Perspectives on outcome following hand and wrist injury in non-osteoporotic patients

Young patients without osteoporosis have high demands of the function of their hand and wrist following injury, because of an active working life. We reported on several outcome measures following hand and wrist injuries in this patient population.  Following wrist fractures, presence of posttraumatic arthritis was high and seemed to worsen over time. Posttraumatic arthritis was associated with diminished movement of the wrist, but not with diminished grip strength. All motion measurements of the injured wrist were diminished compared to the uninjured wrist. An incongruency of the joint surface following injury was associated with diminished range of motion and diminished scores on patient reported outcome captured in questionnaires answered by patients regarding daily tasks with their hand and wrist. Diminished movement of the wrist was also associated with worse scores on the questionnaires.  Of these specific patient reported outcome questionnaires for hand and wrist injuries, we validated two in the Dutch translated version: the DASH-DLV and the DF-PROMIS-UE v2.0 questionnaires. The latter uses a computer algorithm to reduce the number of questions that need to be answered to minimize the burden for patients.  Hand and wrist injuries can evolve in major life events for young patients, due to possible impairment as we reported. For clinical practice, we advise a ‘lean’ core set of outcome measures with known thresholds to find changes in function that a patient actually notices in daily life, known as minimal important change. This will improve the interpretation of clinical relevant outcome following hand and wrist injuries.

Dissertation: http://hdl.handle.net/11370/f0ed1b5b-700e-43b6-b158-0441ffde9f50