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Persistent pain after wrist or hand fracture: development and validation of a prognostic model

Date

2019

Authors

Cashin, A.G.
Traeger, A.C.
Hübscher, M.
Moseley, G.L.
Di Pietro, F.
Parkitny, L.
Mcauley, J.H.

Editors

Advisors

Journal Title

Journal ISSN

Volume Title

Type:

Journal article

Citation

Journal of Orthopaedic and Sports Physical Therapy, 2019; 49(1):28-35

Statement of Responsibility

Conference Name

DOI

10.2519/jospt.2019.8342

Abstract

Background: Worldwide, the incidence of wrist fracture is increasing. There are currently no externally validated prognostic models to inform early decision making for these patients. Objectives: To develop and validate a prognostic model from a comprehensive range of candidate prognostic factors that can identify patients who are at risk of developing persistent pain following wrist or hand fracture. Methods: We developed and validated a prognostic model using secondary data derived from a prospective cohort study (n = 715), with recruitment sites in 3 metropolitan hospitals in Sydney, Australia. The primary outcome was persistent pain 4 months following the injury. The current study used a backward stepwise regression analysis to develop the model in 2 hospitals (n = 408) and externally validate it in a third hospital (n = 307). To determine the accuracy of the model, we assessed calibration and discrimination in accordance with the PROGnosis RESearch Strategy framework. Results: Complete data were available for 95% of the cohort. Of 14 candidate variables, the final model contained 2 prognostic factors: patient age and pain intensity reported at initial presentation. The area under the receiver operating characteristic curve was 0.63 (95% confidence interval: 0.56, 0.69) in the development sample and 0.61 (95% confidence interval: 0.51, 0.70) in the validation sample. The model systematically overestimated risk (intercept, −1.13; slope, 0.73). Conclusion: We developed and externally validated a prognostic model to predict persistent pain 4 months after a wrist or hand fracture. Future studies are needed to assess whether the accuracy of this model can be improved by updating and validating it in local settings.

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Dissertation Note

Provenance

Description

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Rights

Copyright 2019 Journal of Orthopaedic & Sports Physical Therapy

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Grant ID

http://purl.org/au-research/grants/nhmrc/APP1144026
 http://purl.org/au-research/grants/nhmrc/1061279
 http://purl.org/au-research/grants/nhmrc/APP1091415
 http://purl.org/au-research/grants/nhmrc/APP1017607
 http://purl.org/au-research/grants/nhmrc/1047827
 http://purl.org/au-research/grants/nhmrc/1047827

Published Version

https://doi.org/10.2519/jospt.2019.8342

Call number

Persistent link to this record

https://hdl.handle.net/11541.2/135878