The content validity and reliability of the Patient-Rated-Wrist/Hand-Evaluation (PRWHE) and the Disability of the Arm, Shoulder and Hand questionnaire (DASH) in patients with distal radius fractures.

Objectives: The objective of this study was to determine the measurement properties of the Patient-Rated-Wrist/Hand-Evaluation (PRWHE) and the Disability of the Arm, Shoulder and Hand questionnaire (DASH) in patients with a distal radius fracture. Background: Nowadays the assessment of surgery outcomes has shifted toward a more patient-perspective approach. The patient’s perspective is measured with Health Related-Patient Reported Outcome Measures (HR-PROM). Recently the COnsensus-based Standards for the selection of Measurement INstruments-group (COMSIN-group) developed a rating system for evaluating literature on the methodological quality of the research of HR-PROMs in systematic review. The orthopaedic department of the OLVG performed a systematic review on the methodological quality of the research of HR-PROMs in patients with distal radius fractures. The PRWHE and DASH scored best. However more research was needed on the measurement properties of both. Methods: The content validity, reliability (internal consistency, test-retest reliability and measurement error) and floor and ceiling effects were determined for the PRWHE and DASH and its optional modules. All patients, 18 years or older, with a dislocated unilateral distal radius fracture were included. Exclusion criteria were multiple fractures and disability in understanding the Dutch language. Content validity was assessed by a semi-structured phone interview eight weeks after sustaining a distal radius fracture. Reliability was assessed 4-8 months after a distal radius fracture by completing the HR-PROMs twice. Methodological quality was rated according to the COSMIN-checklist. Results: A total of 20 patients were included to asses the content validity of the PRWHE and DASH. A total of 70 patients were included to test the reliability of the PRWHE and DASH. Both HR-PROM showed good content validity. All items of the PRWHE were named during the interviews. Only one item of the DASH was not named. Both the PRWHE and DASH showed acceptable reliability: Cronbach’s α 0.96 vs. 0.97, Intra Class Correlation [ICC] 0.88 vs. 0.87, Standard Error of Measurement (SEM) 7.35 vs. 5.77, Smallest Detectable Difference (SDD) 20.38 vs. 16.00. The optional modules work and sport of the DASH showed acceptable reliability: Cronbach’s α 0.94 vs. 0.95, ICC 0.92 vs. 0.83, SEM 5.06 vs. 7.35, SDD 14.03 vs. 20.38. Floor effects were only present in the optional module work of the DASH and almost in the optional module sport. No ceiling effects were present. Methodological quality in assessing the content validity of the PRWHE, DASH and it modules was rated ‘excellent’. For the PRWHE and DASH the assessment of the test-retest validity and measurement error was rated ‘good’, the assessment of the internal consistency rated ‘poor’. The assessment of the internal consistency, test re-test reliability and measurement error of the optional module work of the DASH scored ‘good’ on methodological quality. The internal consistency, the test-retest reliability and measurement error of the optional module sport of the DASH scored ‘fair’ on methodological quality. Conclusion: For both the PRWHE and the DASH acceptable measurement properties were found in patients with dislocated distal radius fractures. The optional modules of the DASH are less useful is assessing the function in patients witch distal radius fractures. To gain ‘excellent’ methodological quality more patients should be included. Level of evidence: Level III