Introduction
The Patient-Rated Wrist Evaluation (PRWE) is a cornerstone in the assessment of upper extremity conditions, as it provides a quantitative, patient-centric measure of wrist-specific pain and functional disability. To begin with, it was first developed in 1996, and later, validated and published 1998 by Joy C. MacDermid and colleagues. Since then, the PRWE quickly became a highly utilized tool in orthopaedic research. In fact, its development was originally published in the Journal of Orthopedic Trauma. Moreover, since its validation, the scale has accumulated over 1,000 citations on Google Scholar, which clearly reflects its profound influence on clinical practice and scientific inquiry.
Finaly, this comprehensive article explores the PRWE’s design, scoring, practical applications, and psychometric strength, offering a vital resource for experts in orthopedics and musculoskeletal health.
Key Features of the Patient-Rated Wrist Evaluation (PRWE)
Purpose and Use
The primary purpose of the PRWE is to self-assess the severity of wrist pain and the resulting functional disability in daily life. As a result, clinicians commonly use this patient-reported outcome (PRO) measure to evaluate treatment success following surgery or rehabilitation for common wrist pathologies. Furthermore, the PRWE is particularly valuable because it directly captures the patient’s perspective on their disability, a critical element often missed by purely objective measures.
Target Population
The PRWE is validated for use with adults (18+) who present with wrist injuries or disorders, including:
- Young Adults (18–24 years).
- Middle-Aged Adults (25–44 years).
- Older Adults (45–64 years).
Importantly, the PRWE has not been specifically validated for pediatric or senior-specific populations.
Structure
The PRWE scale comprises 15 items which are organized into two main subscales:
- Pain Subscale (5 items): This section assesses different dimensions of pain, including pain at rest, pain during repeated movement, pain when lifting, worst pain experienced, and pain frequency.
- Function Subscale (10 items): This subscale evaluates the patient’s ability to perform specific activities of daily living. These activities are further broken down into two parts:
- Specific Activities (6 items): Tasks like turning a doorknob, cutting meat, buttoning a shirt, pushing from a chair, carrying a heavy object, and using toilet paper.
- Usual Activities (4 items): Broader life roles such as personal care, household work, job-related tasks, and recreational activities.
Scoring Method
Each of the 15 items in the PRWE is measured using an 11-point numeric rating scale (NRS), ranging from 0 (no difficulty/no pain) to 10 (worst possible difficulty/pain). The scoring calculation requires three distinct steps:
- Pain Score: Sum the scores of the 5 pain-related items. This yields a total pain score from 0 to 50.
- Function Score: Sum the scores of the 10 function-related items, and then divide the result by 2. This step standardizes the score to a range of 0 to 50.
- Total Score: Add the Pain Score and the adjusted Function Score. The total PRWE score ranges from 0 to 100.
Crucially, in the PRWE scoring model, a lower score indicates a better outcome, whereas a score of 100 represents the worst possible pain and functional disability.
Although no strict clinical cut-off scores exist, interpretation relies on the continuous total score and the change in score over time to determine treatment efficacy.
Administration Format
The PRWE is highly efficient, taking approximately 5–10 minutes to complete. Since no specialized training is necessary for its use, the scale is self-administered, which enhances its practicality in high-volume clinics.
Furthermore, the questionnaire is available in several administration formats, including:
- Paper-based.
- Digital (online).
- Mobile app.
Applications of the Patient-Rated Wrist Evaluation (PRWE)
The PRWE possesses significant clinical utility across several stages of patient care within the domain of orthopaedics and musculoskeletal rehabilitation.
- Screening: Clinicians can use it to quickly identify patients who require more intensive intervention or are at high risk for prolonged disability.
- Monitoring: The scale’s sensitivity to change makes it an excellent tool for tracking a patient’s progress during non-operative or post-surgical rehabilitation.
- Treatment Planning: The detailed subscale scores guide therapists and surgeons in customizing treatment programs to target specific functional deficits.
- Research: In academic settings, the PRWE is widely accepted as a primary or secondary outcome measure in clinical trials for evaluating treatments for conditions like scaphoid fractures or carpal instability.
Language and availability
The PRWE’s utility is strengthened by its availability in multiple languages, thus supporting its use in global research and diverse clinical populations. Key validated translations include:
- English.
- Mandarin Chinese.
- Spanish.
