Relationship Between Magnitude of Limitations and Patient Experience During Recovery from Upper-Extremity Fracture

The relationship between the magnitude of limitations (measured by patient-reported outcome measures, or PROMs) and satisfaction with care providers and hospital services (measured by patient-reported experience measures, or PREMs) over the course of recovery after injury is unclear. The purpose of this study was to assess the relationship between a range of PROMs and 2 PREMs at 3 time points (initial office visit within a week, 2 to 4 weeks, and 6 to 9 months) after shoulder, elbow, and wrist fractures.

We enrolled 744 adult patients with an isolated shoulder, elbow, or wrist fracture and invited them to complete PROMs (the Patient-Reported Outcomes Measurement Information System Upper Extremity Physical Function computer adaptive test [PROMIS UE], PROMIS Physical Function (PROMIS PF) scale, Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH] questionnaire, EuroQol 5-Dimensions 3-Level Index [EQ-5D-3L], and Oxford Shoulder Score [OSS], Oxford Elbow Score [OES], or Patient-Rated Wrist Evaluation [PRWE]) and PREMs (Numerical Rating Scale [NRS] for satisfaction with care providers [NRS-C] and for satisfaction with hospital services [NRS-S]) at their initial visit at the outpatient surgical practice (maximum, 1 week after the fracture), between 2 and 4 weeks after the injury, and between 6 and 9 months after the injury. Correlational analysis was performed at each time point.

There was moderate correlation between the PROMIS UE and the NRS-C (r = 0.56) and NRS-S (r = 0.59) at 6 to 9 months after injury, which was stronger than the correlation at the 2 to 4-week mark (NRS-C, r = 0.34; NRS-S, r = 0.36) and at the evaluation that took place within a week after the injury (NRS-C, r = 0.18; NRS-S, r = 0.16). These correlational trends were observed with all forms of PROMs. Patients reporting greater limitations after injury were also less satisfied with their care and services.

The increasing alignment of PROMs and PREMs over the course of recovery after an upper-extremity fracture suggests that restored physical function may improve perceptions of satisfaction with care providers and hospital services over time. Future studies should assess factors that could be addressed to improve patient satisfaction and their limitations during recovery after fracture in order to maximize patient outcomes.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.