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What Is the Interversion Reliability and Agreement Between the Decision Tree Patient-rated Wrist Evaluation and the
Sebastiaan Tjènne Peters1,2,3,4, Robbert Maarten Wouters1,2, Ruud Willem Selles1,2
1Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
The shortened Decision Tree-Patient-Rated Wrist Evaluation (DT-PRWE) is a reliable and faster alternative to the full PRWE for assessing wrist conditions. This validated tool significantly reduces patient completion time while maintaining accuracy, making it suitable for clinical practice and research.
Area of Science:
- Orthopedics and Sports Medicine
- Rehabilitation and Physical Therapy
- Health Outcomes Research
Background:
- Item reduction strategies, like the Decision Tree-Patient-Rated Wrist Evaluation (DT-PRWE), aim to improve patient-reported outcome measure (PROM) response rates and reduce patient burden.
- A 5-item DT-PRWE was developed from the 15-item Patient-Rated Wrist Evaluation (PRWE), showing promise in simulated data but requiring real-world validation.
Purpose of the Study:
- To evaluate the interversion reliability and agreement between the DT-PRWE and the full PRWE in a clinical setting.
- To compare the completion time between the DT-PRWE and the PRWE.
Main Methods:
- A prospective diagnostic study involving 119 adult patients with wrist conditions at a specialized hand and wrist clinic.
- Patients completed the full PRWE at baseline and the DT-PRWE 5-10 days later.
- Interversion reliability was assessed using intraclass correlation coefficients (ICC) and Pearson correlation; agreement was evaluated using Bland-Altman plots and mean differences; completion time was compared using the Wilcoxon signed-rank test.
Main Results:
- The DT-PRWE demonstrated good to excellent interversion reliability (ICC 0.78-0.88) and high correlation (r = 0.81-0.88) with the PRWE across total, pain, and function scores.
- High agreement was observed between the two versions, with standard error of measurement (SEM) values below minimum important change (MIC) thresholds.
- The DT-PRWE showed a 70% reduction in completion time (median 1 min 5 sec vs. 3 min 33 sec for PRWE), with a median difference of 2 min 28 sec (p < 0.001).
Conclusions:
- The DT-PRWE is a reliable and time-efficient alternative to the full PRWE for assessing wrist conditions in clinical practice and research.
- Its digital implementation and comparability with existing PRWE data support its adoption.
- Future research should focus on cross-cultural validation, test-retest reliability, and the impact of shortened PROMs on compliance.
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