Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 2, pp 197–205 | Cite as

Recommendation for measuring clinical outcome in distal radius fractures: a core set of domains for standardized reporting in clinical practice and research

  • Jörg Goldhahn
  • Dorcas Beaton
  • Amy Ladd
  • Joy Macdermid
  • Amy Hoang-KimEmail author
Trauma Surgery



Lack of standardization of outcome measurement has hampered an evidence-based approach to clinical practice and research.


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.


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.


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.


Distal radius fracture Consensus Core outcome measures Health measurement Pain Function 



The consensus paper is the result of two workshops organized jointly by the international society for fracture repair (ISFR) and the international osteoporosis foundation (IOF) supported by unrestricted grants from Amgen, Lilly, Novartis, Pearltec, Servier, and Stryker. This manuscript was approved by the fracture working group under the committee of scientific advisors of the IOF.


  1. 1.
    About Us (2012) Definition of Health. WHO. Accessed 12 April 2012
  2. 2.
    Abraham A, Handoll HH, Khan T (2008) Interventions for treating wrist fractures in children. Cochrane Database Syst Rev 2:CD004576PubMedGoogle Scholar
  3. 3.
    Amadio P (1996) Review of outcomes. J of Hand Surg 21:781–787CrossRefGoogle Scholar
  4. 4.
    Beaton DE, Wright JG, Katz JN (2005) Development of the QuickDASH: comparison of three-item reduction approaches. J Bone Joint Surg Am 87:1038–1046PubMedCrossRefGoogle Scholar
  5. 5.
    Bellamy N, Kirwan J, Boers M et al (1997) Recommendations for a core set of outcome measures for future phase II clinical trials in knee, hip and hand osteoarthritis. Consensus development at OMERACT III. J Rhematol 24:799–802Google Scholar
  6. 6.
    Changulani M, Okonkwo U, Keswani T, Kalairajah Y (2008) Outcome evaluation measures for wrist and hand: which one to choose? Int Orthop 32:1–6PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Cieza A, Ewert T, Ustün TB et al (2004) Development of ICF core sets for patients with chronic conditions. J Rehabil Med 36(suppl 44):9–11Google Scholar
  8. 8.
    Coenen M, Cieza A, Freeman J et al (2011) Members of the consensus conference. The development of ICF Core Sets for multiple sclerosis: results of the international consensus conference. J Neurol 258:1477–1488PubMedCrossRefGoogle Scholar
  9. 9.
    Finger ME, Escorpizio R, Glässel A et al (2011) ICF core set for vocational rehabilitation: results of an international consensus conference. Disabil Rehabil 34(5):429–438PubMedCrossRefGoogle Scholar
  10. 10.
    Goldhahn J, Angst F, Simmen BR (2008) What counts: outcome assessment after distal radius fractures in aged patients. J Orthop Trauma 22:S126–S130PubMedCrossRefGoogle Scholar
  11. 11.
    Green DP, O’Brien ET (1978) Open reduction of carpal dislocations: indications and operative techniques. J Hand Surg 3:250–265CrossRefGoogle Scholar
  12. 12.
    Handoll HH, Madhok R, Howe TE (2006) Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev 3:CD003324PubMedGoogle Scholar
  13. 13.
    Hoang-Kim A (2010) The first international society for fracture repair and international osteoporosis foundation “osteoporosis: from evidence to action” combined symposium and working groups. Adv Orthop 2:15–18Google Scholar
  14. 14.
    Hoang-Kim A, Scott J, Micera G et al (2009) Functional assessment in patients with osteoporotic wrist fractures treated with external fixation: a review of randomized trials. Arch Orthop Trauma Surg 129:105–111PubMedCrossRefGoogle Scholar
  15. 15.
    Hoang-Kim A, Pegreffi F, Moroni A, Ladd A (2011) Measuring wrist and hand function: common scales and checklists. Injury 42:253–258PubMedCrossRefGoogle Scholar
  16. 16.
    Hodsman AB, Leslie WD, Tsang JF, Gamble GD (2008) 10-year probability of recurrent fractures following wrist and other osteoporotic fractures in a large clinical cohort: an analysis from the manitoba bone density program. Arch Intern Med 10(168):2261–2267CrossRefGoogle Scholar
