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Biomedical subjects

Joy C MacDermid

Publications and source records attributed to Joy C MacDermid.

At least 19 recordsLinked to original sources
PubMed2007

Plate fixation of olecranon osteotomies.

The management of intra-articular distal humeral fractures remains a difficult surgical problem. Although an olecranon osteotomy provides excellent exposure for management of these fractures, a number of complications can occur after the creation and repair of the osteotomy including nonunion, malunion, hardware failure, and pain secondary to prominent hardware. In an effort to reduce the incidence of these complications, the senior authors now use contoured 3.5 mm reconstruction plates for the fixation of their apex-distal chevron olecranon osteotomies. Two surgeons at a single institution used this technique of exposure on a series of 17 consecutive patients with intra-articular distal humerus fractures between 1996 and 1999. In this series, all osteotomies united. There was one complication related specifically to the osteotomy: one of the screws in the plate penetrated the proximal radioulnar joint, interfering with forearm rotation; a second procedure was required to shorten the screw. Only one of the 17 patients requested plate removal during the 32 month (average) follow-up period. Plate fixation of olecranon osteotomies using a 3.5 mm reconstruction plate provides a construct with predictable healing and few complications. The overall results using this technique are comparable with other reported methods in the literature.

Bone Plates↗
PubMed2006

Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727].

BACKGROUND: A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT) interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning) related to health outcome measures. METHOD/DESIGN: Physical and occupational therapists (n = 144) will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1) Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS), and 2) Online Problem-Based course (e-PBL). SHIPS will consist of face-to-face problem-based learning (PBL) for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT interventions and to identify elements that contribute to changing clinical behavior. Chart audits will determine the utilization of outcome measures (counts). Incorporation of outcome measures into clinical reasoning will be assessed using an innovative technique: chart-stimulated recall. DISCUSSION: A strategy for optimal transfer of health outcome measures into practice will be developed and shared with multiple disciplines involved in primary and specialty management of musculoskeletal and childhood disability.

Journal Article↗
PubMed2006

Cross-sectional and longitudinal construct validity of two rotator cuff disease-specific outcome measures.

BACKGROUND: Disease-specific Quality Of Life (QOL) measures are devised to assess the impact of a specific disease across a spectrum of important domains of life. The purpose of this study was to examine the cross-sectional and longitudinal construct validity (sensitivity to change) of two rotator cuff disease-specific measures, the Rotator Cuff-Quality Of Life (RC-QOL) and the Western Ontario Rotator Cuff (WORC) index, in relation to one another and to other joint and limb specific measures in the same population of the patients suffering from rotator cuff pathology. METHODS: Participants enrolled were consecutive patients who received physical therapy for management of impingement syndrome or received treatment following rotator cuff repair, acromioplasty or decompression surgeries. All subjects received physical therapy treatment and completed four outcome measures at 3 single points (initial, interim, and final). Cross-sectional convergent validity was assessed at each of the 3 time-points by correlating the WORC and RC-QOL's scores to each other and to two alternative scales; a joint-specific scale, the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form and a limb-specific measure, the Upper Extremity Functional Index (UEFI). Non-parametric statistics (Spearman's rho and Wilcoxon-Mann-Whitney tests) examined the construct validity. The standardized response mean (SRM) was used to examine sensitivity to change. RESULTS: Forty-one participants entered the study and their scores were compared at 3 cross sectional single points. The correlation coefficients among the 4 measures varied from 0.60 to 0.91. Correlation between corresponding domains of the WORC and RC-QOL varied from 0.45 to 0.85. The known group validity was not significantly different among individual sub-scores and total scores. The final SRMs were (1.42), (1.43), (1.44), and (1.54) for the ASES, RCQOL, WORC, and UEFI respectively. CONCLUSION: The WORC and RC-QOL exhibit similar cross-sectional convergent validity in patients suffering from rotator cuff pathology. The sensitivity to change was very close among all scores, with the UEFI having the highest sensitivity. Further research is needed to examine the extent to which each physical or emotional domain contributes to prognostic or therapeutic decision-making.

Adult↗
PubMed2006

All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: a protocol for a randomized trial [NCT00128076].

