Construct Validity of the Chinese Version of the Patient-rated Wrist Evaluation Questionnaire (PRWE-Hong Kong Version)

doi:10.1197/j.jht.2005.10.003

Journal of Hand Therapy

Volume 19, Issue 1, January–March 2006, Pages 18-27

https://doi.org/10.1197/j.jht.2005.10.003 Get rights and content

Abstract

With increasing economic globalization, including health care, it is important to use standardized outcome measures applicable to a broad spectrum of patients in a wide array of countries. The purpose of this study was to verify construct and content validity and reliability of the Chinese version of the Patient-rated Wrist Evaluation Questionnaire (PRWE-Hong Kong version). The PRWE was translated into Chinese, and face validity was established by inviting experts and patients to participate in the panel review of the questionnaire. A correlation field study was performed using a convenience sample of 47 patients with wrist injuries. Patients were assessed at baseline and six weeks after the initial measurement. The following measures were taken: the Chinese version of the PRWE and the Medical Outcome Short Form (36) Health Survey (SF-36), Visual Analogue Scale (VAS) for pain, active wrist range of motion, grip strength, and the Jebsen Hand Function Test. Statistical analysis consisted of Pearson correlation coefficients (convergent validity), factor analysis (content validity), paired t-test (convergent validity), and the Cronbach alpha (internal consistency). Clinically relevant correlations existed between “Pain at rest” and the VAS “resting pain” (r = 0.785, p < 0.0001) as well as between “Pain on repeated wrist movement” and the VAS “exertion pain” (r = 0.872, p < 0.0001). The “Physical Component Summary” of the SF-36 was found significantly correlated with the PRWE function subset total score (r = −0.618, p < 0.0001), and the PRWE total score (r = −0.645, p < 0.0001). The specific function subset score also correlated with the wrist flexion range (r = −0.308, p < 0.0001) and the grip strength (r = −0.488, p = 0.035). Two factors were found that accounted for 61% of the variance. The Cronbach alpha coefficients ranged from 0.7805 to 0.9502, indicating that the internal consistency of the questionnaire items was sound and reliable. Positive correlations between the wrist ranges of motion (ROM) and the specific function subset score showed that the function subset measured dimensions related to wrist-specific performance in activities of daily living. Factor analysis results supported the construct validity of the PRWE-Hong Kong version in wrist-injured patients. Internal consistency testing results suggested that item consistency within subset items was good and persisted over time. In conclusion, the Chinese version of the PRWE is a reliable and valid self-rated tool in measuring treatment outcome. It supplements traditional objective clinical measures and is potentially applicable in Hong Kong clinical settings.

Section snippets

Translation Procedures

The PRWE was first translated into Chinese (Appendix A) by a certified translator whose first language was Chinese, with a strong background in English. She was certified after completing her study in “Translation” in the Hong Kong Polytechnic University of Hong Kong. The translated PRWE was then reviewed on its semantic and cultural equivalence by a panel of experts using a standardized questionnaire. Fourteen multidisciplinary panel members, including a clinical, medical professor, medical

Content Validation

According to the results of data analysis and qualitative feedback from the panel members, the questionnaire achieved its representativeness and relevance in assessing the Chinese patients' wrist conditions. The conceptual and semantic equivalencies achieved over 60% agreement among the panel members. Moreover, during the trial test, ten patients were requested to rate their wrist conditions by the PRWE-HK, and results showed that all ten gave positive answers. They reported that the

Discussion

The items in the new questionnaire (the PRWE-HK) were found to have over 60% agreement among the panel members, and the new questionnaire was accepted as semantically and culturally equivalent to the original version of the questionnaire.

