title: The effects of pain, supination, and grip strength on patient-rated disability after operatively treated distal radius fractures.
abstract: OBJECTIVE
  The correlation between physician-observed parameters and patient-rated disability in distal radius fractures is complex and poorly understood. Anecdotal clinical experience suggests that supination is an important factor in the return of functional status after distal radius fracture. To explore this relationship, we conducted a retrospective multivariate linear regression analysis of an existing patient database to evaluate the hypothesis that range of motion and other objective parameters are important determinants of patient-rated disability.
  
  
  METHODS
  We analyzed a prospectively gathered registry of patients undergoing operative fixation of distal radius fractures using physical examination parameters measured at each follow-up visit and patient-based outcomes including Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and visual analog scale for pain. We constructed a multivariate linear regression model to evaluate the association of range of motion, grip strength, and visual analog scale score with the DASH score.
  
  
  RESULTS
  We analyzed data from 190 patients and 611 total clinic visits. Pain, grip strength, and supination were significantly correlated with DASH scores, controlling for all other factors. These 3 variables were able to predict 56% of the variability of the DASH score. Flexion-extension, radial-ulnar deviation, and pronation had no significant correlation to DASH score.
  
  
  CONCLUSIONS
  Pain, strength, and supination appear to be important determinants of patient-rated outcomes after distal radius fracture. Pain and strength continuously improve over time up to 2 years after surgery, whereas supination plateaus more quickly, usually within the first 3 to 6 months.
  
  
  METHODS
  Diagnostic II.
authors.affiliation: Department of Orthopaedics, Columbia University Medical Center, New York, NY, USA. efs2129@columbia.edu
authors.forename: Eric
authors.initials: E
authors.lastname: Swart
authors.forename: Kate
authors.initials: K
authors.lastname: Nellans
authors.forename: Melvin
authors.initials: M
authors.lastname: Rosenwasser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D018737:Hand Strength; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011885:Radius Fractures / Q000503:physiopathology* / Q000601:surgery*; D016059:Range of Motion, Articular; D013484:Supination; D011795:Surveys and Questionnaires; D016896:Treatment Outcome