RESPONSIVENESS OF THE ACTIVE WRIST JOINT POSITION SENSE TEST FOLLOWING DISTAL RADIUS FRACTURE INTERVENTION

Abstract

The primary purpose of this study was to determine the responsiveness of the active wrist joint position sense (JPS) test to detect wrist sensori-motor status change at 8 and 12 weeks following distal radius fracture (DRF) treatment intervention. Responsiveness, defined as the instrument's ability to accurately detect change, was analyzed via distribution- and anchor-based statistical methods. Distribution-based analysis encompassed both group- (i.e., effect size [ES], standardized response mean [SRM]) and individual-based (i.e., minimum detectable change [MDC]) statistical indices. Anchor-based analysis was used to determine the minimal clinically important deficit (MCID) value by linking active wrist JPS test scores to Patient Global Impression of Change (PGIC) scale values. The secondary purposes of the study were to: 1) compare the active wrist JPS test responsiveness as reflected by its MCID value between non-surgical and surgical DRF treatment interventions, 2) compare the active wrist JPS test responsiveness as reflected by its MCID value between participants with high- and low-pain levels, 3) compare the active wrist JPS test scores between participants with high- and low-pain levels, 4) assess the relationship between active wrist JPS test MCID value and function, and 5) determine the intra-tester reliability of the PGIC scale for assessing global health status change following DRF treatment intervention. A prospective cohort study design was utilized. Thirty-three participants between 25 and 90 (mean 59.72) years of age following any non-surgical and surgical DRF treatment intervention were recruited. The active wrist JPS test was determined to be highly responsive based on group-based statistical indices (ES [8 weeks = 1.53, and 12 weeks = 2.36] and SRM [8 weeks = 1.57, and 12 weeks = 2.14]). Statistically significant MDC values were 4.28 and 4.94 deg at 8 and 12 weeks following treatment initiation, respectively. Clinically meaningful MCID values at 8 and 12 weeks were 5.00 and 7.09 deg, respectively. Responsiveness levels were not significantly different between the two treatment and pain-level groups at 8 and 12 weeks post DRF treatment intervention. High-pain participants demonstrated significantly greater JPS deficits at both 8 and 12 weeks, and a significant association existed between active wrist JPS test MCID value and function. The PGIC scale intra-tester reliability was found to be high (ICC = 0.97). Based on this study's findings, clinicians can use this highly responsive test with confidence to measure statistically and clinically meaningful conscious wrist sensori-motor function change following DRF treatment.