BACKGROUND: Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopic repair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair. METHODS/DESIGN: This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator cuff tears. A national consensus meeting of investigators in the Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS Canada) identified this question as the top priority for shoulder surgeons across Canada. The primary outcome measure is a valid quality-of-life scale (Western Ontario Rotator Cuff (WORC)) that addresses 5 domains of health affected by rotator cuff disease. Secondary outcomes will assess rotator cuff functionality (ROM, strength, Constant score), secondary dimensions of health (general health status (SF-12) and work limitations), and repair integrity (MRI). Outcomes are measured at baseline, at 6 weeks, 3, 6, 12, and 24 months post-operatively by blinded research assistants and musculoskeletal radiologists. Patients (n = 250) with small or medium-sized cuff tears identified by clinical examination and MRI who meet eligibility criteria will be recruited. This sample size will provide 80% power to statistically detect a clinically important difference of 20% in WORC scores between procedures after controlling for baseline WORC score (alpha = 0.05). A central methods centre will manage randomization, data management, and monitoring under supervision of experienced epidemiologists. Surgeons will participate in either conventional or expertise-based designs according to defined criteria to avoid biases from differential surgeon expertise. Mini-open or all-arthroscopic repair procedures will be performed according to a standardized protocol. Central Adjudication (of cases), Trial Oversight and Safety Committees will monitor trial conduct. We will use an analysis of covariance (ANCOVA), where the baseline WORC score is used as a covariate, to compare the quality of life (WORC score) at 2 years post-operatively. As a secondary analysis, we will conduct the same statistical test but will include age and tear size as covariates with the baseline score. Enrollment will require 2 years and follow-up an additional 2 years. The trial will commence when funding is in place. DISCUSSION: These results will have immediate impact on the practice behaviors of practicing surgeons and surgical trainees at JOINTS centres across Canada. JOINTS Canada is actively engaged in knowledge exchange and will publish and present findings internationally to facilitate wider application. This trial will establish definitive evidence on this question at an international level.

Arthroscopy↗
PubMed2006

The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity.

BACKGROUND: The Shoulder Pain and Disability Index (SPADI) is a self-report measure developed to evaluate patients with shoulder pathology. While some validation has been conducted, broader analyses are indicated. This study determined aspects of cross-sectional and longitudinal validity of the SPADI. METHODS: Community volunteers (n = 129) who self-identified as having shoulder pain were enrolled. Patients were examined by a physical therapist using a standardized assessment process to insure that their pain was musculoskeletal in nature. This included examination of pain reported during active and passive shoulder motion as reported on a visual analogue pain scale. Patients completed the SPADI, the Coping Strategies Questionnaire (CSQ) and the Sickness Impact Profile (SIP) at a baseline assessment and again 3 and 6 months later. Factor analysis with varimax rotation was used to assess subscale structure. Expectations regarding convergent and divergent subscales of CSQ and SIP were determined a priori and analysed using Pearson correlations. Constructed hypotheses that patients with a specific diagnosis or on pain medication would demonstrate higher SPADI scores were tested. Correlations between the observed changes recorded across different instruments were used to assess longitudinal validity. RESULTS: The internal consistencies of the SPADI subscales were high (alpha > 0.92). Factor analysis with varimax rotation indicated that the majority of items fell into 2 factors that represent pain and disability. Two difficult functional items tended to align with pain items. Higher pain and disability was correlated to passive or negative coping strategies, i.e., praying/hoping, catastrophizing on the CSQ. The correlations between subscales of the SPADI and SIP were low with divergent subscales and low to moderate with convergent subscales. Correlations, r > 0.60, were observed between the SPADI and pain reported on a VAS pain scale during active and passive movement. The two constructed validity hypotheses (on diagnosis and use of pain medications) were both supported (p < 0.01). The SPADI demonstrated significant changes over time, but these were poorly correlated to the SIP or CSQ suggesting that these scales measure different parameters. CONCLUSION: The SPADI is a valid measure to assess pain and disability in community-based patients reporting shoulder pain due to musculoskeletal pathology.

Adaptation, Psychological↗
PubMed2006

Functional outcomes of arthroscopic capsular release of the elbow.