Reliability of the scale as expressed by internal consistency was good. The correlation between the physical dimensions of the wrist (ROM and grip strength) and the specific function subset of the PRWE-HK indicated that the subjective ratings on the functional

Limitations of the Study

The sampling size for the study was small since only 47 subjects were involved. It might lead to the nonclarity of actual numbers of factors composing the PRWE-HK. Larger sample size for factor analysis could enhance the stability of the statistical result. For validation, we probably would need a more homogeneous sample. Due to the time limitation, the responsiveness of the PRWE-HK was not investigated. Responsiveness is the ability of an instrument to detect small but important clinical

Conclusion

This study explored the newly translated version of a self-rated questionnaire, the PRWE-HK, to assess wrist conditions in terms of pain and functional difficulties. Quality criteria as suggested by Bialocerkowski et al. were used, including content validity, construct validity, and reliability to quantify its suitability in clinical use.²⁷ Reliability as measured by internal consistency was good. Results of this validation study showed that the PRWE-HK provided patients with easy rating of

Acknowledgment

The authors would like to thank Caroline W. Stegink Jansen, PT, PhD, for her professional advice and hard work during the final stages of manuscript preparation.

Quiz: Article #017

Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.

#1.
The original PRWE was developed in:
- a.
  Hong Kong
- b.
  Canada
- c.
  US
- d.
  UK
#2.
The ___________ is a wrist specific outcome measure:
- a.
  SF-36
- b.
  DASH
- c.
  JHFT
- d.
  PRWE
#3.
There was an agreement rate of approximately _____% among panel members:
a.
90
b.
70
c.
60
d.
50
#4.
The PRWE-HK is recommended because:
- a.
  patient responses are not to be trusted
- b.
  traditional clinical measures are often inadequate to assess patient

