Better Outcome Measure for Distal Radius Fixation?

In an analysis of six outcome measures for distal radius fixation, researchers recommend the use of QuickDASH, Patient-Rated Wrist Evaluation, Flexion-extension arc range and Grip strength fraction up to six months post-surgery and QuickDASH and Patient-Rated Wrist Evaluation after six months.

“Many standardized outcome measures exist to measure recovery after surgical fixation of distal radius fractures, however, choosing the optimal instrument is difficult. We evaluated responsiveness, ceiling/floor effects, and criterion validity over multiple time intervals across a 2-year follow-up period for six commonly used instruments,” the researchers wrote in “A comparison measures across the recovery period after distal radius fixation – Which to use and when?” The study was published on January 29, 2021 in the Journal of Orthopaedic Surgery.

QuickDASH is a series of 11 self-administered questions on function, symptoms and quality of life related to the upper limb. Patient-Rated Wrist Evaluation or PRWE was designed to measure pain and disability after distal radius fracture. It is broken down to two subscales: pain and function.

Flexion-extension arc range (FEArc) and grip strength fraction (GripFrac) are rated by the clinician not the patient. The tests focus on range of motion and grip strength, respectively.

Cooney modification of the Green and O’Brian score (CGNO) is wrist-specific and is also clinician rated. It measures pain, functional status, range of motion and grip strength. Sarmiento modification of the Gartland and Werley score (SGNW) includes questions for both the clinician and patient.

The analysis included 259 patients who received open reduction and internal fixation for distal radius fractures between 2012 and 2015. They were all administered the six outcome measures at 1.5, 3, 6, 12 and 24 months postoperatively. Responsiveness was evaluated by calculating standardized response means (SRM) and Cohen’s d effect sizes (ES).

According to the analysis, SRM (1.5-24 months) were 1.81, 1.77, 1.43, 1.16, 2.23, 2.45 and ES (1.5-24 months) were 1.81, 1.82, 1.95. 1.31, 1.99 and 2.90 for QuickDASH, PRWE, CGNO, SGNW, FEARc and GripFrac, respectively. Spearman correlation coefficients against QuickDASH at 24 months were 0.809, 0.248, 0.563, 0.285 and 0.318 for PRWE, CGNO, SGNW, FEArc and GripFrac, respectively. More than 15% of patients reached the maximum score before 6 months for PRWE and SGNW.

“Other measurement properties of outcome measures which lay outside the scope of this study remain relevant and additional high-quality evidence should be considered to fully inform the clinician’s choice of instrument,” the researchers wrote.