PURPOSE: Elbow contracture is a common and difficult problem to manage. The purpose of this study was to determine the functional outcomes of arthroscopic capsular release in the management of elbow contractures. METHODS: A total of 22 patients (14 males, 8 females; mean age, 42 years) undergoing arthroscopic contracture release were retrospectively reviewed at a minimum follow-up of 1 year (mean, 25 months). In all, 20 patients had a capsulectomy, and 2 underwent capsulotomy. Patient-rated questionnaires (Disability of the Arm, Shoulder, and Hand questionnaire [DASH], American Shoulder and Elbow Surgeons Elbow Form [ASES-e], and Short Form-36 [SF-36]) and clinical, radiographic, and objective evaluations were used to assess outcomes. Motion and strength were measured by independent evaluators through standard goniometry and the LIDO Isokinetic System (Loredan Biomedical, West Sacramento, CA). RESULTS: Mean flexion significantly improved from 122 degrees +/- 15 degrees to 141 degrees +/- 12 degrees (P < .001). Mean extension significantly improved from 38 degrees +/- 18 degrees to 19 degrees +/- 13 degrees (P < .001). Mean arc improvement was 38 degrees +/- 23 degrees (P < .001). None of the patients had instability, and no major neurovascular complications were reported. All patients had improved elbow function with a mean ASES-e score of 31 out of 36. Most patients were satisfied with their surgery, experienced minimal pain, and exhibited minimal impairment on the DASH. CONCLUSIONS: Arthroscopic debridement and capsulectomy of the contracted elbow is effective. Results are comparable with those of other reports in the literature in which both arthroscopic and open methods were used. LEVEL OF EVIDENCE: Level IV.

Adolescent↗
PubMed2006

Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes.

BACKGROUND: Comminuted fractures of the radial head are challenging to treat with open reduction and internal fixation. Radial head arthroplasty is an alternative treatment with results that compare favorably with those reported after open reduction and internal fixation of similar fractures. The purpose of this study was to evaluate the two-year outcomes and the rate of recovery of a closely followed cohort of patients in whom an unreconstructible radial head fracture had been treated with a modular metallic prosthesis. METHODS: Twenty-six patients (seventeen female and nine male; mean age, fifty-four years) with an unreconstructible comminuted radial head fracture and associated elbow injuries were treated with a modular metallic radial head arthroplasty. Patients who had presented more than four weeks following the injury or had had the radial head arthroplasty as a second-stage or salvage procedure were excluded. Of the twenty-six patients, twenty-two had an associated elbow dislocation, and thirteen of them also had an associated fracture of the coronoid process. Patients were prospectively followed at three, six, twelve, and twenty-four months. Self-reported limb function, general health, range of motion, and isometric strength were assessed by an independent observer. RESULTS: Following treatment of the injury, significant decreases in self-reported and measured impairments were noted over time, with the majority of the recovery occurring by six months and little further recovery noted between six and twenty-four months. There were slight-to-moderate deficits in the range of motion and strength compared with the values on the contralateral, unaffected side. Patient satisfaction was high at three months and remained high at two years. All elbow joints remained stable, no implant required revision, and there was no evidence of overstuffing of the joint. Mild osteoarthritis was seen in five (19%) of the twenty-six patients. CONCLUSIONS: An arthroplasty with a modular metallic radial head is a safe and effective option for the treatment of unreconstructible radial head fractures associated with other elbow injuries. Recovery primarily occurs by six months, with minimal additional improvements over the next eighteen months.

Adult↗
PubMed2005

The International Classification of Functioning as an explanatory model of health after distal radius fracture: a cohort study.

BACKGROUND: Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health. METHODS: This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome. RESULTS: Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE. CONCLUSION: The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture.

Activities of Daily Living↗
PubMed2005

Reliability and validity of the AGREE instrument used by physical therapists in assessment of clinical practice guidelines.

BACKGROUND: The AGREE instrument has been validated for evaluating Clinical Practice Guidelines (CPG) pertaining to medical care. This study evaluated the reliability and validity of physical therapists using the AGREE to assess quality of CPGs relevant to physical therapy practice. METHODS: A total of 69 physical therapists participated and were classified as generalists, specialist or researchers. Pairs of appraisers within each category evaluated independently, a set of 6 CPG selected at random from a pool of 55 CPGs. RESULTS: Reliability between pairs of appraisers indicated low to high reliability depending on the domain and number of appraisers (0.17-0.81 for single appraiser; 0.30-0.96 when score averaged across a pair of appraisers). The highest reliability was achieved for Rigour of Development, which exceeded ICC> 0.79, if scores from pairs of appraisers were pooled. Adding more than 3 appraisers did not consistently improve reliability. Appraiser type did not determine reliability scores. End-users, including study participants and a separate sample of 102 physical therapy students, found the AGREE useful to guide critical appraisal. The construct validity of the AGREE was supported in that expected differences on Rigour of Development domains were observed between expert panels versus those with no/uncertain expertise (differences of 10-21% p = 0.09-0.001). Factor analysis with varimax rotation, produced a 4-factor solution that was similar, although not in exact agreement with the AGREE Domains. Validity was also supported by the correlation observed (Kendall-tao = 0.69) between Overall Assessment and the Rigour of Development domain. CONCLUSION: These findings suggest that the AGREE instrument is reliable and valid when used by physiotherapists to assess the quality of CPG pertaining to physical therapy health services.

