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: Upper extremity unit. Participants: One hundred members of the International Wrist Investigators were surveyed by mail to assist in development 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. Intervention: Information from the expert survey, biomechanical literature, and patient interviews was used as a basis for item generation and definition of structural limitations for a scale that would be practical in the clinic. Patients with distal radius or scaphoid fractures completed the Patient-Rated Wrist Evaluation (PRWE) on two occasions to determine test-retest reliability. Patients with distal radius fractures (n = 101) completed the PRWE and the SF-36 and were tested with traditional impairment measures at baseline and at two, three, and six months after fracture to determine construct and criterion validity. Main Outcome Measures: Reliability coefficients (ICCs) and validity correlations (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 outcome tools. Brevity and simplicity were seen as essential in the clinic environment. A fifteen-item questionnaire (the PRWE) was designed to measure wrist pain and disability. Test-retest reliability was excellent (ICCs > 0.90). Validity assessment demonstrated that the instrument detected significant differences over time (p < 0.01) and was appropriately correlated with alternate forms of assessing parameters of pain and disability. Conclusions: The PRWE provides a brief, reliable, and valid measure of patient-rated pain and disability.