用于桡骨远端骨折的患者自评腕关节评估（PRWE）和上肢、肩部和手部功能障碍（DASH）问卷是否真的有效且可靠？
Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable?
作者信息
Kleinlugtenbelt Y V, Krol R G, Bhandari M, Goslings J C, Poolman R W, Scholtes V A B
机构信息
Department of Orthopaedic and Trauma Surgery, Joint Research OLVG Oost, PO Box 95500, 1090 HM, Amsterdam, the Netherlands; Department of Orthopaedic and Trauma Surgery, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, the Netherlands; and Division of Ortopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St, Hamilton, Ontario L8N 3Z5, Canada
Department of Orthopaedic and Trauma Surgery, Joint Research OLVG Oost, PO Box 95500, 1090 HM, Amsterdam, The Netherlands.
出版信息
Bone Joint Res. 2018 Jan;7(1):36-45. doi: 10.1302/2046-3758.71.BJR-2017-0081.R1.
OBJECTIVES
The patient-rated wrist evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are patient-reported outcome measures (PROMs) used for clinical and research purposes. Methodological high-quality clinimetric studies that determine the measurement properties of these PROMs when used in patients with a distal radial fracture are lacking. This study aimed to validate the PRWE and DASH in Dutch patients with a displaced distal radial fracture (DRF).
METHODS
The intraclass correlation coefficient (ICC) was used for test-retest reliability, between PROMs completed twice with a two-week interval at six to eight months after DRF. Internal consistency was determined using Cronbach's α for the dimensions found in the factor analysis. The measurement error was expressed by the smallest detectable change (SDC). A semi-structured interview was conducted between eight and 12 weeks after DRF to assess the content validity.
RESULTS
A total of 119 patients (mean age 58 years (sd 15)), 74% female, completed PROMs at a mean time of six months (sd 1) post-fracture. One overall meaningful dimension was found for the PRWE and the DASH. Internal consistency was excellent for both PROMs (Cronbach's α 0.96 (PRWE) and 0.97 (DASH)). Test-retest reliability was good for the PRWE (ICC 0.87) and excellent for the DASH (ICC 0.91). The SDC was 20 for the PRWE and 14 for the DASH. No floor or ceiling effects were found. The content validity was good for both questionnaires.
CONCLUSION
The PRWE and DASH are valid and reliable PROMs in assessing function and disability in Dutch patients with a displaced DRF. However, due to the high SDC, the PRWE and DASH are less useful for individual patients with a distal radial fracture in clinical practice.: Y. V. Kleinlugtenbelt, R. G. Krol, M. Bhandari, J. C. Goslings, R. W. Poolman, V. A. B. Scholtes. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? 2018;7:36-45. DOI: 10.1302/2046-3758.71.BJR-2017-0081.R1.
目的
患者自评腕关节评估（PRWE）和上肢、肩部与手部功能障碍（DASH）问卷是用于临床和研究目的的患者报告结局指标（PROMs）。目前缺乏高质量的方法学临床计量学研究来确定这些PROMs用于桡骨远端骨折患者时的测量特性。本研究旨在验证PRWE和DASH在荷兰移位型桡骨远端骨折（DRF）患者中的有效性。
方法
采用组内相关系数（ICC）评估重测信度，在DRF后6至8个月时，间隔两周对PROMs进行两次测量。使用Cronbach's α系数确定因子分析中各维度的内部一致性。测量误差用最小可检测变化（SDC）表示。在DRF后8至12周进行半结构化访谈以评估内容效度。
结果
共有119例患者（平均年龄58岁（标准差15）），74%为女性，在骨折后平均6个月（标准差1）时完成了PROMs测量。PRWE和DASH均发现一个总体有意义的维度。两种PROMs的内部一致性均极佳（PRWE的Cronbach's α为0.96，DASH的为0.97）。PRWE的重测信度良好（ICC为0.87），DASH的重测信度极佳（ICC为0.91）。PRWE的SDC为20，DASH的SDC为14。未发现地板效应或天花板效应。两种问卷的内容效度均良好。
结论
PRWE和DASH在评估荷兰移位型DRF患者的功能和残疾情况时是有效且可靠的PROMs。然而，由于SDC较高，在临床实践中，PRWE和DASH对个体桡骨远端骨折患者的作用较小。：Y. V. Kleinlugtenbelt、R. G. Krol、M. Bhandari、J. C. Goslings、R. W. Poolman、V. A. B. Scholtes。患者自评腕关节评估（PRWE）和上肢、肩部与手部功能障碍（DASH）问卷用于桡骨远端骨折时真的有效且可靠吗？2018；7：36 - 45。DOI：10.1302/2046 - 3758.71.BJR - 2017 - 0081.R1 。
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