Research methodology in distal radius fracture care 1 step backward, 2 steps forward

The clinical practice guideline for distal radius fractures (DRF) has 29 recommendations; however, none of these recommendations were given a “strong” rating owing to limited strength of the evidence. Therefore, determining effective evidence-based treatment of patients with DRFs is crucial. To conduct best evidence clinical trials, and to properly compare results, there must be a consensus on the use of inclusion criteria and of outcome measures. This thesis aimed to investigate a critical component of the methodology used in DRF research, which might help us to improve the quality of future research. We therefore focused on an underappreciated aspect of methodology: assessment tools used for diagnosis and trial eligibility in patients with DRFs, and the quality of patient-reported outcome measures (PROMs). It appeared that the used classification systems have serious limitations and in our systematic review we found limited to no evidence for any of the measurement properties of the PROMs. This led us to perform a study following the COSMIN standards to ensure high methodological quality. Based on our results we now have strong evidence that both the PRWE and the DASH questionnaires have good content validity and are reliable and internally consistent instruments for the assessment of patients with distal radius fractures.
Furthermore, we showed that spectrum bias has significant influence on the intra-observer agreement of distal radius fracture treatment plans. Finally, we show that is prudent to look more closely at methodological limitations of published research, especially the underappreciated and under-recognized methodological limitations discussed in this thesis.