title: Comparison of ceiling effects between two patient-rating scores and a physician-rating score in the assessment of outcome after the surgical treatment of distal radial fractures.
abstract: We compared the ceiling effects of two patient-rating scores, the Disability of the Arm, Shoulder and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE), and a physician-rating score, the Modified Mayo Wrist Score (MMWS) in assessing the outcome of surgical treatment of an unstable distal radial fracture. A total of 77 women with a mean age of 64.2 years (50 to 88) who underwent fixation using a volar locking plate for an unstable distal radial fracture between 2011 and 2013 were enrolled in this study. All completed the DASH and PRWE questionnaires one year post-operatively and were assessed using the MMWS by the senior author. The ceiling effects in the outcome data assessed for each score were estimated. The data assessed with both patient-rating scores, the DASH and PRWE, showed substantial ceiling effects, whereas the data assessed with MMWS showed no ceiling effect. Researchers should be aware of a possible ceiling effect in the assessment of the outcome of the surgical treatment of distal radial fractures using patient-rating scores. It could also increase the likelihood of a type II error.
authors.affiliation: KEPCO Medical Center, 308, Uicheon-ro, Dobong-gu, Seoul, South Korea.
authors.forename: S-J
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Hanyang University College of Medicine, 17, Haengdang-dong, Seongdong-gu, Seoul, South Korea.
authors.forename: B-G
authors.initials: BG
authors.lastname: Lee
authors.affiliation: Eulji University College of Medicine, 280-1, Hagye-dong, Nowon-gu, Seoul, South Korea.
authors.forename: C-H
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Ajou University Hospital, 164, World Cup-ro, Suwon, South Korea.
authors.forename: W-S
authors.initials: WS
authors.lastname: Choi
authors.affiliation: Myongji Hospital, 697-24, Hwajung-dong, Deokyang-gu, Goyang, South Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Hanyang University College of Medicine, 17, Haengdang-dong, Seongdong-gu, Seoul, South Korea.
authors.forename: K-H
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*
keywords: distal radius fracture; patient-rating scale; DASH; PRWE; physician-rating scale; MMWS; ceiling effect