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Patient-reported outcome measures used for hand and wrist disorders: An overview of systematic reviews
Christina Ziebart1, Pavlos Bobos2, Rochelle Furtado1
1Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada; School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada; Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada.
Background:
Multiple options for patient reported outcome measures are available to assess patients with hand, wrist and elbow impairments. This review of systematic reviews (overview) evaluated the evidence on these outcome measures.
Methods:
An electronic search of six databases (MEDLINE, Embase, CINAHL, ILC, the Cochrane Central Register of Controlled Trials (CENTRAL), and LILACS) was performed in September 2019, and updated in August 2022. The search strategy was designed to locate systematic reviews that addressed at least one clinical measurement property of PROMs used for patients with hand and wrist impairment. Two independent reviewers screened the articles and extracted the data. The AMSTAR tool was used to assess the risk of bias in the included articles.
Results:
Eleven systematic reviews were included in this overview. A total of 27 outcome assessments were assessed, with DASH, PRWE and MHQ assessed by five, four, and three reviews, respectively. We found high-quality evidence of good to excellent internal consistency (ICC = 0.88-0.97), poor content validity but high construct validity (r > 0.70), moderate- to high-quality evidence for the DASH. The reliability of the PRWE was excellent (ICC >0.80), the convergent validity was excellent (r > 0.75), but poor criterion validity compared to the SF-12. The MHQ also reported excellent reliability (ICC = 0.88-0.96), and good criterion validity (r > 0.70), but poor construct validity (r > 0.38).
Conclusion:
Clinical decisions around which tool will depend on which psychometric property is most important for the assessment and whether global or specific condition assessment is needed. All of the tools demonstrated at least good reliability; therefore, the clinical decisions will rely on the type of validity for clinical application. The DASH has good construct validity, while the PRWE has good convergent validity, and the MHQ has good criterion validity.
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