upper limb outcome measures

Traditional outcome measures in CMD include gross motor and mobility assessments, yet significant motor declines underscore the need for valid upper extremity motor assessments as a clinical endpoint. Key words: functional assessment, upper limb, outcome mea-sure… John M. Miguelez, CP, FAAOP (D), is the president and senior clinical director of Advanced Arm Dynamics (AAD), which he founded in 1998. The ArmAssist is a simple low-cost robotic system for upper limb motor training that combines known benefits of repetitive task-oriented training, greater intensity of practice, and less dependence on therapist assistance. Marino, R. J., Shea, J. A license is required to use the QUEST. Only 15 measures were used in more than 5% of studies (dotted line). Outcome Measures Injury-Psychological Readiness to Return to Sport scale 6 questions (confidence)20 FOTO SPADI The selection of measures for clinical evaluation will depend on the patient’s level of function and goals for treat-ment. Örebro Studies in Care Sciences 48. 6,34. limb function, motion, motion capture, outcome measures, patient outcome assessment, prosthetic performance, upper limb. Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review Background Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians. The license, which includes the QUEST manual and assessment form, can be purchased from the CanChild e-store. Recent literature has reported the need to utilise validated upper limb outcome measures in the assessment and management of patients with neck pain. Previous article. Outcome measures for upper limb prosthetics can be either observational based, timed, or self-reported by means of interviews or questionnaires. The aim of this study was to provide a systematic review of psychometric studies of upper extremity (UE) outcome measures validated by Rasch analysis and assess the extent to which their measurement areas cover the domains of the International Classification of … 1996 Jun;29(6):602-8. • Upper limb outcome measures are increasingly recognised as valuable and meaningful • Rapid progress over the last few years has facilitated measurement of the upper limb in both ambulant and non-ambulant boys to enable longitudinal evaluations in clinical trials and natural history studies. The AM-ULA is a new measure of activity performance for adults with upper limb amputation that considers task completion, speed, movement quality, skillfulness of prosthetic use, and independence in its rating system. The ARAT is a proven standardized evaluative measure to assess specific changes in upper limb function among individuals who sustained cortical damage resulting in hemiplegia. Conclusion: UE-MEPs may represent a clinically relevant outcome measure to quantify corticospinal tract integrity in PwPMS, at least when LE-MEPs cannot provide a measurable response. The search identified 660 peer-reviewed publications related to outcome measurement with upper limb amputees of which 25 met all of the author's inclusion criteria for full review. The FMA, a measure of body function, has recently been recommended as a primary outcome measure for intervention trials targeting the upper limb throughout different phases after stroke (71, 72). Included articles addressed the effects of multiple sessions of an intervention involving a VR component. an upper extremity outcome measure nor examined the psychometric properties of the PSFS for patients with musculoskel-etal problems of the upper extremity. It’s having specific upper limb experience, coupled with an ability to consistently deliver prostheses that are successfully worn and not just utilized but maximized. In March 2013, a team of physical and occupational therapists published an outcomes measurement tool for adults with upper-limb amputations, the Activities Measure for Upper Limb Amputees (AM-ULA), to assess rehabilitation progress and document the effectiveness of prostheses.The efforts were predicated on prior research that revealed most outcome measures for patients with upper-limb … The use of core outcomes makes it easier for the results of trials to be compared, contrasted and combined within systematic reviews and meta analyses. Both have been widely used and are available in different language versions. Development of a functional protocol is regarded as a realistic enhancement for research of neck and upper extremity disorders in the workplace. Of these measures the Fugl-Meyer Test (FMT) was the most commonly used, almost twice as much as the others. Measures pain and function in the upper limb and the effect of treatment on pain and shoulder function. These are reports directly from the patients,which reflect their preferences and perceptions.Patients assess constructs such as symptoms,satisfaction, function, health perceptions, andquality of life. Frequency of use of different upper limb outcome measures (in % of studies). Upper limb disability is a common musculoskeletal condition frequently associated with neck pain. The Action Research Arm Test (ARAT) is a commonly used standardized and reliable measure for stroke rehabilitation. The