PRWE Score

Original Editor - Aarti Sareen

Top Contributors - Aarti Sareen and Evan Thomas

Introduction

PRWE is the Patient-Rated Wrist Evaluation.The PRWE is a 15-item questionnaire designed to measure wrist pain and disability in activities of daily living. Developed in 1998 for clinical assessment and is used for specific wrist problems.It is one of the reliable upper extremity outcome instrument.[1]

The PRWE allows patients to rate their levels of wrist pain and disability from 0 to 10, and consists of 2 subscales:

  1. Pain subscale: contains 5 items each of which is further rated from 1-10. The maximum score in this section is 50 and minimum 0
  2. Function subscale: contains total 10 items which are further divided into 2 sections i.e specific activities (having 6 items) and usual activities (having 4 items). The maximum score in this section is 50 and minimum 0.

Development of PRWE

Scale items were generated using information obtained from patient and expert interviews, biomechanical literature, and other questionnaires.
Items were reduced and refined through expert interviews and pilot testing on small groups of patients. It Surveyed 100 (66 responded) international wrist investigators (IWIW) to generate items particularly. After developing the items PRWE was tested.[2]

Testing the PRWE

A test-retest reliability study was conducted on patients with distal radius (n=64) or scaphoid (n=35) fractures. The total PRWE score’
s test-retest reliability was excellent over both the short term (2-7 days, ICC > = 0.90) and the long term (1 year, ICC = 0.91). The pain subscale also had excellent short-term and long-term reliability (ICC = 0.90, 0.91, respectively).The function subscale demonstrated excellent short-term reliability (ICC > = 0.88) and moderate long-term disability (ICC = 0.61).[3][4][5]

Objectives

  • To determine level of wrist disability
  • To set treatment goals
  • To determine whether change has occurred
  • To communicate in a meaningful way to payers

Scoring

There are 3 steps to score PRWE

Step 1: Measure the pain score of all 5 items

PRWE1.PNG

Step 2: Measure the function score of all the 10 items and divide it by 2

 PRWE2.PNG

Step 3: Add pain and function score.

Total Score = Sum of pain+ function scores (Best Score = 0, Worst Score = 100)

Less score = better outcome

Merits and Demerits

Merits:

  • Developed with patient interviews
  • Region-specific (wrist) assessment
  • Short and quick
  • Reliable

Demerits

  • Validated / developed from fewer centers
  • Region-specific
  • No hand dominance

PRWHE

Patient rate wrist/hand evaluation (PRWHE) is the modified version of PRWE. The PRWHE has the same items and scoring system as the PRWE. The PRWHE is preferred in hand/wrist clinics as it is more specific and easier to use and also asses the hand along with wrist.

Changes between the PRWE and PRWHE
1) In the PRWHE, the term “wrist” is replaced with “wrist/hand”.
2) The PRWHE has an optional aesthetics question on the form (not part of the scale scoring).

References

  1. Angst F, John M, Goldhahn J, et al. Comprehensive assessment of clinical outcome andfckLRquality of life after resection interposition arthroplasty of the thumb saddle joint.fckLRArthritis Rheum 2005;53:205-213
  2. MacDermid JC, Turgeon T, Richards RS, etfckLRal. Patient rating of wrisfckLRt pain and disability:fckLRa reliable and valid measurement tool. J Orthop Trauma 1998;12:577-586
  3. MacDermid JC, Turgeon T, Richards RS, etfckLRal. Patient rating of wrisfckLRt pain and disability:fckLRa reliable and valid measurement tool. J Orthop Trauma 1998;12:577-586
  4. MacDermid JC, Richards RS,Roth JH. DistfckLRal radius fracture:fckLRa prospective outcomefckLRstudy of 275 patients. J Hand Ther 2001;14:154-169
  5. MacDermid JC, Roth JH,Richards RS. Pain afckLRnd disability reportedfckLRin the year followingfckLRa distal radius fracture: A cohort stfckLRudy. BMC Musculoskelet Disord 2003;4:24