Karagiannopoulos Christos, Sitler Michael, Michlovitz Susan, Tucker Carole, Tierney Ryan
Doctor of Physical Therapy Program, DeSales University, Center Valley, PA, USA.
Office of the Provost, Temple University, Philadelphia, PA, USA.
J Hand Ther. 2016 Oct-Dec;29(4):474-482. doi: 10.1016/j.jht.2016.06.009. Epub 2016 Oct 18.
Prospective cohort study.
The active wrist joint position sense (JPS) test has been determined to be a clinically useful test for assessing wrist sensorimotor (SM) status after distal radius fracture (DRF). Its responsiveness is yet to be determined.
Primary study aim was to determine the active wrist JPS test responsiveness to detect change in wrist SM status at 8 and 12 weeks after DRF treatment intervention. Secondary aims were to compare group (nonsurgical, surgical, high, and low pain) test responsiveness; compare pain-level group participants test scores; determine the relationship between test minimal clinically important difference (MCID) value and function; compare functional outcomes across assessment times; and determine the Patient Global Impression of Change Scale intrarater reliability.
A total of 33 male and female participants were tested at baseline, 8, and 12 weeks after nonsurgical (n = 13) and surgical (n = 20) DRF treatment interventions. Distribution-based analysis encompassed both group- (ie, effect size, standardized response mean) and individual-based (ie, minimum detectable change) statistical indices. Anchor-based analysis determined the MCID value by linking test scores to the Patient Global Impression of Change Scale.
The active wrist JPS test is highly responsive based on effect size (8 weeks = 1.53 and 12 weeks = 2.36) and standardized response mean (8 weeks = 1.57 and 12 weeks = 2.14). Statistically significant minimum detectable change values were 4.28° and 4.94° at 8 and 12 weeks, respectively. Clinically meaningful MCID values were 5.00° and 7.09° at 8 and 12 weeks, respectively. Between treatment type and pain-level group responsiveness levels were not significantly different. High-pain participants demonstrated significantly greater JPS deficit. Test MCID values and function were significantly associated.
This is the first study to determine the active wrist JPS test responsiveness as reflected by its group- and individual-based statistical indices following DRF surgical and non-surgical interventions among low- and high-pain level participants. The statistical analysis approach, which was used to determine the aforementioned variables of the active wrist JPS test, is consistent with current research. This study's strengths included its design, methodology, and statistical approach. The study findings must be interpreted, however, within the content of several methodological limitations.
The active wrist JPS test was determined to be highly responsive to detect wrist SM status change at 8 and 12 weeks regardless of treatment type or pain level. Clinicians can use this test with confidence to measure clinically meaningful SM impairment after DRF treatment.
2b.
前瞻性队列研究。
主动腕关节位置觉（JPS）测试已被确定为评估桡骨远端骨折（DRF）后腕部感觉运动（SM）状态的一项临床有用测试。但其反应性尚未确定。
主要研究目的是确定主动腕关节JPS测试在DRF治疗干预后8周和12周时检测腕部SM状态变化的反应性。次要目的是比较各分组（非手术、手术、高疼痛和低疼痛）的测试反应性；比较疼痛水平分组参与者的测试分数；确定测试最小临床重要差异（MCID）值与功能之间的关系；比较不同评估时间的功能结果；以及确定患者整体变化印象量表的评分者内信度。
共33名男性和女性参与者在非手术（n = 13）和手术（n = 20）DRF治疗干预后的基线、8周和12周接受测试。基于分布的分析包括基于分组（即效应量、标准化反应均值）和基于个体（即最小可检测变化）的统计指标。基于锚定的分析通过将测试分数与患者整体变化印象量表相关联来确定MCID值。
基于效应量（8周 = 1.53，12周 = 2.36）和标准化反应均值（8周 = 1.57，12周 = 2.14），主动腕关节JPS测试具有高度反应性。8周和12周时具有统计学意义的最小可检测变化值分别为4.28°和4.94°。8周和12周时具有临床意义的MCID值分别为5.00°和7.09°。治疗类型和疼痛水平分组之间的反应性水平无显著差异。高疼痛参与者表现出明显更大的JPS缺陷。测试MCID值与功能显著相关。
这是第一项确定主动腕关节JPS测试反应性的研究，该反应性通过其在低疼痛和高疼痛水平参与者的DRF手术和非手术干预后的基于分组和基于个体的统计指标来反映。用于确定主动腕关节JPS测试上述变量的统计分析方法与当前研究一致。本研究的优势包括其设计、方法和统计方法。然而，研究结果必须在若干方法学局限性的背景下进行解释。
无论治疗类型或疼痛水平如何，主动腕关节JPS测试在8周和12周时对检测腕部SM状态变化具有高度反应性。临床医生可以放心使用该测试来测量DRF治疗后具有临床意义的SM损伤。
2b。
