title: Baseline predictors of pain and disability one year following extra-articular distal radius fractures.
abstract: Distal radius fractures are common injuries; however, identifying which factors are responsible for predicting outcomes remains an area of controversy. The purpose of this study was to define factors predictive of patient-reported pain and disability at 1 year in a prospective cohort of extra-articular distal radius fractures (n = 222). Data were collected at the initial visit and after 3, 6, and 12 months. The primary outcome was the 1-year patient-rated wrist evaluation (PRWE) score. The effect of baseline patient and injury characteristics on the 1-year PRWE score was assessed. Univariate and forward stepwise regression analyses both agreed that the most influential predictor of pain and disability at 1 year was injury compensation. The 1-year PRWE score was significantly higher for subjects involved with third-party claims (35.48) compared to those that were not involved in any claims (14.97), p = 0.006. The regression model found that three baseline factors - injury compensation, education, and other medical comorbidities - explained 16.4% of the variance in PRWE scores at 1 year. No injury characteristic, including the degree of initial fracture displacement, was found to significantly influence the 1-year PRWE score. This study has shown that baseline patient and injury characteristics play a small role in predicting 1-year patient-reported pain and disability in extra-articular distal radius fractures. Conceptual factors outside of this biomedical model should be investigated.
authors.affiliation: Division of Orthopedic Surgery, Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, 268 Grosvenor St, London, Ontario, N6A 4L6, Canada. rgrewa@uwo.ca
authors.forename: Ruby
authors.initials: R
authors.lastname: Grewal
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
authors.forename: Janet
authors.initials: J
authors.lastname: Pope
authors.forename: Bert M
authors.initials: BM
authors.lastname: Chesworth
references.citation: J Hand Ther. 1996 Apr-Jun;9(2):178-83
references.pmid: 8784681
references.citation: J Hand Surg Am. 2000 Mar;25(2):330-40
references.pmid: 10722826
references.citation: Clin Orthop Relat Res. 1987 Jul;(220):241-52
references.pmid: 3594997
references.citation: J Orthop Trauma. 1998 Nov-Dec;12(8):577-86
references.pmid: 9840793
references.citation: Med J Aust. 1996 Jul 15;165(2):80-2
references.pmid: 8692067
references.citation: J Bone Joint Surg Am. 1989 Jul;71(6):839-47
references.pmid: 2745480
references.citation: J Hand Surg Am. 1998 May;23(3):381-94
references.pmid: 9620178
references.citation: J Bone Joint Surg Am. 1951 Oct;33-A(4):895-907
references.pmid: 14880544
references.citation: J Clin Epidemiol. 2002 Sep;55(9):849-54
references.pmid: 12393071
references.citation: J Bone Joint Surg Br. 2000 Sep;82(7):972-6
references.pmid: 11041584
references.citation: Injury. 1985 Mar;16(5):289-95
references.pmid: 4008001
references.citation: Am J Public Health. 1982 Jun;72(6):605-7
references.pmid: 7072880
references.citation: Clin Orthop Relat Res. 1986 May;(206):202-10
references.pmid: 3708976
references.citation: Acta Orthop Belg. 2003 Dec;69(6):510-4
references.pmid: 14748106