The Patient-Rated Wrist Evaluation (PRWE) User Manual December
Contents
1. Hand n 36 Wrist n 24 SRM ES SRM ES SRM ES PRWHE 1 51 1 61 1 49 1 67 1 55 1 49 DASH 1 37 1 49 1 29 1 59 1 76 1 31 Esthetics 0 89 0 94 0 89 0 97 0 87 0 89 SRM Standardized Response Mean ES Effect Size Reference MacDermid et al 2004 14 Page 20 10 11 12 Bibliography of Published Studies Angst F John M Goldhahn J et al Comprehensive assessment of clinical outcome and quality of life after resection interposition arthroplasty of the thumb saddle joint Arthritis Rheum 2005 53 205 213 Brooks S Cicuttini FM Lim S et al Cost effectiveness of adding magnetic resonance imaging to the usual management of suspected scaphoid fractures Br J Sports Med 2005 39 75 79 De Smet L Robijns F Degreef I Outcome of proximal row carpectomy Scand J Plast Reconstr Surg Hand Surg 2006 40 302 306 Harness N Ring D Jupiter JB Volar Barton s fractures with concomitant dorsal fracture in older patients J Hand Surg Am 2004 29 439 445 Hildebrand KA Ross DC Patterson SD et al Dorsal perilunate dislocations and fracture dislocations questionnaire clinical and radiographic evaluation J Hand Surg Am 2000 25 1069 1079 Jupiter JB Ring D Weitzel PP Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years J Hand Surg Am 2002 27 714 723 Karnezis IA Fragkiadakis EG Association between objective clinical variables and patient rated disability2. important or beneficial Validity Content Validity the extent to which the instrument adequately covers the concepts of interest Construct Validity the extent to which the instrument corresponds to theoretical constructs Criterion Concurrent Validity the extent to which the instrument relates with a gold standard or more established measure Responsiveness or Longitudinal Validity Responsiveness The ability of the instrument to detect change Page 9 Table 1 Reliability of the PRWE in Published Studies Study Population Type PRWE Results Comparators MacDermid et 28 acute Colles 10M 18F Short Term 2 7 days Acute and Treated Colles SF 36 al 1998 15 Age 60 3 11 2 T R reliability Total ICCs gt 0 90 36 treated Colles 12M 24F Pain ICCs gt 0 90 Age 44 7 10 2 Function ICCs gt 0 85 35 one year Scaphoid 34M 1F Age 34 0 10 0 Long Term 1 year T R Scaphoid Group ICC 0 19 0 89 reliability Total ICC 0 91 Pain ICC 0 90 Function ICCs gt 0 61 Schmitt amp Di 211 patients 50 2 F n 20 DASH SF 12 PCS Fabio 2004 19 age 47 5 18 88 with T R reliability ICC 0 91 ICC 0 81 ICC 0 86 musculoskeletal disorders Mean follow up 3 months SEM 5 22 5 86 3 53 MDC 90 12 2 13 7 8 2 MID 24 0 17 1 7 3 Legend F female ICC intraclass correlation coefficient M male MDC minimum detectable change MID minimal important difference SEM standard error of measuremen
3. 0 50 0 44 0 14 0 44 ROM 0 67 Specific Function 0 44 Grip 0 94 Usual Function 0 36 Dexterity 0 19 Total 0 50 Total 0 81 0 6 months Pain 2 42 2 32 0 91 1 65 Page 14 Specific Function 7 01 Usual Function 2 29 Total 3 91 MacDermid et al 129 patients 32 M ES None 2003 13 Age 50 15 with 0 12 months Pain 2 28 distal radius fractures calculated Specific Function 4 37 manually Usual Function 2 47 Total 3 46 MacDermid et al 24 out of 60 total 0 3 months DASH 2004 14 wrist patients 8M SRM 1 55 1 76 16F Age 21 75 ES 1 49 1 31 Schmitt amp Di 211 patients 50 2 Baseline DASH SPADI SF 12 PCS Fabio 2004 19 F age 47 5 18 88 r with GDR r 0 56 n 63 r 0 71 n 206 r 0 69 n 138 with musculoskeletal disorders 3 month rs with GDR r 0 61 n 40 r 0 67 n 143 r 0 64 n 95 ES 1 87 1 67 1 51 SRM 1 94 1 76 1 22 Guyatt s Index 1 16 1 16 0 95 Reliable change 0 75 0 70 0 48 proportion MID proportion 0 55 0 50 0 55 Schmitt amp Di 211 patients 50 2 PRWE Change n 40 DASH Change SF 12 PCS Change SPADI Change Fabio 2005 18 F age 47 5 18 88 n 139 n 139 n 91 with musculoskeletal r with r 0 61 r 0 67 r 0 54 r 0 63 disorders 155 prospective completed 3 month change change follow ups 54 8 F scores on GDR age 49 6 18 88 r with r 0 62 r 0 66 r 0 57 r 0 62 retrospective change Legend
