PEM

Mike Hayton now regularly uses the PEM patient scoring system in clinic, pre and post op.

So why do we use Patient Evaluation Measure (PEM) Forms?
Although there are many patient questionnaires looking into the wrist and hand, PEM forms have the advantage of being used preoperatively, during treatment and post operatively.
PEM was developed in the UK in 1995 and consists of a set of 18 questions. The 18 questions have been split into three sections, the first being five questions on treatment. The second section contains ten questions on the condition of your hand at this moment in time, and the third section is an overall assessment containing three questions.
PEM has a scoring system, whereby each question from sections two and three are marked from 1-7, 7 being the worst outcome and 1 being the best outcome, and written as a percentage.
Research conducted by authors from Leicester carried out a study over a three year period on 80 patients with acute scaphoid fractures. The patients were examined five times within that three year period.
At each visit, a PEM form was completed by each participant and the hand was examined for tenderness and information on the type, site, severity and frequency of pain and swelling were recorded. The grip strength was measured at each visit, as was range of movement of the affected area. 
The examined information was correlated with the PEM score at each visit. The authors found with patient's that had changes in symptoms on their examination, also had significant changes in their PEM score, confirming the responsiveness of this type of scoring system.
Advantages of the PEM scoring system is the style of it is simple; using short, clear questions and it is set out in a visual analogue format, so it is relatively easy for patients to understand. However, it is suggested if PEM were to be used repeatedly, the patient should know their previous answers in order to provide a more accurate measure of change.

The authors from this Leicester study confirmed from their findings, that no bias existed from the PEM scores with regards to gender, age and hand dominance, nor the side on which was the affected hand. The study concludes that PEM is an internally consistent form, which is highly reliable, valid and responsive when assessing outcomes of disorders in of the hand.
So following on from the up-to-date research above, using PEM scores with patients can have a real benefit, not only to surgeons who use this type of scoring system, including Mr Mike Hayton, but also to the individual patients themselves.

Please click this link to the original article and look at the questions


J.J. Dias, B. Bhowal, C.J. Wildin, J.R. Thompson. From Leicester Royal Infirmary, Leicester, England.