Original Communications
Self-reported disability following distal radius fractures: The influence of hand dominance*,**,*,**

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Abstract

The purpose of this study was to record the spectrum of self-reported disability following distal radius fractures and to gauge for differences in hand dominance in the use of subjective outcome data. Items were generated through patient interviews, literature review, and peer consultation. Fifty-three items were evaluated by a group of 55 patients recovering from a fracture of the distal radius, which established the prevalence, mean severity score, and overall severity score (or impact) of each item as it related to physical function and social/emotional impact. Hand dominance, age, and gender were also recorded. The results confirm that many patients who sustain distal radius fractures experience substantial impairment across a spectrum of quality of life domains. Because patients who sustain a dominant wrist injury are likely to report greater functional impairment across a wider range of activities, they also possess a greater potential for improvement. The practical implication is that outcome studies for the treatment of distal radius fractures should take hand dominance into account. (J Hand Surg 2000;25A:476–482. Copyright © 2000 by the American Society for Surgery of the Hand.)

Section snippets

Materials and methods

The methodology used for assessing the spectrum of self-reported wrist disability was modeled after that of Guyatt et al,14 who established guidelines in the development and testing of a disease-specific quality of life measure. The study site was a tertiary-care adult general hospital with a large outpatient emergency patient base. Given that distal radius fractures were seen in the latter group, we felt that the study population was not significantly different from that of other community

Phase I: Item selection

Nineteen patients were interviewed as part of the item selection phase according to our criteria. The mean age was 47.8 years (range, 21–75 years). There were 8 men and 11 women. Patient diagnosis included only distal radius fractures. There were 8 nondominant and 11 dominant wrist injuries. Open-ended questions were asked to elicit problems with the injured wrist. Patients were unanimous in describing some limitation of their regular activities of daily living. Items generated by the patients

Discussion

Patients who sustain displaced distal radius fractures report significant deficits throughout several domains of health-related quality of life. Difficulties with activities of daily living and frustration are pervasive among patients. Impairments related to hobbies, sports, and social activities are particularly important for a small subset of patients. The results demonstrate the degree to which hand dominance can influence daily activities.

In evaluating the spectrum of self-reported

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      Citation Excerpt :

      Moreover, no significant differences could be found in the mortality rate and autonomy levels between PHFs affecting the dominant arm and PHFs affecting the nondominant arm. Patients suffering a fracture involving the dominant hand have shown severe impairment in their quality of life perception because there are specific tasks that can be done only with the dominant hand.3,10 Sustaining a displaced distal radius fracture may impair quality of life in several areas in terms of health in most patients, whereas impairments in hobbies and social activities may be relevant to only a small subset of patients, and dominance has been shown to have a strong influence on daily activities.3,10

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    *

    No benefit in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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    Reprint requests: Geoffrey F. Dervin, MD, Department of Orthopaedic Surgery, The Ottawa Hospital, General Site, 501 Smyth Rd, RM 5004, Box 502, Ottawa, Ontario, Canada K1H-8L6.

    *

    J Hand Surg 2000;25A:476–482

    **

    0363-5023/00/25A03-0013$3.00/0

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