Ersetzt der Disability of Arm, Shoulder and Hand Questionnaire (DASH-Fragebogen) die Erfassung von Bewegungsausmaß und Kraft bei der Bewertung von Ergebnissen?

Validity and Responsiveness of Forearm Strength Measurements in the Evaluation of Distal Radioulnar Joint Implant Arthroplasty

PURPOSE

To assess the responsiveness of forearm strength tests and to correlate the change to grip strength and a patient-reported outcome measure used for evaluation of distal radioulnar joint (DRUJ) implant arthroplasty.

METHODS

We performed a retrospective review of 18 patients treated with Herbert (n = 12) and Scheker (n = 6) DRUJ implants. Patients who had undergone the various measurements of arm and grip strength both before surgery and after a minimum follow-up of 1 year were included. Our primary aim was to compare the responsiveness of grip strength with our new methods for measuring forearm torque and lifting strength. The secondary aim was to correlate observed changes in strength measurements to change in a patient-reported outcome measure with use of the patient-reported wrist evaluation (PRWE). Measurements of grip strength, forearm torque, and lifting strength were performed with the Jamar dynamometer and the Kern and Baseline instruments. Preoperative values were compared with 1-year values.

RESULTS

Standardized response mean and effect size values were higher for forearm torque than for grip strength. Change in forearm torque and lifting strength had a moderate to strong correlation with change in PRWE. The correlation between grip strength and PRWE was weak.

CONCLUSIONS

Forearm torque measurements were better than grip strength in detecting changes after DRUJ arthroplasty. It also had a stronger correlation to patient-reported outcome, measured with the PRWE.

CLINICAL RELEVANCE

Forearm torque testing may add further information to the evaluation of DRUJ disorders and their treatments. These tests can provide quantifiable data on the patient's ability to perform various tasks requiring physical strength.

Functional Outcomes After Salvage Procedures for Wrist Trauma and Arthritis (Four-Corner Fusion, Proximal Row Carpectomy, Total Wrist Arthroplasty, Total Wrist Fusion, Wrist Denervation): A Review of Literature

Background:

Several salvage procedures for the arthritically destroyed wrist exist. Each of these has advantages as well as disadvantages.

Aims:

The aim of this article is to give practical insights for the clinician on: (1) biomechanical and clinical fundamentals of normal and impaired wrist motion; (2) difficulties in assessment of postoperative outcome between measured motion by the surgeon and self-reported outcome by the patient; (3) indications for each procedure; and (4) differences in functional outcome between partial and complete motion-preserving as well as complete motion-restricting salvage procedures.

Methods:

In trend, Proximal Row Carpectomy (PRC) is slightly superior over four-corner fusion (4CF) in terms of functional outcome, but the methodology-related postoperative motion is decreased for both procedures. Furthermore, PRC is easier to perform, needs lower costs, and has fewer complications than 4CF. Total Wrist Arthroplasty (TWA) has the advantage compared to PRC and 4CF that the preoperative motion values are preserved, but it is limited by decreased load-bearing capacity for the wrist. Total Wrist Fusion (TWF) is associated with a higher load-bearing capacity for the wrist than TWA, but it is limited for carrying out essential activities of daily living. Both PRC and 4CF can be combined primarily by wrist denervation. Wrist denervation alone does not impair the movement of the wrist.

Results and Conclusion:

Salvage procedures for the arthritically destroyed wrist should be detected regarding patients age- and gender-related claims in work and leisure. Not all of them can be successfully re-employed in their original occupations associated with high load-bearing conditions.

The effects of pain, supination, and grip strength on patient-rated disability after operatively treated distal radius fractures

PURPOSE

The correlation between physician-observed parameters and patient-rated disability in distal radius fractures is complex and poorly understood. Anecdotal clinical experience suggests that supination is an important factor in the return of functional status after distal radius fracture. To explore this relationship, we conducted a retrospective multivariate linear regression analysis of an existing patient database to evaluate the hypothesis that range of motion and other objective parameters are important determinants of patient-rated disability.

METHODS

We analyzed a prospectively gathered registry of patients undergoing operative fixation of distal radius fractures using physical examination parameters measured at each follow-up visit and patient-based outcomes including Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and visual analog scale for pain. We constructed a multivariate linear regression model to evaluate the association of range of motion, grip strength, and visual analog scale score with the DASH score.

RESULTS

We analyzed data from 190 patients and 611 total clinic visits. Pain, grip strength, and supination were significantly correlated with DASH scores, controlling for all other factors. These 3 variables were able to predict 56% of the variability of the DASH score. Flexion-extension, radial-ulnar deviation, and pronation had no significant correlation to DASH score.

CONCLUSIONS

Pain, strength, and supination appear to be important determinants of patient-rated outcomes after distal radius fracture. Pain and strength continuously improve over time up to 2 years after surgery, whereas supination plateaus more quickly, usually within the first 3 to 6 months.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic II.

RELATIONSHIP OF IMPAIRMENT, DISABILITY AND WORKING STATUS AFTER RECONSTRUCTIVE SURGERY OF THE WRIST

The aim was to study the relationship between impairment (function) and disability (participation) in wrist surgery, according to the WHO definitions.

The outcome of 205 wrist operations were studied. The impairment was expressed as range of motion (ROM) and gripping force, the disability as the DASH score.

There was a significant correlation between DASH and gripping force (R = 0.47). The correlation between ROM and DASH was weaker (R = 0.24).

In manual workers, shorter temporary disability periods were significantly associated with lower DASH score.

In (reconstructive) wrist surgery, impairment, disability and working status are significantly correlated. Gripping force measurement is a reliable tool for evaluation and gives a good impression of the disability. Preservation of some mobility is important, however the amount of ROM is not essential for the disability.

Quantitative Adjustment of the Influence of Depression on the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire

Upper extremity specific disability as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire varies more than expected based upon variations in objective impairment influenced by depression. We tested the hypothesis that adjusting for depression can reduce the mean and variance of DASH scores. Five hundred and sixteen patients (352 men, 164 women) with an average of 58 years of age (range, 18-100) were asked to simultaneously complete the DASH and Center for Epidemiologic Studies Depression Scale (CES-D) scores at their initial visit to a hand surgeon. Pearson's correlations between each of the DASH items and the CES-D score were obtained. The DASH score was then adjusted for the influence of Depression for women and men using ordinary least-squares regression and subtracting the product of the regression coefficient and the CES-D score from the raw DASH score. The average DASH score was 24 points (SD, 19; range, 0-91), and the average CES-D score was 10 points (SD, 8; range, 0-42). Thirteen of the 30 items of the DASH demonstrated correlation greater than r = 0.20. Adjustment of these DASH items for the depression effect led to significant reductions in the mean (5.5 points; p < 0.01) and standard deviation (0.8 points; p < 0.01) of DASH scores. Adjustment for depression alone had a significant but perhaps clinically marginal effect on the variance of DASH scores. Additional research is merited to determine if DASH score adjustments for the most important subjective and psychosocial aspects of illness behavior can improve correlation between DASH scores and objective impairment.