Using the DASH to Model Clinical Recovery Trajectory After Operative Management of Distal Radius Fracture.

Purpose: There is a paucity of literature examining the trajectory of meaningful clinical improvement after distal radius fracture (DRF) fixation. We sought to answer the following questions: (1) When do patients meet the minimum clinically important difference (MCID) in the -Disabilities in Arm, Shoulder, and Hand questionnaire (DASH) score change after DRF fixation? (2) What gains in terms of number of MCIDs achieved (as measured by DASH) do patients make as they recover from DRF fixation? (3) What patient and injury factors are characteristic of patients who meet or do not meet the average recovery trajectory?

Methods: We performed a retrospective review of an institutional database of DRF patients treated with operative fixation. The change in DASH scores from before surgery to approximate follow-up intervals of 0 to 2 months, 3 to 6 months, and a minimum of 9 of 12 months was assessed, in which a delta of 14 reflected the MCID. The change in DASH score from before surgery to each follow-up interval was divided by 14 to determine the number of MCIDs, representing appreciable clinical improvement. Patient characteristics were compared between those who did and did not reach average levels of clinical improvement.

Results: The study included 173 patients. Mean DASH score before surgery was 74 (SD, 19; range, 0-100). After surgery, this improved to 50 (SD, 24; range, 0-100) by 0 to 2 months, 22 (SD, 22; range, 0-98) by 3 to 6 months, and 9.8 (SD, 15; range, 0-75) by a minimum of 9 to 12 months. Overall, 96% of patients reached the MCID by 1 year. Mean cumulative number of MCIDs achieved (ie, number of 14-point decreases in DASH score) at each interval was 1.57, 3.64, and 4.43, respectively. Assuming 4.43 represents maximum average improvement at 1 year, patients achieved 35% (1.57 of 4.43) of recovery from 0 to 2 months after surgery and 82% (3.64 of 4.43) of recovery by 3 to 6 months after surgery. There appeared to be no difference in terms of age, sex, or body mass index with respect to these findings.

Conclusions: Overall, 96% of patients undergoing DRF fixation will achieve one DASH MCID by 1 year after surgery. Patients achieved over 80% of total expected functional improvement by 3 to 6 months after surgery, which appeared to be irrespective of age, sex, or body mass index.

Type Of Study/level Of Evidence: Therapeutic IV.