Development and Application of the WFS-175: A Novel Multidimensional Score for Wrist Function

Abstract

Purpose

We present a novel protocol for wrist function assessment that integrates both objective factors (range of motion and grip strength) and subjective domains (pain, motor function, and quality of life) into the composite Wrist Function Score - 175 (WFS-175) score.

Methods

The protocol consists of three main steps: (1) data collection, which involves measuring the wrist range of motion in six directions using a goniometer and grip strength, including maximum strength, endurance, and recovery, using a Jamar dynamometer, alongside concurrent subjective assessment with a standardized questionnaire; (2) standardization of all data onto a unified scoring scale, applying a linear formula to calculate the total WFS-175 score (maximum 175 points), with the following components: range of motion (30 points), grip strength (40 points), pain (25 points), motor function (40 points), and quality of life (40 points); and (3) input of results into the AppSheet/Google Sheets system, which provides automated calculation, storage, reporting, and graphical visualization for longitudinal tracking of functional recovery.

Results

This protocol yields a standardized assessment form that enables precise calculation of the WFS-175 score. It integrates muscular endurance and recovery measures and fully digitalizes the workflow.

Conclusions

Initial applications show that the WFS-175 score effectively evaluates wrist function and tracks recovery over time. For example, a postoperative patient scored 164/175, indicating excellent recovery.

Clinical relevance

The WFS-175 protocol offers a novel and digital-ready solution for standardized wrist function assessment. By combining objective and subjective measures in one scoring system, it enhances sensitivity and supports clinical decision making in modern rehabilitation.

Wrist function assessment is a critical component in the treatment, rehabilitation, and research of upper-extremity disorders.¹ However, conventional scoring systems largely rely on subjective evaluations or focus on isolated parameters such as range of motion or grip strength.^2,3 This approach risks overlooking subtle or latent dysfunctions and limits comparability between assessments and among patients. Moreover, important dimensions such as muscular endurance and postexertional recovery, essential for a comprehensive evaluation of wrist function, are often not incorporated into existing methodologies.

To address these limitations, we developed the Wrist Function Score - 175 (WFS-175), an integrated scoring system that combines both objective measurements and subjective assessments within a single standardized protocol. The WFS-175 not only provides a comprehensive profile of wrist function but also facilitates digitalization and automation of the assessment process, meeting the practical demands of contemporary clinical practice.

Materials and Methods

The WFS-175 scoring protocol was developed to provide a standardized, multidimensional evaluation of wrist function by integrating both objective physical measurements and subjective patient-reported outcomes. The methodology was designed for ease of implementation in both clinical and research settings and consists of four core components: data collection, scoring standardization, functional classification, and digital integration.

Data collection

Participants were seated comfortably with their forearms supported and wrists in a neutral position. Wrist range of motion (ROM) was measured in six directions: flexion, extension, radial deviation, ulnar deviation, pronation, and supination, using a goniometer. Each movement was scored based on normative data or comparison to the unaffected side, with a combined maximum ROM score of 30 points.

Grip strength was assessed in three phases using a Jamar dynamometer:

• 1.Maximum grip strength (MGS): Participants performed three maximal efforts, each lasting 3 seconds with 1-minute rests. The highest value was recorded and converted to a maximum score of 20 points.⁴
• 2.Fatigue grip strength (FGS): Participants performed five consecutive 2-second grips with 1-second rests. The fifth grip was scored relative to MGS, contributing up to 15 points.
• 3.Recovery grip strength (RGS): After a 2-minute rest, a single grip effort was performed. The result was scored relative to MGS, contributing up to 5 points.

Subjective assessments were conducted using a standardized questionnaire covering three domains:

• 1.Pain (PA): Assessed using a visual analog scale across four items: average pain, frequency of pain, sleep disruption, and interference with daily life. Total score: 25 points.^5,6
• 2.Motor function (MF): Evaluated via four functional tasks, including fine object manipulation and lifting. Total score: 40 points.
• 3.Quality of life (QoL): Measured via impact on occupational tasks, emotional well-being, and adaptability. Total score: 40 points.

Scoring system and composite index

Each individual parameter was converted into a subscore and combined using the following formula:

WFS-175 = ROM + (MGS + FGS + RGS) + PA + MF + QoL

The total maximum score is 175 points. The functional status was classified as follows: (1) 150–175: Excellent function. (2) 125–149: Good with minor limitations. (3) 100–124: Moderate impairment. (4) 75–99: Severe impairment.

<75: Profound dysfunction.

Digital integration and data management

All data were entered into a cloud-based platform (AppSheet integrated with Google Sheets), which automatically calculated total scores, classified functional status, and visualized longitudinal recovery progress through charts and trendlines. This digital workflow minimized human error, enhanced data accessibility, and facilitated future integration with analytics tools and AI algorithms. To facilitate an easier understanding of the utility solution, the Figure illustrates the implementation process of the innovation.

Figure 1.

Flowchart of the wrist function assessment protocol using the WFS-175 scoring system.

Ethical considerations

This study was approved by the institutional review board of the hospital. All participants provided written informed consent, and The Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations were observed where applicable (institutional review board reference number: 4038/GCN-HDDD).

Results

The implementation of the WFS-175 protocol resulted in the development of a comprehensive and standardized wrist function assessment tool, allowing for precise evaluation through a multidimensional composite score.

