PATIENT RATING OF WRIST PAIN AND DISABILITY - A RELIABLE AND VALID MEASUREMENT TOOL

Objective: The goal of this study was to develop a reliable and valid tool for quantifying patient-rated wrist pain and disability. Design: Survey, tool development, reliability, and validity study. Setting: Up per extremity unit. Participants: One hundred members of the Internati onal Wrist Investigators were surveyed by mail to assist in developmen t of the scale. Patients with distal radius (ra = 64) or scaphoid (n = 35) fractures were enrolled in a reliability study, and 101 patients with distal radius fractures were enrolled in a validity study. Interv ention: Information from the expert survey, biomechanical literature, and patient interviews was used as a basis for item generation and def inition of structural limitations for a scale that would be practical in the clinic. Patients with distal radius or scaphoid fractures compl eted the Patient-Rated Wrist Evaluation (PRWE) on two occasions to det ermine test-retest reliability. Patients with distal radius fractures (n = 101) completed the PRWE and the SF-36 and were tested with tradit ional impairment measures at baseline and at two, three, and six month s after fracture to determine construct and criterion validity. Main O utcome Measures: Reliability coefficients (ICCs) and validity correlat ions (Pearson product moment correlations). Results: Patient opinions on pain and on ability to do activities of daily living and work were thought to be the most important dimensions to include in subjective o utcome tools. Brevity and simplicity were seen as essential in the cli nic environment. A fifteen-item questionnaire (the PRWE) was designed to measure wrist pain and disability. Test-retest reliability was exce llent (ICCs > 0.90). Validity assessment demonstrated that the instrum ent detected significant differences over time (p < 0.01) and was appr opriately correlated with alternate forms of assessing parameters of p ain and disability. Conclusions: The PRWE provides a brief, reliable, and valid measure of patient-rated pain and disability.