A structured literature synthesis of wrist outcome measures: An evidence-based approach to determine use among common wrist diagnoses

Distal Radius Fracture Rehabilitation

Distal radius fracture (DRF) is arguably the most common upper extremity fracture resulting from a fall accident. These clinical practice guidelines (CPG) were developed to guide all aspects of the management of DRF by physical therapists and other rehabilitation practitioners, such as certified hand therapists. This CPG employed a systematic review methodology to locate, appraise, and synthesize contemporary evidence while developing practice recommendations for determining the prognosis of outcomes, examination, and interventions while managing individuals with DRF. The quality of the primary studies found in the literature search was appraised using standardized tools. The strength of the available evidence for a particular practice domain (e.g., prognosis or intervention) was graded as strong, moderate, weak, or conflicting, where such gradings guided the level of obligation for each practice recommendation. Lastly, the CPG also provided the gaps in the evidence pool for the rehabilitation of DRF that future research efforts can address. J Orthop Sports Phys Ther 2024;54(9):CPG1-CPG78. doi:10.2519/jospt.2024.0301.

Investigation of reliability, validity, and cutoff value of the Jebsen-Taylor Hand Function Test

STUDY DESIGN

This is a cross-sectional study.

INTRODUCTION

The Jebsen-Taylor Hand Function Test (JTHFT) evaluate the efficacy of treatment and assess a broad range of hand functions.

PURPOSE OF THE STUDY

The purpose of this study was to investigate the psychometric properties of the JTHFT and to determine cutoff values.

METHODS

The test-retest reliability was assessed by determining intraclass correlation coefficient (ICC), the hypothesis testing validity was assessed by using Spearman rho coefficient, and the receiver operating characteristic curve, area under the curve of the receiver operating characteristic, sensitivity, and specificity were calculated to determine the cutoff values. We administered JTHFT, Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and assessed grip strength with Jamar dynamometer. We included 162 healthy participants and 143 patients with hand injuries.

RESULTS

The JTHFT subtests and total score have a good to excellent test-retest reliability (except lifting large light object for dominant hand-ICC: 0.77) for both dominant and nondominant hand (ICCs = 0.84-0.97). There was a statistically significant, weak positive correlation between the JTHFT total score and DASH-T (r = 0.39, P < .001 for the injured hand; r = 0.35, P < .001 for the uninjured hand) and also statistically significant weak negative correlation between grip strength for injured hand and JTHFT total score for injured hand (r = -0.33; P < .001). The cutoff value of the total score was found to be 37.08 s for injured hand.

DISCUSSION AND CONCLUSION

JTHFT is a reliable and valid instrument. Clinicians and researchers may use this test with confidence to assess the dexterity of hand injury patients.

Measurement Properties of Outcome Measures Used to Assess Physical Impairments in Patients After Distal Radius Fracture: A Systematic Review

OBJECTIVES

Individuals with distal radius fractures (DRF) may experience difficulty with gripping an object, painful wrist movements, sensorimotor difficulties, and swelling around the wrist and hand. A comprehensive review of the existing evidence concerning the measurement properties of common physical impairment measures can provide a valuable resource to guide hand therapy practice while managing DRF. The primary objective was to locate and assess the quality of literature on the measurement properties for the measures of physical impairment used in individuals with DRF.

METHODS

Two reviewers searched PubMed, CINAHL, and EMBASE. A combination of DRF, measurement properties, and physical impairments were used as keywords, and articles were independently assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments critical appraisal tool. Primary studies were included if they examined at least 1 of the following: reliability, validity, responsiveness, or indices of true and meaningful changes for measures of physical impairment in the DRF sample. A total of 19 articles were included in this review. The quality of the studies ranged from 46% to 92%. This review suggests that measures such as assessment of grip strength and supination and pronation range of motion (ROM), using various goniometric devices, showed good intrarater and interrater reliability, construct validity, and responsiveness in individuals with DRF.

CONCLUSION

Acceptable reliability and responsiveness were reported in grip and wrist ROM assessments for measuring changes in wrist and hand function after DRF; however, wrist ROM assessed using traditional goniometric techniques were less reliable in individuals with DRF.

IMPACT

This study provides insight into which objective tools might be better suited for measuring outcomes related to DRF.

Assessing kinematic variability during performance of Jebsen-Taylor Hand Function Test

STUDY DESIGN

Clinical measurement; 22 subjects with no upper limb disability completed the Jebsen-Taylor Hand Function Test (JHFT).

INTRODUCTION

To realize the potential of 3D motion capture to augment evaluation of individuals with upper limb disability/impairment, it is important to understand the expected kinematic motion that characterizes performance during functional evaluation.

PURPOSE OF THE STUDY

To assess kinematic variability and establish kinematic patterns for the JHFT.

