Measuring Outcome after Wrist Injury: Translation and Validation of the Swedish Version of the Patient-Rated Wrist Evaluation (PRWE-Swe)

<p>Abstract</p> <p>Background</p> <p>There is a need for outcome measurement instruments for evaluation of disability after trauma. The Patient-Rated Wrist Evaluation (PRWE) is a self-administered region-specific outcome measuring instrument developed for use in evaluating disability and pain of the wrist. The aim of this study is to translate and to cross-culturally adapt the PRWE for use in a Swedish patient population. Moreover, we aim at investigating the PRWE in terms of validity, reliability and responsiveness.</p> <p>Methods</p> <p>We performed a translation and cross-cultural adaptation of the PRWE to Swedish (PRWE-Swe), utilising the process recommended by the American Association of Orthopedic Surgeons. A total of 124 patients with an injury to the wrist were included in the study. They filled in the PRWE and the DASH questionnaires at two separate occasions.</p> <p>Results</p> <p>Reliability of the PRWE in terms of internal consistency (Cronbach's alpha 0.97) and test-retest stability (intraclass correlation coefficient 0.93) were excellent. Face validity and content validity were judged as good. Criterion validity assessed as the correlation between the PRWE and the DASH was also good (Spearman's rho = 0.9). Responsiveness measured by the standardized response mean (SRM) was good with an SRM_PRWEof 1.29.</p> <p>Conclusion</p> <p>This Swedish version of the PRWE is a short and easily understood self-administered questionnaire with good validity, reliability, and responsiveness. Our results confirm that the PRWE is a valuable tool in evaluating the results after treatment of a wrist injury.</p

Family physicians' effort to stay in charge of the medical treatment when patients have home care by district nurses. A grounded theory study

<p>Abstract</p> <p>Background</p> <p>District nurses (DNs) provide home care for old persons with a mixture of chronic diseases, symptoms and reduced functional ability. Family physicians (FPs) have been criticised for their lack of involvement in this care. The aim of this study was to obtain increased knowledge concerning the FP's experience of providing medical treatment for patients with home care provided by DNs by developing a theoretical model that elucidates how FPs handle the problems they encounter regarding the individual patients and their conditions.</p> <p>Methods</p> <p>Semi-structured interviews were conducted with 13 Swedish FPs concerning one of their registered patients with home care by a DN, and the treatment of this patient. Grounded theory methodology (GTM) was used in the analyses.</p> <p>Results</p> <p>The core category was the effort to stay in charge of the medical treatment. This involved three types of problems: gaining sufficient insight, making adequate decisions, and maintaining appropriate medical treatment. For three categories of patients, the FPs had problems staying in charge. Patients with reduced functional ability had problems providing information and maintaining treatment. Patients who were "fixed in their ways" did not provide information and did not comply with recommendations, and for patients with complex conditions, making adequate decisions could be problematic. To overcome the problems, four different strategies were used: relying on information from others, supporting close observation and follow-up by others, being constantly ready to change the goal of the treatment, and relying on others to provide treatment.</p> <p>Conclusion</p> <p>The patients in this study differed from most other patients seen at the healthcare centre as the consultation with the patient could not provide the usual foundation for decisions concerning medical treatment. Information from and collaboration with the DN and other home care providers was essential for the FP's effort to stay in charge of the medical treatment. The complexity of the situation made it problematic for the FP to make adequate decisions about the goal of the medical treatment. The goal of the treatment had to be constantly evaluated based on information from the DN and other care providers, and thus this information was absolutely crucial.</p