  17. 17.
    ICF Core Set Projects (2010) ICF Research Branch website. Accessed 12 April 2012
  18. 18.
    ICF Research Branch (2010) Development of ICF core sets for hand conditions. Accessed 12 April 2012
  19. 19.
    Institute for Work and Health (2012) The DASH outcome measure. Accessed 12 April 2012
  20. 20.
    Kennedy CA, Beaton DE, Solway S et al (2011) The DASH and QuickDASH outcome measures user’s manual, 3rd edn. Institute for Work and Health, TorontoGoogle Scholar
  21. 21.
    Kotsis SV, Lau FH, Chung KC (2007) Responsiveness of the Michigan Hand Outcomes Questionnaire and physical measurements in outcome studies of distal radius fracture treatment. J Hand Surg 32:84–90CrossRefGoogle Scholar
  22. 22.
    Lips P, Jameson K, Bianchi ML et al (2010) Validation of the IOF quality of life questionnaire for patients with wrist fracture. Osteo Int 21:61–70CrossRefGoogle Scholar
  23. 23.
    Lohr KN, Aaronson NK, Alonso J et al (1996) Evaluating quality-of-life and health status instruments: development of scientific review criteria. Clin Ther 18:979–992PubMedCrossRefGoogle Scholar
  24. 24.
    MacDermid JC, Tottenham V (2004) Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther 17:18–23PubMedCrossRefGoogle Scholar
  25. 25.
    McKay SD, MacDermid JC, Roth JH, Richards RS (2001) Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg Am 26(5):916–922PubMedCrossRefGoogle Scholar
  26. 26.
    Michlovitz SL, LaStayo PC, Alzner S, Watson E (2001) Distal radius fractures: therapy practice patterns. J Hand Ther 14:249–257PubMedCrossRefGoogle Scholar
  27. 27.
    Mokkink LB, Terwee CB, Patrick DL et al (2010) The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 63:737–745PubMedCrossRefGoogle Scholar
  28. 28.
    Riddle DL, Stratford PW, Singh JA et al (2009) Variation in outcome measures in hip and knee arthroplasty clinical trials: a proposed approach to achieving consensus. J Rheum 36:2050–2056PubMedCrossRefGoogle Scholar
  29. 29.
    Shauver MJ, Yin H, Banerjee M et al (2011) Current and future national costs to medicare for the treatment of distal radius fracture in the elderly. J Hand Surg 36:1282–1287CrossRefGoogle Scholar
  30. 30.
    Stucki G, Grimby G (2004) Foreword: applying the ICF in medicine. J Rehabil Med 36:5–6CrossRefGoogle Scholar
  31. 31.
    Tugwell P, Boers M (1993) OMERACT conference on outcome measures in rheumatoid arthritis clinical trials: conclusion. J Rheum 20:590Google Scholar
  32. 32.
    US Food and Drug Administration (2009) Guidance for Industry Patient-reported outcome measures: use in medical product development to support labeling claims. US department of health and human services food and drug administration. available Accessed 12 April 2012
  33. 33.
    Vannabouathong C, Sprague S, Bhandari M (2011) Guidelines for fracture healing assessments in clinical trials. Part I: definitions and endpoint committees. Injury 42:314–316PubMedCrossRefGoogle Scholar
  34. 34.
    Williamson PR, Altman D, Blazeby J et al (2012) Driving up the quality and relevance of research through the use of agreed core outcomes. J Health Serv Res Policy 17:1–2PubMedCrossRefGoogle Scholar
  35. 35.
    World Health Organization (2001) International classification of functioning, disability and health (ICF). Switzerland, Geneva, pp 10–20Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jörg Goldhahn
    • 1
  • Dorcas Beaton
    • 2
  • Amy Ladd
    • 3
  • Joy Macdermid
    • 4
  • Amy Hoang-Kim
    • 5
    Email author
  1. 1.Institute for Biomechanics of ETH ZurichZurichSwitzerland
  2. 2.Mobility Program Clinical Research UnitLi Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoCanada
  3. 3.Robert A. Chase Hand and Upper Limb CenterDepartment of Orthopaedic Surgery, Stanford UniversityStanfordUSA
  4. 4.School of RehabilitationMcMaster UniversityHamiltonCanada
  5. 5.Division of Orthopaedic Surgery, Institute of Medical Sciences, St. Michael’s HospitalUniversity of TorontoTorontoCanada

Personalised recommendations