Few studies describe the responsiveness of functional outcomes measures in patients sustaining hand fractures.
1 – To explore the responsiveness of three function-oriented Patient Report Outcome (PRO) measures with a cohort of hand fracture patients. 2 – To examine patients' PRO preference.
60 participants with 74 hand fractures at an outpatient hospital-based hand therapy clinic consented to participate in this study. They completed the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Michigan Hand Outcomes Questionnaire (MHQ), and Patient-Rated Wrist/Hand Evaluation (PRWHE) at three trials: T1 (evaluation), T2 (one month later), and T3 (two months later). Participants also identified which PRO they felt best reflected their hand use and which was easiest to complete. Descriptive statistics, analyses of variance (ANOVA), effect size, and standardized response mean (SRM) were employed to describe participants, determine functional change between trials, and examine and compare PRO responsiveness. Questionnaire preference at T1 was reported.
Participants demonstrated functional improvement, as measured by the DASH, PRWHE, and MHQ. T1 scores: DASH = 41.85 (SD ± 22.78), MHQ = 50.13 (SD ± 18.36), and PRWHE = 48.18 (SD ± 22.07). T2 scores: DASH = 22.11 (SD ± 18.18), MHQ = 69.89 (SD ± 15.93), and PRWHE = 22.62 (SD ± 18.15). T3 scores: DASH = 17.56 (SD ± 18.01), MHQ = 75.37 (SD ± 19.19), and PRWHE = 22.40 (SD ± 19.04). Each PRO demonstrated significant test score differences between trials (p < .001). Large responsiveness (≥.80) was noted between T1 and T2: (effect size: .98–1.23; SRM: 1.31–1.49) and T1 and T3 (effect size: 1.21–1.54; SRM 1.49–1.84). Smaller responsiveness effects were noted between T2 and T3 (effect size: .35–.64, SRM: .38–.81). No significant differences between questionnaire responsiveness were found. Patients reported PRWHE easiest to complete and MHQ best reflecting their hand use.
DASH, MHQ, and PRWHE were each able to describe functional limitations in this cohort of patients with hand fractures. In capturing improvement over time they demonstrated comparable responsiveness in assessing change in patients with hand fractures.
Level of evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Therapy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The frequency and epidemiology of hand and forearm fractures in the United States.J Hand Surg. 2001; 26A: 908-915
- Incidence and demographics of the hand fractures in British Columbia, Canada: a population-based study.J Hand Surg. 2006; 31A: 1068.e1-1068.e9
- Open hand fractures: an analysis of the recovery of active motion and of complications.J Hand Surg. 1993; 18A: 387-394
- Outcomes of hand fractures.Hand Clin. 2013; 29: 621-630
- Is there evidence for early mobilization following extraarticular hand fracture?.J Hand Ther. 2004; 17: 300-308
- Rehabilitative strategies following hand fractures.Hand Clin. 2013; 29: 585-600
- Hand fractures: a review of current treatment strategies.J Hand Surg. 2013; 38A: 1021-1031
- 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; 17: 18-23
- Management of metacarpal fractures.J Hand Ther. 2003; 16: 143-151
- Rehabilitation for proximal phalangeal fractures.J Hand Ther. 2003; 16: 129-142
- Rehabilitation approaches for distal and middle phalanx fractures of the hand.J Hand Ther. 2003; 16: 105-116
- Metacarpal fractures in athletes: treatment, rehabilitation, and safe early return to play.J Hand Ther. 2003; 16: 171-179
- Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study.J Hand Surg. 2008; 33A: 1362-1368
- Measurement of health outcomes following tendon and nerve repair.J Hand Ther. 2005; 18: 297-312
- Towards a Common Language for Functioning, Disability, and Health: ICF the International Classification of Functioning, Disability, and Health.World Health Organization, Geneva2002
- 2008 practice analysis study of hand therapy.J Hand Ther. 2009; 22: 61-76
- How Occupational Therapists Specializing in Hand Therapy Consider Participation during the Evaluation Process: A Look at Diagnostic Reasoning.2009 (Doctoral Dissertation)
- Clinimetric evaluation of measurement tools used in hand therapy to assess activity and participation.J Hand Ther. 2009; 22: 221-236
- Development of an upper extremity outcome measure. The DASH (disabilities of the arm, shoulder, and hand).Am J Ind Med. 1996; 29: 602-608
