Comparison between patient-reported and physician-estimated pain and disability in hand and wrist disorders

Background Pain and disability are important components of the assessment of hand problems, but it is unknown how physician estimates compare to patient self-reports. Objective To analyse differences between patient-reported and physician-estimated pain and disability in patients with hand or wrist disorders and to analyse factors influencing these differences. Methods Observational study of patients with hand or wrist disorders seen during multidisciplinary outpatient consultations. Patients, rehabilitation medicine (RM) consultants, RM trainees and plastic surgeons completed visual analogue scales (VASs) to rate the level of self-reported (patients) or estimated (physicians) pain and disability. Multilevel analyses were performed to evaluate differences in VAS-pain and VAS-disability scores between patients and physicians and to evaluate the influences of diagnosis, physician experience and medical specialty. Results Complete data were obtained for 250 patients. Levels of pain and disability estimated by physicians were lower compared to patient self-reports. Ratings differed among medical specialties. Pain was underestimated to a greater extent by plastic surgeons compared to RM consultants. Disability was underestimated to a greater extent by RM consultants compared to plastic surgeons. Estimates of pain and disability did not differ between consultants and trainees in RM. Type of diagnosis did not influence the degree of underestimation of pain and disability. Conclusions Physicians underestimate pain and disability compared to self-reports in patients with hand or wrist disorders. Ratings differ among medical specialties: plastic surgeons underestimate pain more, while RM consultants underestimate disability more. Physician experience and diagnosis do not influence the degree of underestimation of pain and disability.