Cardiology↗
PubMed2005

Preliminary evaluation of the generalized work distress scale in patients with work-related upper extremity disorders.

This study evaluated the reliability and construct validity of the Generalized Work Distress Scale in 207 patients attending a specialty clinic with work-related upper extremity disorders. Factor analyses were conducted and compared to the original developmental study confirming a two-factor solution: an internal factor related to Work-Related Dysphoria and an external factor related to Work-Related Support. Reliability (internal consistency) of factors was high (Cronbach's alpha = 0.87 and 0.89). The Work-Related Dysphoria factor was more related to self-reported global depressed mood and self-reported upper extremity functional disability, than was Work-Related Support. This study provided preliminary support for the use of this scale in patients with work-related upper extremity disorders and consideration to depressive symptoms in these patients. Further investigation of the psychometric properties of this scale and its predictive validity are required.

Cohort Studies↗
PubMed2005

Reliability and comparison of acromion assessment techniques on X-ray and magnetic resonance imaging (reliability of acromion assessment techniques).

OBJECTIVE: To determine the reliability and correlation of plain radiography and magnetic resonance imaging (MRI) in the assessment of acromion morphology. MATERIALS AND METHODS: Acromion morphology was assessed using the lateral acromion angle (LAA) and the acromion-humeral interval (AHI). Thirty patients who had X-rays and MRI for impingement syndrome were included. Six blinded observers assessed the acromion morphology subjectively and objectively. RESULTS: Neither acromion assessment technique demonstrated a positive correlation (kappa and intraclass coefficient < 0.55) between X-ray and MRI. Both techniques were reliable (kappa and intraclass coefficient > 0.55) when measured objectively by experienced observers. CONCLUSION: The LAA and the AHI are both reliable acromion assessment techniques on X-ray and MRI when measured objectively and by experienced observers.

Acromion↗
PubMed2004

Hand therapy management of intra-articular fractures with open reduction and pi plate fixation: a therapist's perspective.

Open reduction enhances the opportunity for patients to benefit from early rehabilitation following complex distal radius fractures. In the early phase of rehabilitation, therapists focus on motion, edema management, early identification of complications, and assist patients to understand and deal appropriately with their injury. Frequent and gentle exercise in elevation is key to restoring movement without adverse impacts on pain or edema. After six weeks, the focus of rehabilitation should be on ameliorating any residual physical impairments and moving patients towards normal activity. Strengthening, mobilization splinting, and reintegration into work activities may be required. Both physical impairment (volume, motion, strength, sensibility, dexterity) and self-report (pain and disability) measures may be required at different stages to provide a comprehensive view of recovery.

Journal Article↗
PubMed2004

Clinical and electrodiagnostic testing of carpal tunnel syndrome: a narrative review.

Carpal Tunnel Syndrome (CTS) is a pressure-induced neuropathy that causes sensorimotor disturbances of the median nerve, which impair functional ability. A clear history that elicits relevant personal and work exposures and the nature of symptoms can lead to a high probability of a correct diagnosis. Hand diagrams and diagnostic questionnaires are available to provide structure to this process. A variety of provocative tests have been described and have variable accuracy. The Phalen's wrist flexion and the carpal compression tests have the highest overall accuracy, while Tinel's nerve percussion test is more specific to axonal damage that may occur as a result of moderate to severe CTS. Sensory evaluation of light touch, vibration, or current perception thresholds can detect early sensory changes, whereas 2-point discrimination changes and thenar atrophy indicate loss of nerve fibers occurring with more severe disease. Electrodiagnosis can encompass a variety of tests and is commonly used to assess the presence/severity of neuropathic changes and to preclude alternative diagnoses that overlap with CTS in presentation. The pathophysiologic changes occurring with different stages of nerve compression must be considered when interpreting diagnostic test results and predicting response to physical therapy management.

Carpal Tunnel Syndrome↗
PubMed2003

Pain and disability reported in the year following a distal radius fracture: a cohort study.