4. 012 3 6 7 8 9 10 Never Always Please turn the page Pain score 1 2 7 9 5 24 50 Page 6 2 FUNCTION A SPECIFIC ACTIVITIES Rate the amount of difficulty you experienced performing each of the items listed below over the past week by circling the number that describes your difficulty on a scale of 0 10 Azero 0 means you did not experience any difficulty and a ten 10 means it was so difficult you were unable to do it at all Sample scale gt 0123 45 67 8 9 10 No Difficulty Unable To Do Tum a door knob using my affected hand 0 1 20 5 6 7 8 9 10 Cut meat using a knife in my affected hand 01 2 3 6 7 8 9 10 Fasten buttons on my shirt 01 JOL 5678910 Use my affected hand to push up from a 012345 8 9 10 chair Carry a 10lb object in my affected hand 012 3 45 6 7 10 Use bathroom tissue with my affected hand 012 3 6 7 8 9 10 B USUAL ACTIVITIES Rate the amount of difficulty you experienced performing your usual activities in each of the areas listed below over the past week by circling the number that best describes your difficulty on a scale of 0 10 By usual activities we mean the activities you performed before you started having a problem with your wrist A zero 0 means that you did not experience any difficulty and a ten 10 means it was so difficult you were unable to do any of your usual activities Personal care activities dressing washing 0 3456789 10 Household work
5. 46 7 9 4 53 4 9 2 2 4 1 1 25 4 22 4 Angst et al 103 osteoarthritis 6 2 years German PRWE DASH Symptoms 79 5 19 3 2005 1 patients 18M 85F Pain 77 0 24 0 DASH Function 78 7 19 0 Age 67 7 38 5 90 6 Function 81 4 23 0 DASH Total 78 4 17 7 underwent resection Total 79 0 22 5 SF 36 PCS 43 3 10 8 interposition SF 36 MCS 53 4 9 9 arthroplasty of thumb HFI KFT 90 6 15 8 saddle joint Custom 64 2 8 5 Rad Abd Palmar Abd 86 2 14 7 51 3 23 5 Grip kg 20 0 8 6 Pinch kg 4 9 1 8 Brooks et al 28 patients with MRI group None 2005 2 suspected schapoid Pain 5 9 0 07 fractures randomized to Function 7 08 0 70 MRI group n 11 age 35 0 64 M or Control group control group n 17 Pain 6 5 0 56 age 29 0 35 M Function 8 03 0 56 Wright et al 32 patients with distal EF group EF group 19 EF group ORIF group 2005 21 radius fractures 47 months range 0 58 DASH 15 range 0 41 DASH 16 range 0 67 Page 18 11 external fixation Ext Flex 59 57 Ext Flex 63 64 EF patients 3M 8F ORIF ORIF group 20 Sup Pron 76 82 Sup Pron 80 78 Age 50 21 64 vs group 17 range 0 80 Rad UlInar Dev 21 36 Rad UlInar Dev 23 36 21 open reduction months Grip 99 affected X 100 grip Grip 75 affected X 100 grip internal fixation ORIF unaff unaff patients 11M 10F Age 50 1 19 74 De Smet et al 21 patient
