Measurement properties of the Dutch versions of QuickDASH and PRWHE in patients with complaints of hand, wrist, forearm and elbow.

BACKGROUND: The shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient Rated Wrist/Hand Evaluation (PRWHE) are commonly used questionnaires to assess patient-reported hand function. Information about the measurement properties of the Dutch versions is scarce. OBJECTIVE: To gain insight into the measurement properties of the Dutch language versions of the QuickDASH and the PRWHE in patients with (non)specific complaints of the hand, wrist, forearm and elbow. METHODS: Internal consistency, construct validity, test-retest reliability, responsiveness, and floor and ceiling effects were assessed according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations. RESULTS: Questionnaires were filled out by 132 patients. Internal consistency of QuickDASH (Cronbach's α= 0.92) and PRWHE (Cronbach's α= 0.97) was high. Predefined hypotheses for construct validity were not confirmed for 75% for both QuickDASH and PRWHE (accordance with 62% of predefined hypotheses for both questionnaires). Test-retest reliability of QuickDASH (ICC = 0.90) and PRWHE (ICC = 0.87) was good. Both QuickDASH (AUC = 0.84) and PRWHE (AUC = 0.80) showed good responsiveness. No floor or ceiling effects were present. CONCLUSIONS: Measurement properties of the Dutch language versions of the QuickDASH and the PRWHE, applied to patients with (non)specific complaints of the hand, wrist, forearm and elbow, were very similar. Test-retest reliability and responsiveness were good for both QuickDASH and PRWHE. Construct validity could not be demonstrated sufficiently.

Comparison between patient-reported and physician-estimated pain and disability in hand and wrist disorders.

BACKGROUND: Pain and disability are important components of the assessment of hand problems, but it is unknown how physician estimates compare to patient self-reports. OBJECTIVE: To analyse differences between patient-reported and physician-estimated pain and disability in patients with hand or wrist disorders and to analyse factors influencing these differences. METHODS: Observational study of patients with hand or wrist disorders seen during multidisciplinary outpatient consultations. Patients, rehabilitation medicine (RM) consultants, RM trainees and plastic surgeons completed visual analogue scales (VASs) to rate the level of self-reported (patients) or estimated (physicians) pain and disability. Multilevel analyses were performed to evaluate differences in VAS-pain and VAS-disability scores between patients and physicians and to evaluate the influences of diagnosis, physician experience and medical specialty. RESULTS: Complete data were obtained for 250 patients. Levels of pain and disability estimated by physicians were lower compared to patient self-reports. Ratings differed among medical specialties. Pain was underestimated to a greater extent by plastic surgeons compared to RM consultants. Disability was underestimated to a greater extent by RM consultants compared to plastic surgeons. Estimates of pain and disability did not differ between consultants and trainees in RM. Type of diagnosis did not influence the degree of underestimation of pain and disability. CONCLUSIONS: Physicians underestimate pain and disability compared to self-reports in patients with hand or wrist disorders. Ratings differ among medical specialties: plastic surgeons underestimate pain more, while RM consultants underestimate disability more. Physician experience and diagnosis do not influence the degree of underestimation of pain and disability.

Health-related physical fitness in patients with complaints of hand, wrist, forearm and elbow: an exploratory study.

OBJECTIVES: Little is known about the physical fitness of patients with complaints of hand, wrist, forearm and/or elbow and its possible determinants. Aims were to assess health-related physical fitness (HRPF) in these patients, to compare HRPF with reference values of healthy persons, and to explore whether HRPF was correlated with symptom severity, upper limb function (ULF) and physical activity (PA). METHODS: Cardiorespiratory fitness, handgrip strength and body composition, self-reported symptom severity, ULF and PA were assessed in adult outpatients with complaints of hand, wrist, forearm and/or elbow diagnosed as CANS. RESULTS: Measurements were completed in 25 subjects (8 males) aged 46.1±14.5 years, of which 44% had specific CANS and 56% had non-specific CANS.Peak oxygen consumption (VO2peak) of men was 2978±983 mL/min and of women was 1978±265 mL/min. Handgrip strength of men was 47.0±11.1 kgf and of women was 32.4±6.3 kgf. Body mass index (BMI) of men was 24.2±2.6 kg/m2 and of women was 27.4±6.1 kg/m2.VO2peak of the study sample was lower than that of healthy adults (-414±510 mL/min, p<0.001). Handgrip strength and BMI were similar to reference values.VO2peak was correlated with PA (r=0.58, p=0.004); BMI was correlated with disability (r=0.48, p=0.022). Other correlations between HRPF and symptom severity and ULF were non-significant. CONCLUSIONS: Patients with CANS have lower cardiorespiratory fitness, but similar handgrip strength and body composition, compared with the healthy population. Cardiorespiratory fitness was correlated with PA and BMI was correlated with disability, no other correlations were observed with symptom severity and ULF.

