Inter-rater reliability, sensitivity to change and responsiveness of the orthopaedic Wolf-Motor-Function-Test as functional capacity measure before and after rehabilitation in patients with proximal humeral fractures

Abstract

Background The incidence of proximal humeral fractures (PHF) increased by more than 30% over the last decade, which is accompanied by an increased number of operations. However, the evidence on operative vs. non-operative treatment and post-operative treatments is limited and mostly based on expert opinion. It is mandatory to objectively assess functional capacity to compare different treatments. Clinical tools should be valid, reliable and sensitive to change assessing functional capacity after PHFs. This study aimed to analyse inter-rater reliability of the videotaped Wolf-Motor-Function-Test-Orthopaedic (WMFT-O) and the association between the clinical WMFT-O and the Disability of the Arm, Shoulder and Hand (DASH) and to determine the sensitivity to change of the WMFT-O and the DASH to measure functional capacity before and after rehabilitation in PHF patients. Methods Fifty-six patients (61.7 ± 14.7 years) after surgical treatment of PHF were assessed using the WMFT-O at two different time points. To determine inter-rater reliability, the videotaped WMFT-O was evaluated through three blinded raters. Inter-rater agreement was determined by Fleiss’ Kappa statistics. Pearson correlation coefficients were calculated to assess the association between the clinical WMFT-O and the video rating as well as the DASH. Sensitivity to change and responsiveness were analysed for the WMFT-O and the DASH in a subsample of forty patients (53.8 ± 1.4 years) who were assessed before and after a three week robotic-assisted training intervention. Results Inter-rater agreement was indicated by Fleiss’ Kappa values ranging from 0.33–0.66 for functional capacity and from 0.27–0.54 for quality of movement. The correlation between the clinical WMFT-O and the video rating was higher than 0.77. The correlation between the clinical WMFT-O and the DASH was weak. Sensitivity to change was high for the WMFT-O and the DASH and responsiveness was given. In comparison to the DASH, the sensitivity to change of the WMFT-O was higher. Conclusion The overall results indicate that the WMFT-O is a reliable, sensitive and responsive instrument to measure more objectively functional change over time in rehabilitation after PHF. Furthermore, it has been shown that video assessment is eligible for studies to ensure a full blinding of raters. Trial registration Clinicaltrials.gov, NCT03100201 . Registered on 28 March 2017. The trial was retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12891-019-2691-0) contains supplementary material, which is available to authorized users.

Robot-assisted training after proximal humeral fracture: A randomised controlled multicentre intervention trial

“…The Wolf Motor Function Test-Orthopaedic has previously shown a somewhat higher sensitivity to change in proximal humeral fracture patients compared to the Disabilities of the Arm, Shoulder and Hand Questionnaire. 15 Considering the results of the minimally important difference (0.3 standard deviations from baseline) of a previous study with a similar study population, it can be seen that the improvements achieved during the intervention period in the present study (Wolf Motor Function Test-Orthopaedic and Disabilities of the Arm, Shoulder and Hand Questionnaire) were not only statistically significant but also clinically relevant. 15…”

“…Clinical baseline and follow-up included the first module of the patient-reported Disabilities of the Arm, Shoulder and Hand Questionnaire as the primary outcome measure and the Wolf Motor Function Test-Orthopaedic version. 13–15 Further clinical assessments during baseline and follow up included a goniometer-based measurement of the active range of motion of the shoulder joint 16 and grip strength using the Jamar dynamometer. 17 The Disabilities of the Arm, Shoulder and Hand Questionnaire was additionally evaluated via a postal questionnaire at six months (6 ± 1 month after surgery) and 13 months (13 ± 2 month after surgery) postoperatively.…”

Sensitivity to change and responsiveness of the Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in patients with subacute cerebral infarction

“…Responsiveness is defined as the ability of an instrument to measure a meaningful or important change in a clinical state 19 , 21 ) . The ES and SRM are used as parameters of responsiveness 23 , 24 ) , as well as sensitivity to change 20 , 35 , 36 , 37 ) . However using parameters such as the ES or SRM to assess responsiveness in common states is inappropriate 22 ) .…”

Smartwatch-based functional assessment for upper extremity impairment after musculoskeletal injuries: A pilot study

“…For the functional evaluations, the WMFT and UEFI were selected, as they mostly comprise typical activities of daily living (ADL). Although WMFT is mainly used in stroke or brain injury, the use of its adapted form has been validated in musculoskeletal cases ( Nerz et al, 2019 ). UEFI was originally developed for functional disability in orthopedic conditions.…”