6. Spearman s correlation coefficient Page 12 Abbreviations DASH Disabilities of the Arm Shoulder and Hand KFT HFI Hand Functional Index of the Keitel Function Test PASE Physical Activity Scale for Elderly PRWE Patient Rated Wrist Evaluation QOL Quality of Life ROM Range of Motion SF 36 BP SF 36 Bodily Pain subscale SF 36 MCS SF 36 Mental Component Summary Score SF 36 PCS SF 36 Physical Component Summary Score SF 36 PF SF 36 Physical Functional subscale Page 13 Table 3 Responsiveness to Change or Longitudinal Validity of the PRWE in Published Studies Study Population Type PRWE Results Comparators MacDermid et al 101 patients 31M ES None 1998 15 70F Age 50 16 0 6 months Total 3 06 with distal radius calculated fractures manually 35 patients 34M 1F Age 34 10 with scaphoid fractures MacDermid et al 59 patients 22M SRM DASH SF 36 subscales Impairment 2000 11 37F Age 53 18 0 3 months Pain 1 52 2 01 0 81 1 33 with distal radius Specific Function 2 47 fractures Usual Function 1 62 Total 2 27 3 6 months Pain 0 67 0 68 0 28 0 65 ROM 0 84 Specific Function 0 62 Grip 1 52 Usual Function 0 44 Dexterity 0 24 Total 0 74 Total 1 42 0 6 months Pain 1 95 2 52 1 07 1 29 Specific Function 3 62 Usual Function 2 24 Total 2 95 ES 0 3 months Pain 1 87 1 86 0 82 1 11 Specific Function 5 87 Usual Function 1 95 Total 3 16 3 6 months Pain
7. civic ccccansccca cee ocean eyes va tnaeyy deb decade y eave dw aanees p 15 Modified Version he PRWHE 5320 555s a e E eeatnnsoreapenieay EE AN p 20 Bibliography of Published Studies s cc1e eecvacwparsasgwiie eects etary Page 2 Introduction What is the Patient Rated Wrist Evaluation PRWE The PRWE is a 15 item questionnaire designed to measure wrist pain and disability in activities of daily living The PRWE allows patients to rate their levels of wrist pain and disability from 0 to 10 and consists of 2 subscales 1 PAIN subscale 0 no pain 10 worst ever gt Pain 5 items 2 FUNCTION subscale 0 no difficulty 10 unable to do gt Specific activities 6 items gt Usual activities 4 items In addition to the individual subscale scores a total score can be computed on a scale of 100 0 no disability where pain and function problems are weighted equally see How to Score the PRWE for detailed scoring instructions The PRWE provides clinicians with a standardized outcome tool that is easy to administer and score in the clinic and complements traditional impairment and radiographic measures The PRWE has been used to assess wrist related pain and disability in various populations see Table 4 for comparative data and its reliability Table 1 validity Table 2 and responsiveness Table 3 have been tested and reported in published studies Objectives of the PRWE 1 To determine level of wrist disabi
8. of the wrist J Bone Joint Surg Br 2002 84 967 970 Karnezis IA Panagiotopoulos E Tyllianakis M et al Correlation between radiological parameters and patient rated wrist dysfunction following fractures of the distal radius Injury 2005 Konrath GA Bahler S Open reduction and internal fixation of unstable distal radius fractures results using the trimed fixation system J Orthop Trauma 2002 16 578 585 MacDermid JC Donner A Richards RS et al Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture J Clin Epidemiol 2002 55 849 854 MacDermid JC Richards RS Donner A et al 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 J Hand Surg Am 2000 25A 330 340 MacDermid JC Richards RS Roth JH Distal radius fracture a prospective outcome study of 275 patients J Hand Ther 2001 14 154 169 Page 21 13 14 15 16 17 18 19 20 21 22 MacDermid JC Roth JH Richards RS Pain and disability reported in the year following a distal radius fracture A cohort study BMC Musculoskelet Disord 2003 4 24 MacDermid JC Tottenham V Responsiveness of the Disability of the Arm Shoulder and Hand DASH and Patient Rated Wrist Hand Evaluation PRWHE in evaluating change after hand therapy J Han
