INTRODUCTION: Lack of standardization of outcome measurement has hampered an evidence-based approach to clinical practice and research.
METHODS: We adopted a process of reviewing evidence on current use of measures and appropriate theoretical frameworks for health and disability to inform a consensus process that was focused on deriving the minimal set of core domains in distal radius fracture.
RESULTS: We agreed on the following seven core recommendations: (1) pain and function were regarded as the primary domains, (2) very brief measures were needed for routine administration in clinical practice, (3) these brief measures could be augmented by additional measures that provide more detail or address additional domains for clinical research, (4) measurement of pain should include measures of both intensity and frequency as core attributes, (5) a numeric pain scale, e.g. visual analogue scale or visual numeric scale or the pain subscale of the patient-reported wrist evaluation (PRWE) questionnaires were identified as reliable, valid and feasible measures to measure these concepts, (6) for function, either the Quick Disability of the arm, shoulder and hand questionnaire or PRWE-function subscale was identified as reliable, valid and feasible measures, and (7) a measure of participation and treatment complications should be considered core outcomes for both clinical practice and research.
CONCLUSION: We used a sound methodological approach to form a comprehensive foundation of content for outcomes in the area of distal radius fractures. We recommend the use of symptom and function as separate domains in the ICF core set in clinical research or practice for patients with wrist fracture. Further research is needed to provide more definitive measurement properties of measures across all domains.
This paper provides detailed accounts of the process undertaken to review the outcome measures used in distal radius fracture trials, cohort studies and case series to interpret those in light of future potential, and reach consensus on a core set of domains. Two sections will be presented in this paper: (1) Defining the conceptual framework and (2) Defining a preliminary set of recommendations on the domains of measurement.
ContributorsGoldhahn, Jorg Beaton, Dorcas Ladd, Amy Macdermid, Joy Hoang-Kim, Amy Distal Radius Working Group of the International Society for Fracture, Repair International Osteoporosis, Foundation
Disease Category: Orthopaedics & trauma
Disease Name: Distal radius fracture
Age Range: 18 - 100
Sex: Either
Nature of Intervention: Any
- Academic research representatives
- Clinical experts
- Epidemiologists
- Methodologists
- Patient/ support group representatives
- Pharmaceutical industry representatives
- COS for clinical trials or clinical research
- COS for practice
- Literature review
- Nominal group technique (NGT)
Two rounds of NGT. First round (2009) - defined what we needed to measure using a conceptual framework. Second round (2011) - participants selected top five outcomes in distal radius fracture patients and then discussed with the group. Literature search (2010) - provided participants with all the questionnaires found in the literature search in order for our discussions and consensus to be well-informed.