Measuring wrist and hand function: Common scales and checklists
Introduction
A 35-year-old motorcyclist presents with ulnar-distal wrist pain. Upon physical examination, you note ulnar pain on axial loading of the wrist and clicking. Radiographs reveal positive ulnar variance. Before performing wrist arthroscopy for ulnocarpal impingement, you tell the patient that these injuries can lead to progressive stiffness and delayed functional consequences. You want to select an appropriate functional outcome measure that can communicate how treatment impacts his ability to perform day-to-day activities, to participate in social activities, and to fulfil societal expectations; however, the process of selecting the instrument is overwhelming.
The plethora of available instruments across a broad spectrum of hand and wrist problems has led to a lack of standardisation in applications, including clinical trials, which has implications for the generalisability of results.19, 25 Concurrent evaluation covering aspects of injury from a number of instruments can inform, from pain and fatigue through to broader aspects of the patient's physical, psychological and social well-being.10, 12 There are disputes in the literature on how to best incorporate the patient's preferences and concerns; however, central to this debate is that appropriate measures in a trial are those that particularly address patients’ concerns.14, 17 For a decade now, the American Association of Orthopaedic Surgery (AAOS) has been involved in the development and dissemination of musculoskeletal instruments to assess the effectiveness of treatment regimens in clinical and in research settings (www.aaos.org-research-outcomes-outcomesmain.asp). In so doing, the AAOS advocates the appraisal of instrument content and provides the researcher with evidence for measurement properties, including reliability and validity in relation to the study population, which are prerequisites for appropriate instrument selection.10 Several initiatives have been proposed to assess health status instruments.33, 38 Only recently, the COSMIN study has been published. International consensus was reached on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes.29 This taxonomy explains relationships between measurement properties that were considered relevant. For instance, internal consistency is placed under the category of reliability because it only informs of the measure's extent to which the items assess the same construct, but not necessarily what it is actually measuring (which would have placed this term otherwise under the construct of validity) (Table 1).29
The responsibility of the researcher and clinician is to first formulate their research question then select a standardised instrument that addresses the primary aims of the trial. Instrument content should be scrutinised because not always do titles of instruments and their constituent scales reflect what the instrument purports to measure.41 For instance, two instruments may be measuring physical function in patients with distal radius fractures; however, one may ask about the level of help a person needs to perform specific tasks whilst, the other may ask about degree of difficulty experienced by the respondents with tasks. The purpose of this paper is to steer the reader through published reviews of patient outcome measures, in the hand and wrist literature, using quality criteria in a helpful way. Finally, we will summarise important points to consider in the selection of these instruments.
Section snippets
Search strategy
The literature search was conducted by a professional librarian (* St. Michael's Hospital, Toronto) using Ovid Medline (1950–Week 13 2010), EMBASE (1980–Week 13 2010), Health and psychosocial instruments (1985–January 2010). The search strategy included the MESH terms: hand (strength, injuries, joints) and wrist (injuries, joint) combined with outcome and process assessment (questionnaires, outcome assessment, health status indicators, quality of life) or disability evaluation or
Results
Combined databases yielded 331 results with 10 additional reviews provided by experts. Ten eligible reviews were identified, 3 of which were systematic reviews (2 hand injury and 1 on wrist injury) (Table 2). The review by Van de Ven-Stevens et al.39 was graded with a high recommendation with 6 out of the 7 categories in the quality assessment of the review fulfilled. Included in this review were 23 instruments, which assess function for the hand. The one systematic review on the wrist did not
Features of high graded systematic review of clinimetric properties
Van de Ven-Stevens et al. conducted a systematic review of outcomes assessing activities in patients with hand injury.39 Two reviewers independently screened English or Dutch articles that were found using Medline, Cochrane Library, Picarta, Occupational Therapy-seeker and CINAHL databases published between 2001 and 2006. Specific instrument names, clinimetric properties and year were used as terms in the search strategy. Their inclusion criteria were: (1) adequate description of the target
References (41)
- et al.
Comparative responsiveness of the Michigan hand outcomes questionnaire and the carpal tunnel questionnaire after carpal tunnel release
J Hand Surg
(2009) - et al.
Reliability and validity testing of the Michigan hand outcomes questionnaire
J Hand Surg
(1998) - et al.
Comparative responsiveness of the disabilities of the arm shoulder, and hand, the carpal tunnel questionnaire, and the SF-36 to clinical change after carpal tunnel release
J Hand Surg
(2003) - et al.
Validity of health status measures in patients with ulnar wrist disorders
J Hand Ther
(2001) - et al.
Responsiveness of the Michigan hand outcomes questionnaire and the disabilities of the arm should and hand questionnaire in carpal tunnel surgery
J Hand Surg
(2005) Development of a scale for patient rating of wrist pain and disability
J Hand Ther
(1996)- et al.
Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture
J Hand Surg
(2000) - et al.
Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist–hand evaluation (PRWHE) in evaluating change after hand therapy
J Hand Ther
(2004) - et al.
The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes
J Clin Epidemiol
(2010) - et al.
Evaluation of wrist and hand handicap and postoperative outcome in rheumatoid arthritis
Hand Clin
(2003)
Clinimetric evaluation of measurement tools used in hand therapy to assess activity and participation
J Hand Ther
Functional and outcome evaluation of the hand and wrist
Hand Clin
Outcomes assessment in hand surgery: when are they meaningful?
J Hand Surg Am
Quality criteria were proposed for measurement properties of health status questionnaires
J Clin Epidemiol
Clinimetric properties of instruments to assess activities in patients with hand injury: a systematic review of the literature
Arch Phys Med Rehabil
Responsiveness of self-report and therapist-rated upper extremity structural impairment and functional outcome measures in early rheumatoid arthritis
Arthritis Care Res
How sharp is the short QuickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function and specific joint conditions
Qual Life Res
Upper extremity collaborative group. Development of the QuickDASH: comparison of three item-reduction approaches
J Bone Joint Surg Am
Measuring the whole or the parts? Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity
J Hand Ther
A systematic review of the content and quality of wrist outcome instruments
Int J Qual Health Care
Cited by (105)
Understanding Health Economics in Hand Surgery
2023, Journal of Hand SurgerySoft tissue interpositional arthroplasty as a treatment of proximal interphalangeal joint arthritis in resource-limited health care facility: A case report
2022, International Journal of Surgery Case ReportsAssociation between perceived and objective hand-wrist function in distal radius fracture
2022, Hand Surgery and Rehabilitation