9. year ICC 0 91 The pain subscale also had excellent short term and long term reliability ICC 0 90 0 91 respectively The function subscale demonstrated excellent short term reliability ICC gt 0 88 and moderate long term disability ICC 0 61 Page 4 For the validity study patients with distal radius n 101 and scaphoid fractures n 35 completed the PRWE and the SF 36 and had their grip strength dexterity and range of motion tested at baseline two month three month and six month follow ups Improvements in the PRWE and SF 36 scores of distal radius group over time were evaluated to assess construct validity The PRWE had a statistically significant 74 improvement over 6 months whereas the SF 36 physical summary score had a statistically significant 16 improvement To determine the criterion validity Pearson correlations were conducted between the PRWE and the SF 36 subscales or impairment measurements Moderate correlations were found between the PRWE total and impairment measures r 0 52 0 61 for radius and scaphoid groups respectively The PRWE scores correlated higher with the SF 36 physical component summary scores r 0 46 to 0 63 than the SF 36 mental component summary scores r 0 30 to 0 41 Reference MacDermid et al 1998 15 Page 5 How to Score the PRWE To minimize nonresponse check forms once patients complete them Computing the Subscales Pain Score Sum of the 5 pain items
10. ES effect size F female M male r Spearman s correlation SRM standardized response mean Abbreviations DASH Disabilities of the Arm Shoulder and Hand GDR Global Disability Rating ROM Range of Motion Page 15 Table 4 Comparative Scores of the PRWE in Published Studies Study Population Mean PRWE Comparators Follow up Mean SD Mean SD MacDermid et 101 patients 31M 70F Impairment Score SF 36 PCS SF 36 MCS al 1998 15 Age 50 16 with Baseline R 74 18 R N A R 40 11 R 50 9 distal radius R fractures 2 months R 42 23 R N A R 43 9 R 48 9 35 patients 34M 1F Age 34 10 with 3 months R 26 20 R 62 13 R 46 10 R 51 8 scaphoid S fractures 6 months R 19 20 R 83 11 R 48 11 R 50 10 S 21 3 S 82 13 S 48 10 S 48 8 Hildebrand et 22 patients all M 37 months 27 19 DASH 16 13 al 2000 5 Age 32 16 60 with Mayo 66 17 periulnate dislocations SF 36 PCS 45 10 or fracture dislocations SF 36 MCS 55 8 underwent ORIF dorsal Flex Ext 57 opposite hand and volar approaches Radioulnar Dev 58 opposite hand Pron Sup 96 opposite hand Grip 73 opposite hand Ziran et al 10 patients 6M 4F 29 months Pain 11 Palmar Flex 60 2000 22 Age 62 38 84 with Disability 9 8 Dorsal Flex 48 residual displaced volar Sup Pron 79 66 fragments underwent transtendinous pinning of distal radius fractures MacDerm
11. RWE 1 09 95 CI 1 76 closed reduction score 0 42 MacDermid et 120 patients 30 M Construct None al 2002 10 Age 52 15 with distal radius r with wrist physical r 0 50 fractures impairment r with grip r 0 46 r with ROM r 0 41 r with dexterity r 0 31 Murphy et al 45 rheumatoid arthritis patients DASH 2003 17 treated either with arthroplasty r with age r 0 38 r 0 48 23F Age 51 1 or arthrodesis 6M 16F Age 51 8 Ability to discriminate No significant across treatments differences between DASH and PRWE Angst et al 103 osteoarthritis patients 18M Construct PRWE German DASH SF 36 SF 36 KFT HFI Custom 2005 1 85F Age 67 7 38 5 90 6 German PCS MCS underwent resection r with DASH r 82 r 0 68 r 0 04 r 0 44 r 0 57 interposition arthroplasty of thumb saddle joint r with SF 36 PCS r 53 rs 68 r 0 18 r 0 32 r 0 38 T with SF 36 MCS T 04 rs 04 r 0 18 r 0 15 r 0 14 T with KFT HFI T 35 rs 44 T 0 32 r 0 15 T 0 30 r with Custom r 56 rs 57 r 0 38 r 0 14 r 0 30 Factor 1 Physical QOL r 0 72 r 0 79 r 0 90 r 0 04 r 0 16 r 0 17 Karnezis et al 30 patients 19F 11M Construct None 2005 8 age 46 1 18 76 with distal radius fractures treated with T with degree of radial Pain 0 58 closed reduction and shortening Total 0 53 percutaneous fixation Mean follow up 12 months r with palmar angle Pain 0 40 Legend F female M male r Pearson correlation coefficient r