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Validation of Persian Version of Patient-Rated Wrist and Hand Evaluation: Confirmatory Factor Analysis and Rasch Analysis
2020, Archives of Rehabilitation Research and Clinical Translation
To determine the factor structure and test the clinometric properties of wrist and hand version of the Patient-Rated Wrist Evaluation.
Cross-sectional study using Rasch analysis and factor analysis. Confirmatory factor analysis was conducted to assess the factor structure. Higher-order factor analysis was used to explore the hierarchical structure of the items. The Rasch model was used to assess the overall fit, reliability, validity, and construct unidimensionality. Rasch analysis and factor analysis were conducted using RUMM2030 and LISREL software, respectively.
Outpatient hand rehabilitation clinic.
A convenience sample of patients (N=206) with various hand injuries who completed the Persian version of the Patient-Rated Wrist and Hand Evaluation (PRWHE-P) at 2 months postinjury. The study included 66 men and 139 women, with a mean age of 40 years.
Not applicable.
The PRWHE-P was used as a patient-reported measure of pain and disability in wrist and hand conditions.
Factor analysis confirmed 3-factor models of the PRWHE-P. Items fit well to the Rasch model in 3 subscales. The PRWHE-P had a good item reliability (0.82) and good internal consistency (0.8). No differential item functioning was detected for age, sex, dominant hand, or injured hand.
The results of this study indicated that the PRWHE-P with 3 sub scales is a reliable and valid measurement tool and could be used in patients with different wrist and hand disabilities.
Construct validity of the Patient-Rated Wrist and Hand Evaluation questionnaire (PRWHE) for nerve repair in the hand
2019, Musculoskeletal Science and Practice
Citation Excerpt :
It may be slightly more responsive than the Disability of the Arm, Shoulder and Hand (DASH) questionnaire (MacDermid and Tottenham, 2004). It has been translated into several languages and validated in various countries (Voche et al., 2003; Xu and Seow, 2003; Wah et al., 2006; Hemelaers et al., 2008; John et al., 2008; Brink et al., 2009; Wilcke et al., 2009; Imaeda et al., 2010; Mellstrand Navarro et al., 2011; Mehta et al., 2012; Rodrigues et al., 2015). For nerve injuries of the hand, a battery of performance-based tests can be used to assess sensory and motor domains (Novak, 2001; Jerosch-Herold, 2005; Vordemvenne et al., 2007; Kim et al., 2011).
Many tools have been described for outcome assessment after nerve repair. The Patient-Rated Wrist and Hand Evaluation (PRWHE) have been shown to be valid for several hand conditions.
To explore the construct validity of the PRWHE in comparison to cold intolerance, pain and dysfunction questionnaires; the Rosén score and its subcomponents; and threshold sensibility, dynamometry and dexterity tests for nerve repair of the hand.
Clinical measurement.
Construct validity was analysed through Pearson's correlation coefficient in a convenience sample of 32 adult patients after long-term median and ulnar nerve repair.
The PRWHE total score was highly to moderately associated with the Disability of Arm, Shoulder and Hand (r = 0.83), Cold Intolerance Symptom Severity (r = −0.60) and McGill's Pain (r = 0.58) questionnaires. In addition, it was correlated to motor (r = −0.55) and sensor subdomains (r = −0.56) of the Rosén score. Substantial to high associations were found for the motor, sensory impairment and dexterity test.
The PRWHE was shown to be valid, based on construct validity, for patients with nerve repair of the hand.
Cross-cultural adaptation and psychometric testing of the Arabic version of the Patient-Rated Wrist Hand Evaluation (PRWHE-A) in Saudi Arabia
2015, Journal of Hand Therapy
Citation Excerpt :
Furthermore, the PRWHE is shorter than the DASH and is more quick and easy to fill out.15 Although alternate language versions of the PRWHE are available,15–25 there is no Arabic version of the PRWHE. Most health status measures were developed in English-speaking countries26; therefore, in most cases clinicians and researchers may not include immigrant populations when developing such measures.
The purposes of this study was to 1) perform a cross-cultural Arabic translation for the Patient-Rated Wrist and Hand Evaluation (PRWHE-A) using standardized guidelines and, 2) to test the psychometrics properties of the translated measure.
A total of 48 patients with variety of hand disabilities, a mean age of 47 ± 16 years were recruited and assessed two times. The intraclass correlation coefficient (ICC) was used for assessing test-retest reliability of the PRWHE-A and its subscales while Cronbach's alpha (CA) was used for assessing the internal consistency. Construct validity was assessed by examining the strength of the correlation between the PRWHE-A and the Arabic version of the Disability of the Arm, Shoulder and Hand (DASH-A).
The PRWHE-A demonstrated excellent test-retest reliability (ICC= 0.97) and internal consistency (CA= 0.96). The DASH-A demonstrated moderately to low correlation (r= 0.64) with the PRWHE-A.
The results of this study indicated that PRWHE-A is a reliable and valid assessment tool and can be used in patients with different wrist/hand disabilities whose primary language is Arabic.
Brazilian version of the Patient Rated Wrist Evaluation (PRWE-BR): Cross-cultural adaptation, internal consistency, test-retest reliability and construct validity
2015, Journal of Hand Therapy
Citation Excerpt :
Also, PRWE is easier and faster to fill out when compared to the DASH, considering it has fewer items.15,17 The PRWE is available in several languages, including Danish, Hindi, Korean, Italian, German, Swedish, Dutch, Japanese and Chinese.17–27 Besides those languages, there are reported translations in Czech, French, Hungarian, Russian, Ukranian and Norwegian.28,29