Development of a standardized scoring instrument

A structured assessment form was created to capture both objective and subjective components of wrist function. The form includes detailed instructions, measurement procedures, and scoring rubrics, ensuring consistency across examiners and sessions. This tool enables direct and systematic calculation of the WFS-175 score, supporting its application in clinical rehabilitation, outcome tracking, and research.

Functional classification framework

Using the composite scoring formula (WFS-175 = ROM + MGS + FGS + RGS + PA + MF + QoL), functional performance was stratified into five categories: excellent (150–175), good (125–149), moderate (100–124), severe (75–99), and profound impairment (<75). This classification assists clinicians in interpreting functional outcomes and monitoring recovery trajectories over time.

Case example: postoperative patient assessment

To illustrate the clinical utility of the WFS-175 system, a case study was conducted involving a man (patient B) following left wrist surgery. The assessment was performed 6 weeks after surgery and yielded the following scores:

• 1.ROM: Full scores were achieved in flexion, extension, pronation, and supination (5/5 each). Ulnar and radial deviation scored 4/5 each, totaling 28/30.
• 2.MGS: The patient achieved 20/20.
• 3.FGS: The fifth grip effort was 60% of MGS, scoring 12/15.
• 4.RGS: Grip strength after 2 minutes returned to 80% of MGS, scoring 4/5.
• 5.Pain: Mild average pain (2/10), frequency 2–3 days/week (4/5), no impact on sleep (5/5), and no interference with activities (5/5), totaling 22/25.
• 6.MF: Full performance in three tasks (10/10), slightly reduced in repetitive actions (8/10), totaling 38/40.
• 7.QoL: No reported negative impacts across four domains, scoring 40/40.
• 8.The final composite score was: WFS-175 = 28 + (20 + 12 + 4) + 22 + 38 + 40 = 164 / 175.

According to the classification framework, patient B demonstrated excellent wrist function, reflecting near-complete recovery without considerable limitations.

Observed advantages of the protocol

The WFS-175 protocol addresses the limitations of conventional assessments by incorporating muscular endurance, recovery metrics, and subjective well-being into a single digital-ready format. This multidimensional approach improves the detection of subtle impairments, supports real time monitoring, and enhances the objectivity of clinical decision making.

Discussion

The WFS-175 protocol was developed in response to a critical gap in the comprehensive evaluation of wrist function. Existing scoring systems often rely on isolated measurements, such as ROM or maximal grip strength, without integrating broader functional domains, endurance, recovery capacity, or patient-reported outcomes. As a result, they may fail to capture nuanced deficits or recovery progress, particularly in patients undergoing postoperative rehabilitation or those with chronic functional limitations.

The WFS-175 score introduces a novel approach by combining six key components: ROM, MGS, fatigue and RGS, pain, MF, and QoL. This composite index reflects not only the mechanical performance of the wrist but also its functional endurance and the patient’s perception of recovery and well-being. These dimensions are crucial in modern musculoskeletal rehabilitation, where subtle impairments, such as delayed recovery after repetitive tasks or persistent low-grade pain, can considerably affect patient outcomes despite normal basic strength or motion.

One of the major innovations of the WFS-175 is the inclusion of triphasic grip strength testing (maximum, fatigue, and recovery). This offers insight into muscle endurance and recovery potential, two parameters often overlooked in traditional wrist scores. In practice, these metrics can guide therapists in tailoring rehabilitation plans to optimize stamina and prevent reinjury.

Additionally, the WFS-175 protocol is designed for full digital integration. Using platforms like AppSheet and Google Sheets, the clinicians can input, analyze, and visualize data in real time. This not only reduces human error but also facilitates longitudinal tracking of recovery, large-scale data aggregation, and potential future integration with artificial intelligence for predictive analytics.

The case study of patient B, who achieved a score of 164/175, demonstrates how the WFS-175 can sensitively capture multidimensional recovery after wrist surgery. Despite only minor limitations in ulnar and radial deviation and fatigue grip, the composite score accurately reflected the patient’s high functional status, supporting both clinical decision making and patient counseling.

Nevertheless, several limitations must be acknowledged. First, although the protocol was tested in a clinical setting, it has yet to undergo large-scale validation to establish normative values across age groups, occupations, and diagnoses. Inter-rater reliability and test–retest consistency also require formal evaluation. Second, the scoring process, although standardized, may be influenced by variability in examiner technique or patient effort, particularly in grip testing and subjective questionnaires. Finally, although the digital interface facilitates data handling, access to devices and training may limit adoption in low-resource settings.

Future research should focus on validating the WFS-175 in diverse populations and comparing its diagnostic sensitivity and responsiveness with established scoring systems such as the Disability of the Arm, Shoulder and Hand (DASH) or the Patient-Rated Wrist Evaluation (PRWE). Additionally, machine learning tools may be employed to analyze score trajectories over time and predict long-term functional outcomes.

In summary, the WFS-175 protocol represents an important advancement in the objective and holistic assessment of wrist function. Its integration of mechanical, functional, and QoL parameters into a single, standardized, and digital-ready tool holds promise for improving rehabilitation strategies and patient-centered care in hand surgery and musculoskeletal medicine.

Conflicts of Interest

No benefits in any form have been received or will be received related directly to this article.