12. The Patient Rated Wrist Evaluation PRWE User Manual December 2007 Joy C MacDermid BScPT MSc PhD School of Rehabilitation Science McMaster University Hamilton Ontario Canada Clinical Research Lab Hand and Upper Limb Centre St Joseph s Health Centre London Ontario Canada E mail macderj mcmaster ca or jmacderm uwo ca Table of Contents Introduction What isthe PR WE seisnes nasen nn n a R E EE p 3 Objectiv sof the PRWE jc c2iccc eran sited eedee Gd a aN A eSa E a e SEERE Kees p 3 Instrument Development D sig ing the PR W Eieckescavesoiunerse ages eee e E A E EEE KESh p 4 Testing the PRW E cgavsdveceweidavacnes cen e e a a oe OEE E me xan p 4 How to Score the PRWE Computing the subscales 5 icciacs cr vescavnuysencsniaves ee ek vince tou eiwedenie ui eda ee venandes p 6 COMPULING ANE TOLALSCOTE cciuas ss pesdunedersaparsn ies sepenan aneii i DO Sallis COUN Oc 01 3ha gt s Seat or a ENE ges sae eases AiR Toes ea i p 6 eT PTE LatON Goes as sees Gel nade a EAA O de Guha RA vane vetnae nent sage AATA seers p 7 Common Questions 25 ei e Lavdse las cies evegy vas eoa dave sdeae dag bases cas sve TEETE IREE p 8 Instrument Properties and Outcome Studies Table 1 Reliability siise cdscvsscadvsiveeseciaersitasesadenie sake peaarersacnmonausar Pe 10 Mala les Vay exe Ate a ahaa ales ag ital hla a Lenin ia Roca AT p 11 Table S Responsiveness 0 0 gt ccwunas tsuneo Genes E E EAEE anes p 14 Table 4 Comparative Data
13. cleaning maintenance 012 4567 8 9 10 Work your job or usual everyday work 012 3 6 8 9 10 Recreational activities 0123 4 5 8 9 10 Function Score 3 4 3 7 8 4 1 3 4 7 2 22 50 Total Score 24 22 46 100 Interpretation gt The total PRWE score rates pain and disability equally gt Higher score indicates more pain and functional disability e g 0 no disability Page 7 Common Scoring 1 How are missing data treated If there is an item missing you can replace the item with the mean score of the subscale 2 What if patients leave the question blank because they cannot do it Make sure the patients understand that they should have answered 10 for the item and make corrections if necessary 3 What if patients rarely perform the task If patients are unsure about how to answer a task that is rarely performed encourage them to estimate their average difficulty Their estimate will be more accurate than leaving the question blank 4 What if patients do not do the task If patients never do the task they should leave the question blank Page 8 Instrument Properties and Outcome Studies Reliability Test Retest Reliability the stability of the instrument over time Standard Error of Measurement the confidence around the value of the score Minimum Detectable Change the smallest real difference in score Minimal Clinically Important Difference the smallest difference in score that is considered