- Reliability and validity testing of the michigan hand outcomes questionnaire.J Hand Surg. 1998; 23A: 575-587
- 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. 2001; 14: 128-146
- The michigan hand outcomes questionnaire (MHQ): assessment of responsiveness to clinical change.Ann Plast Surg. 1999; 42: 619-622
- Development of a scale for patient rating of wrist pain and disability.J Hand Ther. 1996; 9: 178-183
- Measuring wrist and hand function: common scales and checklists.Injury. 2011; 42: 253-258
- Hand therapist use of patient report outcome (PRO) in practice: a survey study.J Hand Ther. 2014; 27: 299-308
- Assessment of functional outcomes.in: Cooper C. Fundamentals of Hand Therapy. 2nd ed. Mosby, St. Louis, MO2014
- Ability to detect change in patient function: responsiveness designs and methods of calculation.J Hand Ther. 2010; 23: 361-371
- Which outcome measure is the best? Evaluating responsiveness of the disabilities of the arm, shoulder, and hand questionnaire, the Michigan hand questionnnaire and the patient-specific functional scale following hand and wrist surgery.Hand. 2009; 4: 311-318
- Responsiveness of the Michigan hand outcomes questionnaire and the disabilities of the arm, shoulder, and hand questionnaire in patients with hand injury.J Hand Surg. 2010; 35A: 430-436
- Responsiveness of the Michigan hand outcomes questionnaire and the disabilities of the arm, shoulder and hand questionnaire in carpal tunnel surgery.J Hand Surg. 2005; 30A: 81-86
- 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; 28A: 250-254
- 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; 25A: 330-340
- Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome.Clin Orthop Relat Res. 2013; 471: 1406-1411
- Responsiveness of the DASH score in surgically treated basal joint arthritis of the thumb: preliminary results.Clin Rheumatol. 2004; 23: 223-224
- Comparative responsiveness of the Michigan hand outcomes questionnaire and the carpal tunnel questionnaire after carpal tunnel release.J Hand Surg. 2009; 34A: 273-280
- Responsiveness of the Michigan hand outcomes questionnaire and physical measurements in outcome studies of distal radius fracture treatment.J Hand Surg. 2007; 32A: 84-90
- Validity and responsiveness of the Michigan hand questionnaire in patients with rheumatoid arthritis: a multicenter, international study.Arthritis Care Res. 2010; 62: 1569-1577
University of Michigan Department of Surgery, Michigan Hand Outcomes Questionnaire: Scoring. Retrieved July 11, 2014 from: http://sitemaker.umich.edu/mhq/scoring.
- Clinical Assessment Recommendations. 2nd ed. The American Society of Hand Therapist, Inc, Chicago1992: 41-45 (55–70)
- A study to compare the reliability of composite finger flexion and goniometry for measurement of range of motion in the hand.Clin Rehabil. 2002; 16: 572-579
- Goniometry of the proximal and distal interphalangeal joints, part II: placement preferences, interrater reliability and concurrent validity.J Hand Ther. 2001; 14: 23-29
- Reproducibility of goniometry of the wrist.Scand J Rehabil Med. 1986; 18: 5-7
JHT Read for Credit
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.The purpose of the study was to measure the responsiveness of the following in a population of patients with hand fractures
- a.the PRWHE
- b.the MHQ
- c.the DASH
- d.all of the above
- #2.The PRO(s) was(were) administered to each subject on
- a.initial evaluation
- b.a clinical visit agreed to by both the testing therapist and the patient
- c.3 separate occasions
- d.initial and final visits
- #3.The greatest responsiveness was found between
- a.T1 and T2
- b.T1 and T3
- c.T2 and T3
- d.T2 and T4
- #4.Within the scientific community it is generally accepted that
- a.reliability and validity are not consistent across diagnoses
- b.PRO responsiveness is not consistent for all diagnoses
- c.validity, but not reliability, is consistent across diagnoses
- d.the WHO is the final arbiter in approving all definitions
- #5.The authors expressed a strong preference for the MHQ
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Published online: May 26, 2015
Accepted: May 19, 2015
Received in revised form: May 14, 2015
Received: February 2, 2014
© 2015 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.