- •There are many patient reported outcome measures for a variety of upper extremity disorders, but it's not always clear which measure is most useful clinically or academically.
- •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.
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.
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.
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).
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.
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
- A new practice analysis of hand therapy.J Hand Ther. 2002; 15: 215-225
- Reflections on the practice of physiotherapy.Scalpel (Brux). 1953; 106: 420-421
- A systematic review of the cross-cultural adaptations and measurement properties of the shoulder pain and disability index.Hand Therapy. 2019; 24: 107-115
- Validity and responsiveness of the short version of the Western Ontario rotator cuff index (short-WORC) in patients with rotator cuff repair.J Orthopaed Sports Physic Ther. 2018; 48: 409-418
- Use of condition-specific patient-reported outcome measures in clinical trials among patients with wrist osteoarthritis: a systematic review.Advances orthoped. 2012; 2012
- Patient rating of wrist pain and disability: a reliable and valid measurement tool.J Orthop Trauma. 1998; 12: 577-586
- Measuring health-related quality of life.Ann Intern Med. 1993; 118: 622-629
- Applying evidence on outcome measures to hand therapy practice.J Hand Ther. 2004; 17: 165-173
- Distal radius fractures: therapy practice patterns.J Hand Ther. 2001; 14: 249-257
- Outcome evaluation in patients with elbow pathology: issues in instrument development and evaluation.J Hand Ther. 2001; 14: 105-114
- Reliability and validity of selected measures associated with increased fall risk in females over the age of 45 years with distal radius fracture - A pilot study.J Hand Ther. 2015; 28: 2-10
- A systematic review of the measurement properties of the patient-rated wrist evaluation.J Orthop Sports Phys Ther. 2015; 45: 289-298
- Overviews of systematic reviews: great promise, greater challenge.Syst Rev. 2017; 6 (:Article number: 185.)https://doi.org/10.1186/s13643-017-0582-8
- External validation of a measurement tool to assess systematic reviews (AMSTAR).PLoS One. 2007; 2: e1350
- AMSTAR 2 overall confidence rating: lacking discriminating capacity or requirement of high methodological quality?.J Clin Epidemiol. 2020; 119: 142-144
- Patient-Reported outcome measures used for neck disorders: an overview of systematic reviews.J orthopaed sports physic ther. 2018; 48: 775-788
- Diagnosing carpal tunnel syndrome: diagnostic test accuracy of scales, questionnaires, and hand symptom diagrams—a systematic review.J orthopaed sports physic ther. 2020; 50: 622-631
- Site-specific patient-reported outcome measures for hand conditions: systematic review of development and psychometric properties.Plastic Reconstruct Surg Global Open. 2019; 7 (. PMID: 31333975; PMCID: PMC6571349)e2256https://doi.org/10.1097/GOX.0000000000002256
- A systematic review of the content and quality of wrist outcome instruments.Int J Qual Health Care. 2000; 12: 149-157
- Outcome evaluation measures for wrist and hand - Which one to choose?.Int Orthop. 2008; 32: 1-6
- The validity and clinical utility of the disabilities of the arm shoulder and hand questionnaire for hand injuries in developing country contexts: a systematic review.J Hand Ther. 2018; 31 (e81): 80-90
- Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties.Syst rev. 2018; 7: 175
- A systematic review of the psychometric properties of the boston carpal tunnel questionnaire.BMC musculoskeletal disord. 2006; 7: 78
- The patient-rated wrist and hand Evaluation: a systematic review of its validity and reliability.New Zealand J Physiother. 2014; 42: 139-145
- Establishing the psychometric properties of 2 self-reported outcome measures of elbow pain and function: A systematic review.J Hand Ther. 2019; 32: 222-232
- A systematic review of the psychometric properties of the Constant-Murley score.J Shoulder Elbow Surg. 2010; 19: 157-164
- Distal radius fracture outcomes and rehabilitation.Geriatr orthopaed surg rehab. 2016; 7: 202-205
- Can radiological results be surrogate markers of functional outcome in distal radial extra-articular fractures?.Int Orthop. 2008; 32: 505-509
- Clinical outcome of scaphoid malunion due to scaphoid fracture nonunion surgical treatment: a 5-year minimum follow-up study.Orthopaed Traumatol: Surg Res. 2015; 101: 359-363
Published online: March 11, 2023
Accepted: October 14, 2022
Received in revised form: May 19, 2022
Received: March 31, 2021
Publication stageIn Press Corrected Proof
Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
© 2022 Elsevier Inc. All rights reserved.