14. d Ther 2004 17 18 23 MacDermid JC Turgeon T Richards RS et al Patient rating of wrist pain and disability a reliable and valid measurement tool J Orthop Trauma 1998 12 577 586 Moro JK Werier J MacDermid JC et al Arthroplasty with a metal radial head for unreconstructible fractures of the radial head J Bone Joint Surg Am 2001 83 A 1201 1211 Murphy DM Khoury JG Imbriglia JE et al Comparison of arthroplasty and arthrodesis for the rheumatoid wrist J Hand Surg Am 2003 28 570 576 Schmitt J Di Fabio RP The validity of prospective and retrospective global change criterion measures Arch Phys Med Rehabil 2005 86 2270 2276 Schmitt JS Di Fabio RP Reliable change and minimum important difference MID proportions facilitated group responsiveness comparisons using individual threshold criteria J Clin Epidemiol 2004 57 1008 1018 Vinnars B Adamsson L af Ekenstam F et al Patient rating of long term results of silicone implant arthroplasty of the scaphoid Scand J Plast Reconstr Surg Hand Surg 2002 36 39 45 Wright JG Gebhardt MC Multicenter clinical trials in orthopaedics time for musculoskeletal specialty societies to take action J Bone Joint Surg Am 2005 87 214 217 Ziran BH Scheel M Keith MW Pin reduction and fixation of volar fracture fragments of distal radius fractures via the flexor carpi radialis tendon J Trauma 2000 49 433 439 Page 22
15. id et 250 patients with distal DASH SF 36 SF 36 Ext Pron Ulnar Grip al 2001 12 radius fractures PCS MCS Flex Sup Rad kg Baseline 75 54 37 51 8 weeks 43 31 42 50 45 36 73 58 19 11 12 3 months 28 22 46 52 51 43 76 65 22 14 17 6 months 20 15 48 52 57 50 78 70 23 17 23 12 months 15 12 48 53 59 53 79 72 25 18 25 Moro et al 24 patients age 54 39 months Wrist DASH SF 36 PCS SF 36 MCS Mayo Elbow Page 16 2001 16 with radial head fractures treated with arthroplasty with metal radial head implant 17 21 Outcome Score 60 10 17 19 47 10 49 13 80 16 Jupiter et al 20 patients 6M 14F 38 months 14 range 0 73 PASE 177 range 50 343 2002 6 Age 68 60 81 with Ext Flex 90 75 opposite hand redisplaced distal radius Rad UlInar dev 75 95 opposite hand fractures treated with Pron Sup 95 95 opposite hand plate and screw fixation Grip 80 opposite hand Modified Garland amp Werley grade 7 excellent 11 good Konrath amp 25 patients 14M 11F 29 months 19 0 22 0 DASH 17 0 18 0 Bahler 2002 9 Age 53 29 89 with Wrist Palmerflex Dorsiflex 54 11 61 10 unstable distal radius Rad UlInar Dev 18 5 25 7 fractures treated with Forearm Sup Pron 82 13 77 12 fragment specific Grip 83 opposite hand fixation MacDermid et 120 patients 30 M Baseline 77 21 None al 2002 10 Age 52 15 with distal radius fractures 6 mon
16. lity 2 To set treatment goals 3 To determine whether change has occurred 4 To communicate in a meaningful way to payers Page 3 Instrument Development Designing the PRWE Active members of the International Wrist Investigators were surveyed by mail to help define the content and structure of the PRWE Physicians were interested in using outcome measures and the response rate was 66 n 100 Range of motion radiographs and grip strength were commonly used as objective measurements in clinical practice and pain ability to do work and daily activities were frequently used to make subjective evaluations of a patient s outcome There was no standardized patient rating scale that can quantify wrist pain and disability and general health surveys such as the SF 36 were too long and did not address issues regarding the wrist Using the survey information obtained from the clinicians a new instrument was developed that was designed to measure the status of the affected wrist simple brief and easy to score and measured the primary constructs of pain and disability of daily living separately Scale items were generated using information obtained from patient and expert interviews biomechanical literature and other questionnaires Items were reduced and refined through expert interviews and pilot testing on small groups of patients The pain subscale was designed to be sensitive to mild pain i e pain that only occurs with activity a
