From 1165 recorded cases of wrist fracture presenting between January 2010 and December 2014, there were 98 potentially eligible participants. 9 opted out and 89 eligible patients were contacted by telephone. From these, 41 consented to undertake the initial survey and 27 of these consented to repeating the survey 1-week later. A profile of the study participants is described in Additional file 1 and the participant flow is displayed in Figure 1. Participant characteristics were similar to the cohort with regard to age, treatment-type and injured side (left or right). There was a low participation rate of males compared with the cohort.
Additional file 1; participant profile
Figure 1. Flowchart of inclusion of participating patients
Incidence of perceived deformity and bother
Of 41 participants, 14 (34%) perceived that they had a wrist deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Three of these four perceived that they had a wrist deformity. Interestingly, one participant who did not perceive a deformity reported that he or she was bothered by the appearance of his or her wrist. Additional file 2 displays a comparison of the perception of bother (dichotomous; yes/no) with the perception of deformity (yes/no). Those who perceived that they had a deformed wrist were more likely to be bothered by the appearance of it than those who perceived no deformity (RR 5.79, p = 0.07).
Additional file 2: deformity vs bother
Association between perceived deformity and treatment-type/function
In the non-surgical treatment group, 11 out of 20 patients (55%) perceived deformity and in the surgical treatment group, only 3 out of 21 patients (14%) believed that their wrist was deformed. Participants treated non-surgically were more likely to perceive deformity compared to those treated surgically (RR 3.85, p = 0.006).
Figure 2 and Additional file 3 display the distribution of PRWE scores according to whether deformity was perceived. Overall, functional outcomes were poorer for those who perceived deformity, but this was not statistically significant (U=239, p=0.15). The mean difference (MD) in PRWE scores between those who perceived deformity and those who did not perceive deformity was 10.9 which was close to the MCID of 11.5 points.
Figure 2; distribution of functional scores by perceived deformity
Additional file 3; distribution of functional scores by perceived deformity
Association between bother and treatment-type/function
All participants who reported that they were bothered by wrist deformity belonged to the non-surgical treatment-type group.
Figure 3 and Additional file 4 display the distribution of PRWE scores by whether bother was reported. There were only four participants who reported that they were bothered by the appearance of their wrist and their functional outcomes were poorer than those who reported that they were not bothered, by both a statistically significant (U=14, p=0.006) and by a clinically important (MD=35.2) margin.
Figure 3; distribution of functional scores by reported bother (yes/no)
Additional file 4; distribution of functional scores by reported bother (yes/no)
Additional file 5 displays the degrees of bother. Additional file 6 is a scatterplot displaying the distribution of functional scores according to the extent of bother reported. The correlation between the extent of bother and functional scores was significant (r = 0.44, p=0.004).
Additional file 5: Deformity vs Degree of Bother
Additional file 6; scatter plot for degree of bother and function scores
Reliability of deformity and bother questions
For the deformity question, all 27 patients who participated in the test-retest component provided a consistent answer on retest, indicating perfect reliability (ᴋ = 1.00) (Additional file 7). For the bother question, 26 participants provided the same answer week-to-week and one changed their answer from a little bothered to not at all bothered. The reliability of the bother question at ᴋ = 0.92 represented “excellent agreement”.
Additional file 7: Reliability of bother question