparability. Recent international working groups have provided consensus statements for outcomes measurement after DRFs. These statements emphasized the growing importance of patient-reported outcome measures as well as traditional measures, including pain assessment, radiographic alignment, performance, and assessment of complications. A standardized instrument and timeline for measuring outcomes following DRFs offers clinicians, researchers, and health care economists a powerful tool. This article reviews the current evidence and provides recommendations for a DRF standardized outcome set.

Improving Efficiency of Patient-Reported Outcome Collection: Application of Computerized Adaptive Testing to DASH and QuickDASH Outcome Scores

PURPOSE

Patient-reported outcome measures assess health status and treatment outcomes in orthopedic care, but they may burden patients with lengthy questionnaires. Predictive models using machine learning, known as computerized adaptive testing (CAT), offer a potential solution. This study evaluates the ability of CAT to improve efficiency of the 30-item Disabilities of the Arm, Shoulder, and Hand (DASH) and 11-item QuickDASH questionnaires.

METHODS

A total of 2,860 DASH and 27,355 QuickDASH respondents were included in the analysis. The CAT system was retrospectively applied to each set of patient responses stored on the instrument to calculate a CAT-specific score for all DASH and QuickDASH entries. The accuracy of the CAT scores, viewed in the context of the minimal clinically important difference for both patient-reported outcome measures (DASH, 12; QuickDASH, 9), was determined through descriptive statistics, Pearson correlation coefficient, intraclass correlation coefficient, and distribution of scores and score differences.

RESULTS

The CAT model required an average of 15.3 questions to be answered for the DASH and 5.8 questions for the QuickDASH, representing a 49% and 47% decrease in question burden, respectively. Mean CAT score was the same for DASH and 0.1 points lower for QuickDASH with similar SDs (DASH, 12.9 ± 19.8 vs 12.9 ± 19.9; QuickDASH, 32.7 ± 24.7 vs 32.6 ± 24.6). Pearson coefficients (DASH, 0.99; QuickDASH, 0.98) and intraclass correlation coefficients (DASH, 1.0; QuickDASH, 0.98) indicated strong agreement between scores. The difference between the CAT and full score was less than the minimal clinically important difference in 99% of cases for DASH and approximately 95% of cases for QuickDASH.

CONCLUSIONS

The application of CAT to DASH and QuickDASH surveys demonstrated an ability to lessen the response burden with negligible effect on score integrity.

CLINICAL RELEVANCE

In the case of DASH and QuickDASH, CAT is an appropriate alternative to full questionnaire implementation for patient outcome score collection.

Cross‑cultural adaptation, construct validity, reliability, and responsiveness of the Thai version of the Patient-Rated Wrist/Hand Evaluation (Thai PRWHE)

PURPOSE

To translate the Patient-Rated Wrist/Hand Evaluation (PRWHE) which is widely used as the evaluation in healthcare and research system in wrist/hand disorder patients into Thai (Thai PRWHE) and to examine its psychometric properties.

METHODS

The PRWHE was translated to Thai, including cross-cultural adaptations, following standard guidelines. Psychometric properties were evaluated with 292 wrist/hand musculoskeletal disorder patients. Internal consistency was assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) was used to determine test-retest reliability over a 7-day interval. Construct validity was evaluated using two methods: Spearman's rank correlation of related and unrelated subscales and confirmatory factor analysis (CFA). Responsiveness was analyzed using the standardized response mean (SRM).

RESULTS

All subscales had high Cronbach's alpha (0.91-0.96). Evaluation of the Pain subscale found good correlations with the Thai PRWHE and the Thai version of disabilities of the arm, shoulder, and hand (Thai DASH) questionnaire (r = 0.55, P < 0.0001) in related dimensions. Unrelated dimensions, the Total Function subscale of the Thai PRWHE, and the Mobility subscale of the Thai EQ-5D-5L had a weak correlation (r = 0.09, P < 0.12). Comparison of the one-factor solution and the bifactor model found the first-order three-factor solution fitted the data better than other models. The test-retest reliability with 61 patients in each subscale revealed excellent reliability (ICC = 0.94-0.96). In the assessment of responsiveness, the SRM with 54 patients was large (0.94).

CONCLUSIONS

The Thai PRWHE has excellent internal consistency in all modules and good construct validity and reliability for Thai patients and provides a large standardized response mean after treatment.