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Psychometric Properties of Common Patient-Reported Outcome Measures in Hand and Wrist Pathologies: A Systematic Review
Anna N. Sullentrup, MS, BS, Jared A. Hilton, MD, Molly Jones, BS, Sarah Rousseau, BS, Brent Prenger, BS, Gillian Hark, BS, Caleb Bischoff, DO, Faith Korpus, BS; Daniel London, MD
University of Missouri, Columbia, MO
Introduction: The Disabilities of the Arm, Shoulder, and Hand (DASH), QuickDASH, Upper Extremity module of the Patient Reported Outcomes Measurement Information System (PROMIS-UE), Michigan Hand Questionnaire (MHQ), brief MHQ (bMHQ), Patient-Rated Wrist Evaluation (PRWE), and Patient-Rated Wrist/Hand Evaluation (PRWHE) are widely used patient-reported outcome measures (PROMs) for hand and wrist pathologies. For a PROM to capture an outcome of interest, it must demonstrate adequate validity, reliability, and responsiveness in the intended population. This review was conducted to evaluate evidence on psychometric properties of these PROMs in patients with hand and wrist conditions stratified by pathology.
Materials & Methods: A systematic review was conducted based on Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. Data were collected regarding patient population, evidence rating, and risk of bias for each analysis. If multiple studies evaluated the same property within a pathology, the rating associated with the lowest risk of bias was utilized.
Results: 151 studies met inclusion criteria (DASH n=40, QuickDASH n=15, PROMIS-UE n=35, MHQ n=34, bMHQ n=7, PRWE n=30, PRWHE n=11). None of these PROMs have been fully characterized for any hand or wrist condition. DASH has been most well-validated in carpal tunnel syndrome, while its properties may be insufficient in assessing flexor tendon injury and Dupuytren's contracture (Table 1). QuickDASH has been most thoroughly evaluated for distal radius fractures, whereas it should be interpreted with caution in carpal tunnel syndrome and basal joint osteoarthritis. PROMIS-UE and PRWHE have been most thoroughly assessed in pooled upper extremity disorders, with minimal pathology-specific characterization. MHQ may be most useful in hand osteoarthritis and distal radius fractures, while it may not adequately capture data in cubital tunnel syndrome. bMHQ has been most thoroughly investigated in Dupuytren's contracture, whereas it may not be appropriate for assessing basal joint osteoarthritis. PRWE has been most well-characterized in distal radius fractures, with less attention dedicated to other conditions.
Conclusions: By definition, psychometric properties of PROMs are pathology-specific. These results indicate that while these instruments provide valuable insight into patient outcomes, they are not appropriate to use for all pathologies. These findings highlight the need for further evaluation of the psychometric properties of these widely used PROMs in specific hand and wrist pathologies so that researchers know they are valid to use.
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