At Riverina Hand Therapy it is important to us that we review how things are going with treatment.  Are things working?  Is pain being relieved?  Is movement and function improving?  Pain is often a large area that we work on in hand, wrist and arm injuries.  Having a way to measure pain, and its effect on how we use our hands, is essential in our practice. It can be hard to measure pain from a therapist’s perspective as we are not the ones experiencing it.  Everyone copes with pain differently, and it is very individual.  How do we capture this information? One way we do this at Riverina Hand Therapy is through a questionnaire called the Patient Rated Wrist and Hand Evaluation (PRWHE). 

The purpose of the PRWHE is:

  •      To measure pain and disability in patients with wrist and hand pathology, from the patient’s perspective
  •      It aims to provide a brief, standardised, and easy to use tool to gather information on pain and functional disability. 
  •      The tool was designed to measure average arm pain and function over a one week period.

How did the PRWHE come to be?

The patient-rated evaluation was developed at the University of Western Ontario.  It was initially developed as a wrist evaluation only (PRWE), based on patients with pathologic wrist conditions.  This particular evaluation was based on eight background studies over three years, which involved looking at literature that detailed requirements needed to perform specific functional tasks, and reviewing already current questionnaires for outcome items.  Questions were then piloted with wrist patients to compile a task list specific to physical capabilities.  Items were eliminated that were not performed by less than 80% of patients, or that were gender biased.  Specific questions were included to obtain a spectrum of heavy and light activities, wrist movements and tasks performed bilaterally or unilaterally.  This tool has since been tested on its application to a variety of hand injuries, with a change in name to Patient-Rated Wrist/Hand Evaluation.

How does it work?

The PRWHE is a two-page questionnaire containing 15 items, each scored from 0-10.  There is an optional section at the end relating to appearance of the hand.  The questionnaire is broken down into two main sections: pain and function.  The function items are then divided into specific activities and usual activities.  Patients are asked to rate how their hand and wrist has felt on average over the last week.  We use the PRWHE as a great baseline measure of how people are coping with their pain, and how their condition is affecting their ability to complete tasks at home. Repeating the questionnaire after a few sessions can give a good indication clinically to improvements gained in therapy. Typical questions that are asked in the questionnaire include:

Rate the average amount of pain in your wrist/hand over the past week at rest, when lifting a heavy object, and when doing something repetitive

Rate the amount of difficulty you experienced performing the following items: Turn a door knob using the affected hand, use your hand to push up from a chair, and complete personal care activities such as dressing.

How do we use the information from the questionnaire?

We score the answers which gives us a total score, but more importantly we look at the specific areas that are painful or causing difficulty and work together on improving these things.  We also use the pain section on its own sometimes to determine if our treatment is effective at reducing pain symptoms in the hand/wrist.  The PRWHE is a great little tool that forms part of our assessments.  If you come to us in pain, you are likely to come across it!

Reference: MacDermid, J.  (1996).  Development of a scale for patient rating of wrist pain and disability.  Journal of Hand Therapy, April-June (p178-183).