METHODS

Upper body joint kinematics were collected using a Vicon motion capture system. Average range of motion and maximum angle were calculated for all tasks. Intrasubject and intersubject variability were assessed by calculating Pearson's correlation coefficient, adjusted coefficient of multiple correlation (CMC_adj), and standard deviation for 10 joint angles at the wrist, elbow, shoulder, and torso.

RESULTS

The writing and picking up small objects tasks generally had high intrasubject variability, with most joint angles having median Pearson's correlation coefficients lower than 0.7. The CMC_adj values were generally greater than 0.5 for elbow, shoulder, and torso joints during can-lifting tasks, indicating high consistency in those kinematic trajectories across subjects. Low consistency across subjects in all joint angles was observed for writing (CMC_adj < 0.07; SD_max > 10°).

DISCUSSION

Kinematic patterns for the JHFT tasks were analyzed.

CONCLUSIONS

With kinematic patterns for the JHFT tasks analyzed, optimal patterns of activity performance can be defined, allowing for easier identification and adjustment of atypical motion. Results can be used to inform selection of tasks for kinematic evaluation and provide expected variability for comparison to patient populations, which is useful for regulatory review and clinical assessment.

Developing a core outcome set for hand fractures and joint injuries in adults: a systematic review

This study identifies the treatment outcome domains used in recently published studies on the treatment of hand fractures and joint injuries with the aim to inform development of a core outcome set. Seven databases were searched from January 2014 to March 2019 for randomized and quasi-randomized studies and large prospective observational studies. We identified 1777 verbatim outcomes in 160 eligible studies. From the verbatim outcomes we distinguished 639 unique outcomes, which we categorized into 74 outcome domains based on the World Health Organization International Classification of Functioning, Disability, and Health framework. The primary outcome was appropriately identified in only 65% (72/110) of randomized and quasi-randomized controlled trials. Of the 72 studies with a primary outcome identified, 74% (53/72) had an appropriate power calculation. The vast heterogeneity in outcome selection across studies highlights the need for a core outcome set of what outcomes to measure in future clinical research on hand fractures and joint injuries.

Effect of Standing on a Standardized Measure of Upper Extremity Function

Although many daily activities that require the upper extremity are performed in standing, arm motor function is generally measured in sitting. The purpose of this study was to examine the effect of standing on a measure of upper extremity function, the Jebsen Hand Function Test (JHFT). Twelve nondisabled adults (26.3 ± 3.1 years) completed the JHFT with the right and left arms under two conditions: sitting and standing. Total time to complete the JHFT increased when performed in standing compared with sitting in both arms (p = .005); mean increase was 4.4% and 5.6% for the right and left arms, respectively. Checker stacking was the only subtest that showed a significant increase in completion time in standing for both arms (p = .001); card turning showed an increase for the left arm only (p = .002). Measurement of upper extremity function in standing may provide insight into arm motor capacity within the context of standing postural control demands.

Reliability, validity, and minimal detectable change of the push-off test scores in assessing upper extremity weight-bearing ability

STUDY DESIGN

Clinical measurement study.

INTRODUCTION

The push-off test (POT) was recently conceived and found to be reliable and valid for assessing weight bearing through injured wrist or elbow. However, further research with larger sample can lend credence to the preliminary findings supporting the use of the POT.

PURPOSE OF THE STUDY

This study examined the interrater reliability, construct validity, and measurement error for the POT in patients with wrist conditions.

METHODS

Participants with musculoskeletal (MSK) wrist conditions were recruited. The performance on the POT, grip isometric strength of wrist extensors was assessed. The shortened version of the Disabilities of the Arm, Shoulder and Hand and numeric pain rating scale were completed. The intraclass correlation coefficient assessed interrater reliability of the POT. Pearson correlation coefficients (r) examined the concurrent relationships between the POT and other measures. The standard error of measurement and the minimal detectable change at 90% confidence interval were assessed as measurement error and index of true change for the POT.

RESULTS

A total of 50 participants with different elbow or wrist conditions (age: 48.1 ± 16.6 years) were included in this study. The results of this study strongly supported the interrater reliability (intraclass correlation coefficient: 0.96 and 0.93 for the affected and unaffected sides, respectively) of the POT in patients with wrist MSK conditions. The POT showed convergent relationships with the grip strength on the injured side (r = 0.89) and the wrist extensor strength (r = 0.7). The POT showed smaller standard error of measurement (1.9 kg). The minimal detectable change at 90% confidence interval for the POT was 4.4 kg for the sample.

CONCLUSIONS

This study provides additional evidence to support the reliability and validity of the POT. This is the first study that provides the values for the measurement error and true change on the POT scores in patients with wrist MSK conditions. Further research should examine the responsiveness and discriminant validity of the POT in patients with wrist conditions.