Cross-cultural adaptation and psychometric properties of the Dutch version of the Hand Function Sort in patients with complaints of hand and/or wrist.

BACKGROUND: Musculoskeletal complaints of arm, neck, and shoulder (CANS) can lead to loss of work productivity. To assess the functional consequences of impairments in work, patient-reported outcomes can be important. The Hand Function Sort (HFS) is a 62-item pictorial questionnaire that focuses on work task performance. The aims of this study were the cross-cultural adaptation of HFS into HFS-Dutch Language Version (HFS-DLV) (Part I) and determining construct validity, internal consistency, test-retest reliability, responsiveness and floor/ceiling effects of HFS-DLV (Part II). METHODS: I: Translation into Dutch using international guidelines. II: Construct validity was assessed with Spearman's correlation coefficients between the HFS-DLV and the Dutch version of the QuickDASH, PRWHE, PDI, RAND-36, NRS-pain, and work ability score. Internal consistency was assessed using Cronbach's α and reliability by a test-retest procedure. A global rating scale of change was used after 4-8 weeks of hand therapy to determine responsiveness. RESULTS: I: Forty patients were included, and no items were changed. II: 126 patients with hand, wrist, and/or forearm disorders classified as specific or nonspecific CANS. Six predefined hypotheses (50%) were confirmed. Cronbach's α: 0.98. Test-retest reliability: ICC of 0.922. AUC of 0.752. There were no floor/ceiling effects. CONCLUSIONS: I: Translation process into the HFS-DLV went according to plan. II: For construct validity, the presumed direction of correlations was correct, but less than 75% of hypotheses were confirmed. Internal consistency was high, suggesting redundancy. Reliability and responsiveness of the HFS-DLV were good. HFS-DLV can be used in research or clinical practice for Dutch patients with CANS, to evaluate self-reported functional work ability.

Construct validity and test-retest reliability of the revised Upper Extremity Work Demands (UEWD-R) Scale.

BACKGROUND: The revised Upper Extremity Work Demand (UEWD-R) Scale is a six-item self-report questionnaire to measure the workload of the upper limbs. UEWD-R consists of a force/posture scale and a repetition scale. Psychometric properties are unknown so far. PURPOSE: Assess the construct validity and the test-retest reliability of UEWD-R. METHOD: Participants from different levels of physical work demands (based on the Dictionary of Occupational Titles (DOT) categories) were included. Construct validity was determined by testing 11 predefined hypotheses regarding UEWD-R related to other constructs, including a workplace observation using the Rapid Upper Limb Assessment (RULA). Correlations between these measures were calculated using Spearman correlation coefficients. Test-retest reliability was determined using the intraclass correlation coefficient (ICC) for agreement. The smallest detectable change (SDC) was calculated. RESULTS: Fifty-four participants participated (63% men, mean age 39.4 years). The four DOT categories were equally represented. Nine out of 11 predefined correlations were confirmed (82%), indicating good construct validity. Strong expected correlations of UEWD-R-total versus RULA-C (r=0.69) and UEWD-R-repetition versus RULA-muscle (r=0.12) were not confirmed. The test-retest reliability was good (ICC agreement=0.79). The SDC was 4.85. CONCLUSION: Construct validity and the test-retest reliability of UEWD-R were good. UEWD-R can be used to evaluate the workload of the upper extremities. However, further research is advised to assess the validity of the UEWD-R not only by testing associations with RULA,but also with other observational measures.

Validity and Reliability of the Upper Extremity Work Demands Scale.

Purpose To evaluate validity and reliability of the upper extremity work demands (UEWD) scale. Methods Participants from different levels of physical work demands, based on the Dictionary of Occupational Titles categories, were included. A historical database of 74 workers was added for factor analysis. Criterion validity was evaluated by comparing observed and self-reported UEWD scores. To assess structural validity, a factor analysis was executed. For reliability, the difference between two self-reported UEWD scores, the smallest detectable change (SDC), test-retest reliability and internal consistency were determined. Results Fifty-four participants were observed at work and 51 of them filled in the UEWD twice with a mean interval of 16.6 days (SD 3.3, range = 10-25 days). Criterion validity of the UEWD scale was moderate (r = .44, p = .001). Factor analysis revealed that 'force and posture' and 'repetition' subscales could be distinguished with Cronbach's alpha of .79 and .84, respectively. Reliability was good; there was no significant difference between repeated measurements. An SDC of 5.0 was found. Test-retest reliability was good (intraclass correlation coefficient for agreement = .84) and all item-total correlations were >.30. There were two pairs of highly related items. Conclusion Reliability of the UEWD scale was good, but criterion validity was moderate. Based on current results, a modified UEWD scale (2 items removed, 1 item reworded, divided into 2 subscales) was proposed. Since observation appeared to be an inappropriate gold standard, we advise to investigate other types of validity, such as construct validity, in further research.