17. out of 50 Best Score 0 Worst Score 50 Function Score Sum of the 10 function items Divided by 2 out of 50 Best Score 0 Worst Score 50 Computing the Total Score Total Score Sum of pain function scores Best Score 0 Worst Score 100 Note responses to the fifteen items are totaled out of 100 where pain and disability are equally weighted Sample Scoring Name Date PATIENT RATED WRIST EVALUATION The questions below will help us understand how much difficulty you have had with your wist in the past week You will be describing your average wist symptoms over the past week on a scale of 0 10 Please provide an answer for ALL questions If you did not perform an activity please ESTIMATE the pain or difficulty you would expect If you have never performed the activity you may leave it blank 1 PAIN Rate the average amount of pain in your wrist over the past week by circling the number that best describes your pain on a scale from 0 10 A zero 0 means that you did not have any pain and a ten 10 means that you had the worst pain you have ever experienced or that you could not do the activity because of pain Sample scale gt 012345 6 7 8 9 10 No Pain Worst Ever RATE YOUR PAIN At rest G 23456789 00 When doing a task with a repeated wrist 0 45678910 movement When lifting a heavy object 012345 es 9 10 When itis at its worst 01234567 a s 10 How often do you have pain
18. s 16M 5F 67 months Total 30 range 0 83 DASH Grip Strength 2006 3 age 39 0 with Kienbock s disease underwent proximal row carpectomy 22 range 0 78 65 opposite hand Score transformed so higher value reflects better health Abbreviations DASH Disabilities of the Arm Shoulder and Hand Ext Extension F Female Flex Flexion GDR Global Disability Rating HFI KFT Hand Functional Index of the Keitel Function Test M Male ORIF Open Reduction Internal Fixation Palmar Abd Palmar Abduction PASE Physical Activity Scale for Elderly Pron Pronation PRWE Patient Rated Wrist Evaluation Rad Abd Radial Abduction Rad Dev Radial Deviation SF 36 MCS SF 36 Mental Component Summary Score SF 36 PCS SF 36 Physical Component Summary Score SPADI Shoulder Pain and Disability Index Sup Supination Ulnar Dev Ulnar Deviation Page 19 Modified Version The Patient Rated Wrist Hand Evaluation PRWHE The PRWE was modified to allow clinicians to assess hand conditions The PRWHE has the same items and scoring system as the PRWE The PRWHE is preferred in hand wrist clinics as it is more specific and easier to use Changes between the PRWE and PRWHE 1 In the PRWHE the term wrist is replaced with wrist hand 2 The PRWHE has an optional aesthetics question on the form not part of the scale scoring Responsiveness of the PRWHE Instrument All n 60
