PMID- 37399255
OWN - NLM
STAT- MEDLINE
DCOM- 20230817
LR  - 20230821
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 105
IP  - 16
DP  - 2023 Aug 16
TI  - QuickDASH and PRWE Are Not Optimal Patient-Reported Outcome Measures After Distal 
      Radial Fracture Due to Ceiling Effect: Potential Implications for Future 
      Research.
PG  - 1270-1279
LID - 10.2106/JBJS.22.01213 [doi]
AB  - BACKGROUND: The aim of this study was to determine the floor and ceiling effects 
      for both the QuickDASH (shortened version of the Disabilities of the Arm, 
      Shoulder and Hand [DASH] questionnaire) and the PRWE (Patient-Rated Wrist 
      Evaluation) following a distal radial fracture (DRF). Secondary aims were to 
      determine the degree to which patients with a floor or ceiling effect felt that 
      their wrist was "normal" according to the Normal Wrist Score (NWS) and if there 
      were patient factors associated with achieving a floor or ceiling effect. 
      METHODS: A retrospective cohort study of patients in whom a DRF was managed at 
      the study center during a single year was undertaken. Outcome measures included 
      the QuickDASH, PRWE, EuroQol-5 Dimensions-3 Levels (EQ-5D-3L), and NWS. RESULTS: 
      There were 526 patients with a mean age of 65 years (range, 20 to 95 years), and 
      421 (80%) were female. Most patients were managed nonsurgically (73%, n = 385). 
      The mean follow-up was 4.8 years (range, 4.3 to 5.5 years). A ceiling effect was 
      observed for both the QuickDASH (22.3% of patients with the best possible score) 
      and the PRWE (28.5%). When defined as a score that differed from the best 
      available score by less than the minimum clinically important difference (MCID) 
      for the scoring system, the ceiling effect increased to 62.8% for the QuickDASH 
      and 60% for the PRWE. Patients who had a ceiling score on the QuickDASH and the 
      PWRE had a median NWS of 96 and 98, respectively, and those who had a score 
      within 1 MCID of the ceiling score reported a median NWS of 91 and 92, 
      respectively. On logistic regression analysis, a dominant-hand injury and better 
      health-related quality of life were the factors associated with both QuickDASH 
      and PRWE ceiling scores (all p < 0.05). CONCLUSIONS: The QuickDASH and PRWE 
      demonstrate ceiling effects when used to assess the outcome of DRF management. 
      Some patients achieving ceiling scores did not consider their wrist to be 
      "normal." Future research on patient-reported outcome assessment tools for DRFs 
      should aim to limit the ceiling effect, especially for individuals or groups that 
      are more likely to achieve a ceiling score. LEVEL OF EVIDENCE: Prognostic Level 
      III . See Instructions for Authors for a complete description of levels of 
      evidence.
CI  - Copyright (c) 2023 The Authors. Published by The Journal of Bone and Joint Surgery, 
      Incorporated. All rights reserved.
FAU - Bell, Katrina R
AU  - Bell KR
AD  - Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, 
      United Kingdom.
FAU - Oliver, William M
AU  - Oliver WM
AD  - Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, 
      United Kingdom.
FAU - White, Timothy O
AU  - White TO
AD  - Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, 
      United Kingdom.
FAU - Molyneux, Samuel G
AU  - Molyneux SG
AD  - Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, 
      United Kingdom.
FAU - Clement, Nicholas D
AU  - Clement ND
AD  - Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, 
      United Kingdom.
FAU - Duckworth, Andrew D
AU  - Duckworth AD
AD  - Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Midlothian, 
      United Kingdom.
AD  - Centre for Population Health Sciences, Usher Institute, University of Edinburgh, 
      Edinburgh, United Kingdom.
LA  - eng
PT  - Journal Article
DEP - 20230703
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
SB  - IM
MH  - Humans
MH  - Female
MH  - Aged
MH  - Male
MH  - *Radius Fractures/surgery
MH  - Retrospective Studies
MH  - Quality of Life
MH  - Patient Reported Outcome Measures
MH  - Patient Outcome Assessment
MH  - *Wrist Fractures
COIS- Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided 
      with the online version of the article ( http://links.lww.com/JBJS/H596 ).
EDAT- 2023/07/03 19:08
MHDA- 2023/08/17 06:42
CRDT- 2023/07/03 14:04
PHST- 2023/08/17 06:42 [medline]
PHST- 2023/07/03 19:08 [pubmed]
PHST- 2023/07/03 14:04 [entrez]
AID - 00004623-202308160-00007 [pii]
AID - 10.2106/JBJS.22.01213 [doi]
PST - ppublish
SO  - J Bone Joint Surg Am. 2023 Aug 16;105(16):1270-1279. doi: 10.2106/JBJS.22.01213. 
      Epub 2023 Jul 3.