- French.
Regarding its access, the PRWE operates under a dual licensing model: it is generally free for non-commercial clinical and academic use. However, permission is required for translations, commercial use, or when integrating the scale into electronic health record systems or software. Licensing and distribution are typically managed through licensing platforms.
Reliability and Validity
The PRWE is classified as a highly reliable and valid instrument for measuring patient-reported wrist outcomes. Its strong psychometric properties are evidenced by an impressive Cronbach’s alpha ranging from 0.95 to 0.98 in original studies, indicating excellent internal consistency across its items. Consequently, researchers trust the PRWE to accurately and consistently capture changes in patient status, cementing its status as a gold standard in upper-extremity PROs.
Limitations and Considerations
Despite its strengths, the PRWE has a few limitations:
- Self-report measure: Responses may be influenced by a desire to report good progress or personal interpretation of the rating scale, potentially leading to social desirability bias.
- Narrow Focus: The instrument focuses solely on wrist pain and function; consequently, it does not capture important psychosocial or general health aspects that influence recovery.
- Cultural Bias: Although translations are available, language barriers and cultural interpretations may affect the validity of responses in certain populations.
- Age Restrictions: The scale is not validated for children or adolescents, limiting its applicability across all age groups with wrist injuries
Other Versions And Related Questionnaires
For researchers needing a broader assessment, other versions and complementary tools exist:
- PRWHE (Patient-Rated Wrist and Hand Evaluation): This expanded version includes additional items to assess hand function, making it suitable for patients with conditions affecting both the wrist and the hand, which are often used interchangeably when hand involvement is clinically significant.
- Complementary Questionnaires: For a comprehensive assessment of the entire limb, the PRWE is often used alongside the DASH (Disabilities of the Arm, Shoulder & Hand) or its abbreviated counterpart, the QuickDASH.
Additional Resources
For researchers and clinicians interested in utilizing the PRWE, the following resources are essential:
- A direct link to the Original Validation Study
- You can access the questionnaire as a PDF through this link
- For inquiries, contact Dr. Joy C. MacDermid, the author of the questionnaire, at macdermi@mcmaster.ca
- For additional PRWE resources, consult McMaster University’s School of Rehabilitation Science.
Frequently Asked Questions (FAQ)
- Who can use the PRWE?
Clinicians, researchers, and healthcare providers use the PRWE for adults (aged 18 and older) with wrist injuries or disorders, primarily in the fields of orthopaedics and rehabilitation.
- How long does it take to complete the PRWE?
Patients typically take 5 to 10 minutes to complete the PRWE, which makes it feasible for frequent use in busy clinical and research settings.
- How is the PRWE administered?
Healthcare teams can administer the questionnaire via paper-based, digital (online), or mobile app formats – offering significant flexibility in usage.
- Is there any cost to using the PRWE?
The PRWE is free for non-commercial clinical and academic use. For commercial or electronic system integration, permission from the publisher or licensor is necessary.
A Word from ResRef about Patient-Rated Wrist Evaluation (PRWE)
The PRWE stands out as a concise, highly reliable tool for capturing wrist-specific pain and functional disability. Its strong psychometric properties, ease of use, and wide adoption support its value in both clinical and research settings. With its ongoing translations and validations, PRWE remains a gold standard in upper-extremity outcome measurement.
References
- MacDermid JC. Development of a scale for patient rating of wrist pain and disability. J Hand Ther. 1996 Apr-Jun;9(2):178-83. Link.
- Bastard C, Sandman E, Balg F, Patenaude N, Chapleau J, Rouleau D. Validity, reliability and responsiveness of the French translation of the Patient-Rated Wrist Evaluation Questionnaire (PRWE). Orthop Traumatol Surg Res. 2024 Apr;110(2):103549. Link.
- Rosales, R.S., García-Gutierrez, R., Reboso-Morales, L. et al.The Spanish version of the Patient-Rated Wrist Evaluation outcome measure: cross-cultural adaptation process, reliability, measurement error and construct validity. Health Qual Life Outcomes 15, 169 (2017). Link.
- Wah JW, Wang MK, Ping CL. Construct validity of the Chinese version of the Patient-rated Wrist Evaluation Questionnaire (PRWE-Hong Kong Version). J Hand Ther. 2006 Jan-Mar;19(1):18-26, quiz 27. Link.