Clinical measurements.
Perform the translation and cross-cultural adaptation of the Patient Rated Wrist Evaluation (PRWE) into a Brazilian version (PRWE-BR), and assess its internal consistency, test-retest reliability and construct validity.
PRWE-BR was developed using standardized guidelines. Sixty-one patients with different wrist injuries were recruited. They were submitted to two assessments, 2–7 days apart. Reliability was measured by internal consistency (Cronbach's alpha) and test-retest reliability (Intraclass Correlation Coefficient). Construct validity was determined via hypothesis testing (Spearman's correlation) of correlations with subscales of SF-36 and DASH.
PRWE-BR and its subscales achieved high internal consistency (Cronbach's alpha ≥ 0.85) and excellent test-retest reliability (ICC ≥ 0.90). Construct validity was established by confirmation of 85.7% of our previously formulated hypotheses.
PRWE-BR is a valid and reliable tool for the assessment of pain and dysfunction in Brazilian patients with injuries involving the wrist joint.
N/A
Evaluation of the Korean version of the patient-rated wrist evaluation
2013, Journal of Hand Therapy
Clinical measurements. Longitudinal.
To translate and cross-culturally adapt the original patient-rated wrist evaluation (PRWE) into a Korean version (K-PRWE), and to measure the reliability, validity, and responsiveness of the K-PRWE for the evaluation of distal radius fractures (DRFs).
K-PRWE was developed by forward and backward translations of the PRWE and resolution of cultural discrepancies. Sixty-three DRF patients that underwent open reduction and volar plate fixation completed the K-PRWE at 3 months and 6 months postoperatively. Grip strength, wrist range of motion, VAS for wrist pain and the Korean version of DASH were performed at 3 months postoperatively. Reliability was measured by determining test-retest reliability (intraclass correlation coefficient) and internal consistency (Cronbach's alpha coefficient). Criterion and construct validity testing was performed using Spearman's correlation test. Responsiveness was evaluated using effect size (ES) and standardized response mean (SRM).
Cronbach's alpha coefficient and the intraclass correlation coefficient of the K-PRWE were 0.94 and 0.96, respectively, which indicated that the internal consistency of the questionnaire items was sound and reliable. The correlation coefficient between K-PRWE and K-DASH scores was 0.74 and between K-PRWE and VAS scores was 0.69. Responsiveness was good with an ES of 0.84 and an SRM of 0.89.
The Korean version of the PRWE was found to be reliable, valid, and responsive to evaluate the pain and disability associated with distal radius fractures.
Cross-cultural adaptation and psychometric testing of the Hindi version of the patient-rated wrist evaluation
2012, Journal of Hand Therapy
Citation Excerpt :
The construct validity of a PRO is usually assessed by examining its relationship with other outcomes that are either considered gold standard or at least measure similar construct. Previous psychometric studies conducted using English version of the PRWE had an advantage in that they were able to assess the relationship of the PRWE with a region-specific scale such as the DASH20,21,26 and global health status measure such as the Short-Form 36.19–21,27 Because there is no hand or UE outcome measure in Hindi, we had to assess the construct validity of the PRWE-H and its subscales by examining their relationship with the one-item outcomes such as the VAS-P, VAS-D, and the objective outcomes, such as the ROM and grip strength of the affected side.
The purpose of this study was to perform cross-cultural adaptation and Hindi translation of the patient-rated wrist evaluation (PRWE) and assess psychometric properties of the PRWE-Hindi. Cross-cultural adaptation and Hindi translation of the PRWE was performed using standardized guidelines. Intraclass correlation coefficient (ICC) was used for assessing test–retest reliability, and Cronbach’s alpha (CA) was used for assessing the internal consistency of the PRWE-Hindi. Construct validity was assessed by examining the correlations between the PRWE-Hindi and grip strength, wrist range of movements, and self-reported pain and disability. A total of 50 patients with distal radius fracture were recruited and assessed three times (baseline, two to three days later, and four to five weeks later). PRWE-Hindi demonstrated excellent test–rest reliability (ICC = 0.81) and internal consistency (CA = 0.89). Moderate to low correlations (r < 0.7) were observed between the PRWE-Hindi and other measures of pain and disability. Our results indicated that PRWE-Hindi is a reliable and valid tool and can be used in patients with wrist/hand injuries whose primary language is Hindi.
N/A.

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Scientific/Clinical ArticleConstruct Validity of the Chinese Version of the Patient-rated Wrist Evaluation Questionnaire (PRWE-Hong Kong Version)

Abstract

Section snippets

Translation Procedures

Content Validation

Discussion

Limitations of the Study

Conclusion

Acknowledgment

Quiz: Article #017

J Hand Surg

J Hand Ther

J Hand Ther

J Hand Surg

J Clin Epidemiol

J Clin Epidemiol

J Hand Surg

J Hand Surg

J Chronic Dis

J Chronic Dis

J Chronic Dis

Factors related to satisfaction in review of patients with hemiresection arthroplasty or silastic thumb arthroplasty

J Hand Ther

Patient rating of wrist pain and disability: a reliable and valid measurement tool

J Orthop Trauma

Scientific/Clinical Article
Construct Validity of the Chinese Version of the Patient-rated Wrist Evaluation Questionnaire (PRWE-Hong Kong Version)