Online Articles
Reliability, validity, responsiveness, and minimal important change of the Disabilities of the Arm, Shoulder and Hand and Constant-Murley scores in patients with a humeral shaft fracture

https://doi.org/10.1016/j.jse.2016.07.072Get rights and content

Background

The Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores are commonly used instruments. The DASH is patient-reported, and the Constant-Murley combines a clinician-reported and a patient-reported part. For patients with a humeral shaft fracture, their validity, reliability, responsiveness, and minimal important change (MIC) have not been published. This study evaluated the measurement properties of these instruments in patients who sustained a humeral shaft fracture.

Methods

The DASH and Constant-Murley instruments were completed 5 times until 1 year after trauma. Pain score, Short Form 36, and EuroQol-5D were completed for comparison. Internal consistency was determined by the Cronbach α. Construct and longitudinal validity were evaluated by assessing hypotheses about expected Spearman rank correlations in scores and change scores, respectively, between patient-reported outcome measures (sub)scales. The smallest detectable change (SDC) was calculated. The MIC was determined using an anchor-based approach. The presence of floor and ceiling effects was determined.

Results

A total of 140 patients were included. Internal consistency was sufficient for DASH (Cronbach α = 0.96) but was insufficient for Constant-Murley (α = 0.61). Construct and longitudinal validity were sufficient for both patient-reported outcome measures (>75% of correlations hypothesized correctly). The MIC and SDC were 6.7 (95% confidence interval, 5.0-15.8) and 19.0 (standard error of measurement, 6.9), respectively, for DASH and 6.1 (95% CI −6.8 to 17.4) and 17.7 (standard error of measurement, 6.4), respectively, for Constant-Murley.

Conclusions

The DASH and Constant-Murley are valid instruments for evaluating outcome in patients with a humeral shaft fracture. Reliability was only shown for the DASH, making this the preferred instrument. The observed MIC and SDC values provide a basis for sample size calculations for future research.

Section snippets

Materials and methods

Data of the first 140 consecutive patients included in a multicenter, prospective cohort study comparing operative and nonoperative treatment of adults with a humeral shaft fracture were used. This study is registered at the Netherlands Trial Register (NTR3617). The study protocol for this trial has been published elsewhere.23 All patients provided signed informed consent.

Study population

The study population comprised 140 patients who sustained a humeral shaft fracture; of these, 19 patients were lost to follow-up (4 after 2 weeks, 5 after 6 weeks, 6 after 3 months, and 4 after 6 months). In addition, 7 patients missed 1 follow-up visit (5 missed at 2 weeks, 1 at 6 weeks, and 1 at 6 months). The median age was 58 years (25th percentile-75th percentile, 41-68) and 63 patients (45.0%) were male. The right arm was affected in 65 patients (46.4%), and the dominant arm was affected

Discussion

Results of the current study show that the DASH and Constant-Murley are valid instruments to describe symptoms and disability experienced by patients who sustained a humeral shaft fracture over time. The DASH was also found to be reliable.

The DASH instrument and the Constant-Murley ROM subscale demonstrated sufficient internal consistency in this population, as reflected by Cronbach α values of at least 0.70. The observed value for the DASH was consistent with previously published values, which

Conclusions

This study confirms, for the first time, that the DASH and Constant-Murley scores are valid for evaluating outcome over time in patients who sustained a humeral shaft fracture. Reliability was confirmed only for the DASH, making this the most suitable instrument. Ceiling effects were noted at the 1-year follow-up, likely owing to increasing numbers of patients with full recovery. For the DASH, the MIC was 6.7 (95% CI, 5.0-15.8) and the SDC was 19.0 (SEM, 6.9). For the Constant-Murley score, the

Disclaimer

This work was funded by a grant from the Osteosynthesis and Trauma Care (OTC) Foundation (reference number 2013-DHEL).

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

Acknowledgments

Dr. Wim E. Tuinebreijer (clinical epidemiologist, Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands) is acknowledged for statistical advice on the MIC analysis. Tim Van der Torre, Jelle E. Bousema, Boyd C. Van der Schaaf, Joyce Van Veldhuizen, Marije C.A.W. Notenboom, Yordi Claes, and Boudijn S.H. Joling (medical students, Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam,

References (38)

  • D. Revicki et al.

    Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes

    J Clin Epidemiol

    (2008)
  • J.S. Roy et al.

    A systematic review of the psychometric properties of the Constant-Murley score

    J Shoulder Elbow Surg

    (2010)
  • G.P. Slobogean et al.

    The reliability and validity of the Disabilities of Arm, Shoulder, and Hand, EuroQol-5D, Health Utilities Index, and Short Form-6D outcome instruments in patients with proximal humeral fractures

    J Shoulder Elbow Surg

    (2010)
  • N.F. SooHoo et al.

    Evaluation of the construct validity of the DASH questionnaire by correlation to the SF-36

    J Hand Surg Am

    (2002)
  • C.B. Terwee et al.

    Quality criteria were proposed for measurement properties of health status questionnaires

    J Clin Epidemiol

    (2007)
  • M.M. Veehof et al.

    Psychometric qualities of the Dutch language version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH-DLV)

    J Hand Ther

    (2002)
  • WangC. et al.

    Is minimally invasive plating osteosynthesis for humeral shaft fracture advantageous compared with the conventional open technique?

    J Shoulder Elbow Surg

    (2015)
  • T. Aasheim et al.

    The DASH and the QuickDASH instruments. Normative values in the general population in Norway

    J Hand Surg Eur Vol

    (2014)
  • F. Angst et al.

    Responsiveness of five condition-specific and generic outcome assessment instruments for chronic pain

    BMC Med Res Methodol

    (2008)
  • Cited by (44)

    • Using autograft in the surgical treatment of isolated distal ulna fractures with open reduction internal fixation improves short-term clinical outcomes: 11 years of experience

      2021, Orthopaedics and Traumatology: Surgery and Research
      Citation Excerpt :

      Patients’ sociodemographic characteristics, fracture characteristics (side, type of trauma, AO/OTA classification of the fracture), implant type, complications (pseudoarthrosis, infection, screw backout) and time to union were recorded. The Disabilities of the Arm, Shoulder and Hand (DASH) score: high scores represent worse results in this questionnaire that evaluates various topics including difficulty in daily life activities, symptoms, sociability and sleep [15]. MAYO Wrist score: in this scoring system, pain, functional status, range of motion and grip strength are evaluated.

    View all citing articles on Scopus

    This study was exempted by the Medical Research Ethics Committee Erasmus MC (No. MEC-2015-217).

    A list of the HUMMER Trial Investigators is available in the online Appendix (available on the journal's website at www.jshoulderelbow.org).

    View full text