BACKGROUND: Distal radius fractures are a common injury that cause pain and disability. The purpose of this study was to describe the pain and disabilities experienced by patients with a distal radius fracture in the first year following fracture. METHODS: A prospective cohort study of 129 patients with a fracture of the distal radius was conducted. Patients completed a Patient-rated Wrist Evaluation at their baseline clinic visit and at 2, 3, 6 and 12 months following their fracture. The frequency/severity of pain and disabilities reported was described at each time point. RESULTS: The majority of patients experienced mild pain at rest and (very) severe high levels of pain with movement during the first two-months following distal radius fracture. This time is also associated with (very) severe difficulty in performing specific functional activities and moderate to severe difficulty in four domains of usual activity. The majority of recovery occurred within six-months, but symptoms persisted for a small minority of patients at one-year following fracture. Patients had the most difficulty with carrying ten pounds and pushing up from a chair. Resumption of usual personal care and household work preceded, and was more complete, than work and recreational participation. CONCLUSIONS: This study demonstrated that the normal course of recovery following a distal radius fracture is one where severe symptoms subside within the first two-months and the majority of patients can be expected to have minimal pain and disability by six-months following fracture. This information can be used when planning interventions and assessing whether the progress of a patient is typical of other patients.

Activities of Daily Living↗
PubMed2003

Identifying cumulative trauma disorders of the upper extremity in workers' compensation databases.

BACKGROUND: Impeding the use of workers' compensation databases for surveillance of cumulative trauma disorder of the upper extremity (CTDUE) is the lack of valid and reliable extraction strategies. METHODS: Using the Z795-96 Coding of Work Injury or Disease Information standard, an algorithm was developed to classify claims as definite, possible, or non-CTDUE. Reliability was assessed with standardized claim reviews. RESULTS: Moderate to substantial agreement (Kappa = 0.48, 95% CI 0.42-0.54, n = 328; weighted Kappa = 0.75, 95% CI 0.70-0.80, n = 328) was demonstrated. The algorithm produced relatively homogeneous groups of definite and non-CTDUE claims but 29.1% of the possible CTDUE claims were categorized as definite CTDUE by claim review. Part of body agreement was almost perfect (Kappa = 0.81-1.00) when determining whether the upper extremity or specific parts of the upper extremity were involved. CONCLUSIONS: The algorithm can be used to estimate the number of CTDUE and extract homogeneous groups of definite and non-CTDUE claims. Furthermore, certain upper extremity part of body codes can be used to target anatomically defined claims.

Algorithms↗
PubMed2003

Trapezial arthroplasty with silicone rubber implantation for advanced osteoarthritis of the trapeziometacarpal joint of the thumb.

INTRODUCTION: Arthritis in the trapeziometacarpal joint of the thumb can cause swelling and loss of motion. Treatment options include arthrodesis, replacement arthroplasty and interposition arthroplasty. Our objective in this clinical study was to determine outcomes after trapezial arthroplasty with a silicone rubber implant and the relationship between self-reported and measured outcomes. METHODS: At the Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ont., a tertiary care centre, we reviewed a series of 26 patients with advanced osteoarthritis who underwent silicone rubber trapezial arthroplasty. The follow-up averaged 6.5 years. We assessed the outcomes subjectively, and by clinical, functional and radiographic examination. RESULTS: Although 88% of patients reported some improvement in pain and satisfaction, when quantified the improvement was less impressive: only 5.7 (on a visual analogue scale of 1-10, poor-excellent) for pain and 5.6 for satisfaction. Superior subjective results were reported by patients older than 60 years. Osteoarthritic changes had caused pronounced functional impairment in the hands of patients who underwent surgery and those who did not, so that any long-term benefit of surgery was not measurable. Patients had difficulty manipulating both small and large objects on the Jebsen's hand function test. Peri-implant and carpal radiographic lytic changes were observed in 90% of patients. Six patients (20%) required revision surgery (3 early, 3 late), including 1 with a pathologic scaphoid fracture. CONCLUSIONS: Although clinical, functional and radiographic results were poor, they did not predict either satisfaction or pain improvement reported by patients, illustrating the need for a comprehensive standardized outcome evaluation to make informed decisions on the value of surgical intervention for osteoarthritis of the trapeziometacarpal joint.

Adult↗
PubMed2002

Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture.

A prospective cohort of 120 patients with distal radius fractures completed a baseline evaluation that determined their age, sex, education level, injury compensation status, AO fracture type, prereduction radial shortening, and postreduction radial shortening. Six months later patients self-reported pain and disability using the Patient-Rated Wrist Evaluation, and were tested for physical impairment (grip, wrist range of motion, and dexterity). Univariate and forward stepwise regression analyses agreed that the most influential predictor of pain and disability at 6 months was injury compensation. Patient education level and prereduction radial shortening also contributed predictive information (R squared = 25%). Wrist impairment was moderately correlated with patient reported pain and disability (r = 0.50). Both impairment and disability measures are required to fully describe outcomes. Further work is required to delineate additional factors that contribute to outcome.

Adult↗