Scientific/Clinical Article| Volume 28, ISSUE 4, P403-411, October 2015

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Responsiveness of three Patient Report Outcome (PRO) measures in patients with hand fractures: A preliminary cohort study


      Study design

      Clinical measurement.


      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



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      JHT Read for Credit

      Quiz: #389

      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 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
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.