The reliability of remembered pre-operative patient-rated wrist and hand evaluation (PRWHE) scores

Abstract

In clinical audits where pre-operative patient-rated wrist and hand evaluation (PRWHE) scores were not recorded, it would be useful if such scores could be recreated at the time of review. We recorded a PRWHE score during the last week before surgery for 143 patients. They were contacted after 21 months and askedto furnish a new PRWHE of the state they were in during the last week before surgery. 80 (56%) of the patients responded. The mean difference was 10 (SD: 20; SEM: 2) higher remembered pre-operative score. The limits of 95% agreement for individual scores were-29 and 50, while the 95% confidence interval of the mean was 6-15. If 10 is subtracted from the mean remembered pre-operative score of a group of patients, the real pre-operative score will with 95% confidence be this score plus/minus 4. Remembered pre-operative PRWHE scores are far too inaccurate to be of value in individual patients. It may be possible to predict the mean real pre-operative PRWHE score in groups of patients with useful accuracy using the remembered pre-operative score.section with ten questions. The questions are answered by using a numeric scale from 0 (No pain/no difficulty) to 10 (worst ever pain/unable to do). The PRWHE is scored so that the pain and function item are weighted equally. This is achieved by dividing the sum score for function by two before adding it to the sum of the pain score. The total PRWHE score grades from 0 (no pain/disability) to 100 (greatest pain/dis-ability). Studies have found strong evidence for the reliability and validity of this tool, 3-5 and it has also been found to be easy and quick for the patient to complete. 3,6 It has been translated into many languages. 6-13 Ideally, patients should evaluate their change in symptoms and function by completing the PRWHE both before treatment and at review. When a pre-operative score has not been obtained, the question arises whether patients are able to accurately recall their pre-treatment score in retrospect. Only a few studies have investigated patients’ ability to recreate their pre-operative PROM score months or years after surgery. Remembered Quick disability of the arm, shoulder and hand (quickDASH) has been studied. 14,15 These papers evaluated their results with correlation tests and concluded that remembered pre-operative scores were quite accurate. However, we feel that this method is inappropriate. It has been pointed out that such tests measure the relationship between two variables, not the agreement between them, and that data which seem to be in poor agreement can produce quite high correlations. 16,17 In a recent paper from our institution, we studied the accuracy of remembered pre-operative QuickDASH scores using Bland-Altman plots. 18 We found that both remembered pre-operative QuickDASH scores and VAS scores were far too inaccurate to be of use in individuals, but it seemed possible that they might be of use in groups ofpatients. To our knowledge, no study has investigated patients’ ability to recall their pre-operative PRWHE score months or years after treatment. The aim of the present study was to assess the accuracy of remembered pre-operative PRWHE scores in a consecutive series of patients.