Measuring Outcomes Over Time in Distal Radius Fractures: A Comparison of Generic, Upper Extremity-Specific and...

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Clinical Outcomes Research

Background:

• Assessing recovery after distal radius fractures requires sensitive outcome measures.
• Generic health status questionnaires may not fully capture changes in specific injuries.
• Upper extremity and wrist-specific measures offer potentially greater responsiveness.

Purpose of the Study:

• To compare the responsiveness of the Short Form-36 (SF-36), Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Rated Wrist Evaluation (PRWE) outcome scores.
• To evaluate these measures in patients over age 50 with distal radius fractures over 12 months.

Main Methods:

• Prospective study of 235 patients with isolated distal radius fractures (age >50).
• Assessments conducted at baseline, 6 months, and 12 months.
• Responsiveness evaluated using standardized response mean and minimal clinically important difference; floor/ceiling effects analyzed.

Main Results:

• DASH and PRWE showed significantly greater responsiveness than SF-36 from baseline to 6 months.
• PRWE demonstrated greater responsiveness than DASH and SF-36 from 6 to 12 months.
• PRWE had high initial ceiling effects (76.6%), decreasing to 16.9% at 12 months; DASH also had ceiling effects.

Conclusions:

• DASH and PRWE are more responsive than SF-36 in the first 6 months post-distal radius fracture.
• PRWE shows superior responsiveness from 6 to 12 months.
• Anatomy- and injury-specific measures are valuable for early recovery assessment, while generic measures may be useful later due to fewer ceiling effects.