19. s well as more severe pain i e pain that occurs at rest The function items must be commonly performed with either hand performed by a majority of patients and easy to comprehend by most respondents The specific function items were comprised of activities involving wrist motion and strength that may be affected by various wrist pathologies The usual function items covered 4 domains self care work role home life and recreation and were designed to assess the patient specific role limitation Expert consensus and statistical analyses of pilot data were used to select the best items for the subscales To keep the instrument brief and easy to use in a clinic the questionnaire format was limited to five pain questions and ten function questions A 0 to 10 scale was selected because a numeric scale is more acceptable to patients easier and score and more responsive to change A total score out of 100 can be computed by equally weighting the pain score sum of five items and the disability score sum of ten items divided by 2 The reliability of the pain and disability subscales and total scores are sufficiently high that they can be used separately in certain applications Testing the PRWE A test retest reliability study was conducted on patients with distal radius n 64 or scaphoid n 35 fractures The total PRWE score s test retest reliability was excellent over both the short term 2 7 days ICC gt 0 90 and the long term 1
20. t T R reliability test retest reliability Page 10 Table 2 Validity of the PRWE in Published Studies Study Population Type PRWE Results Comparators MacDermid et 101 patients 31M 70F Construct Impairment SF 36 PCS SF 36 MCS al 1998 15 Age 50 16 with distal radius Improvement over time p lt 0 0001 p lt 0 0001 p lt 0 0001 NS R fractures 35 patients 34M 1F Age 34 Criterion 10 with scaphoid S fractures r R S with Impairment Pain r 0 45 0 56 score Function r 0 60 0 58 Total r 0 52 0 61 r R S with SF 36 PCS Pain r 0 59 0 59 Function r 0 58 0 46 Total r 0 63 0 57 r R S with SF 36 MCS Pain r 0 30 0 41 Function r 0 37 0 36 Total r 0 33 0 41 r R S with SF 36 BP Pain r 0 72 0 64 Function r 0 66 0 54 Total r 0 73 0 64 r R S with SF 36 PF Pain r 0 47 0 52 Function r 0 48 0 35 Total r 0 52 0 48 Jupiter et al 20 patients 6M 14F Age 68 Construct None 2002 6 60 81 with redisplaced distal r with age r 0 36 radius fractures treated with plate and screw fixation r with PASE r 0 37 r with physician based r 0 62 measures r with radiographic r 0 16 measures Karnezis et al 31 patients 12M 19F Construct None 2002 7 Age 46 1 18 77 with distal Grip strength as Regression coefficient Page 11 radius fractures treated by predictor of P
21. ths 19 18 Vinnars et al 21 scaphoid patients 10 24 years Median None 2002 20 underwent silicone Pain 27 range 26 implant arthroplasty Function 22 range 23 MacDermid et 129 patients 32 M Baseline Pain 33 0 10 8 None al 2003 13 Age 50 15 with Specific 54 0 10 8 distal radius fractures Usual 28 9 9 Total 75 0 17 8 2 months Pain 21 0 11 Specific 29 6 18 4 Usual 15 1 11 7 Total 43 3 23 0 3 months Pain 15 3 11 0 Specific 16 9 15 3 Usual 8 6 9 5 Total 28 21 3 6 months Pain 11 7 11 2 Specific 10 8 13 4 Usual 5 8 8 1 Page 17 Total 20 0 20 6 1 year Pain 8 4 10 0 Specific 6 8 11 Usual 3 5 6 Total 13 5 17 0 Harness et al 8 volar Barton s 48 months 16 range 0 35 Ext Flex 94 84 opposite hand 2004 4 fractures patients 2M Sup Pron 98 95 opposite hand 6F Age 67 58 76 Ulnar Rad Dev 90 90 opposite hand with a subtle fracture in Grip 79 opposite hand dorsal metaphyseal Modified Gartland amp Werley grade 1 excellent 6 good cortex treated with volar plates and screws Schmitt amp Di 211 patients 50 2 F n 44 DASH SF 12 PCS SF 12 MCS GDR SPADI Fabio 2004 age 47 5 18 88 with n 154 n 154 n 154 n 143 n 103 19 musculoskeletal Baseline 46 4 17 1 32 1 17 2 40 3 7 8 53 2 9 6 3 6 1 4 41 3 21 1 disorders 3 months 21 0 20 0 18 2 16 4
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