Quality of Upper Extremity Skills Test is an outcome measure designed to evaluate movement patterns and hand function in children with cerebral palsy. Patient reported OMs tap into the perceptions of the person with the upper limb amputation. Interventions aimed at facilitating upper-lim b function focus on improv - The properties and initial evaluation of these 25 measures against the specific criteria identified on the MOT/FDA guidance are shown in Table 3 and 4 . Upper Extremity Functional Tests Outcome Measures Mechanics Throwing Protocol RTP Matrix. Please provide an answer for each activity. RIMS, the European Network for Best Practice and Research in MS Rehabilitation, provides research outcome measures for mobility, upper limb function and health-related quality of life. The assessment process in both the clinical and research setting has progressively incorporated patient-reported outcome (PRO) measures and upper limb assessment is no exception. The following levels are discussed: above knee/transfemoral, below knee/transtibial, above elbow/transhumeral, below elbow/transradial, and bilateral for upper and lower extremities. Evaluation of outcomes using validated prosthetic outcome measures (OMs) is a current priority in upper limb (UL) prosthetics, and OMs with psychometric evidence toward UL prosthesis users are thus necessary. UPPER LIMB RESEARCH: OUTCOMES When designing any effective research program, it is imperative to reach some consensus on the best way to measure outcomes in various domains, such as func-tional performance, independence, quality of life, and cost. Outcome measures can be an effective way to assess patient progress and improve patient outcomes. However, due to the small percentage of people with upper limb loss, assessment tools designed specifically for this patient population are scarce.1 For this project, description of the test administration, the intended settings, and the structure, i.e., number of items and response options, of … The QUEST is both reliable and valid. Psychometric Properties. This measure has been recommended by the international Stroke Rehabilitation and … While rTMS improved FMA scores specifically when applied in the first month, this effect was not observed for other body function measures. Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure. Each outcome measure will have its own measurement properties and will be likely to have a primary assessment focus – for example, body functions and structures, activities or impact on social participation. This short report reviews 25 upper limb functional assessments (ULAs) cur- rently reported in research and clinical practice. Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. The review itself identified 25 outcome measures used to evaluate upper limb recovery poststroke. The FAFC consists of the 25FWT, the 9HPT and the Sloan low contrast letter acuity test. The 48 outcome measures are in alphabetic order: AMAT = Arm Motor Ability Test, ARAT = Action Research Arm Test, Ashworth = Ashworth scale, BBT = Box and Blocks Test, CAHAI = Chedoke Arm Hand Inventory, CMSA = Chedoke McMaster Stroke Assessment, COPM = Canadian Occupational Performance Measure, DAS = Disability Assessment Scale, DTI = Diffusion Tensor Imaging, EMG = Electromyography, FAT = Frenchay Arm Test, … Over the past decade, efforts by participants of the International Conference on Surgical Rehabilitation of the Upper Limb in Tetraplegia have focused on identifying sensitive, reliable, and meaningful outcome measures of upper-limb (UL) function in tetraplegia [1-6]. In the adult literature, seven outcome measures (4 amputees specific and 3 generic) were revealed. For measuring other upper extremity muscle groups, it is recommended to use the HHD. "The Capabilities of Upper Extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia." Crown Copyright © 2017. 2010; 38(5): 903-911. Clinically this measure may guide the selection of medical, surgical, or therapy interventions and may improve outcome prognosis after brief training. Systemic reviews can help to select outcome measures. It is a structured goal setting tool centred on the 6 common goal areas for treatment, which Source: Stratford P, Binkley J, Stratford D. Development and initial validation of the upper extremity functional index. Although on the surface, the revision by Burger et al. Subjective motor assessment, the MRC Motor Scale, was the most commonly used single outcome measure (21/59 studies). Optional high performance items are available for sport/music and work. In mixed (motor and sensory) upper limb (distal to brachial plexus and proximal to wrist) nerve injury studies, there was a much broader spread of outcome measure use with 41 outcome measures used across 59 studies (Figure 4). There are two different types of OMs: “patient reported” and “performance.”. Validated tools are particularly required for passive and lower level func-tion. Region-specific outcome measures for the entire upper extremity include, in order of frequency of citation, the Dis- ability of … 4.2 Evaluation of Upper Extremity There is a wide range of upper extremity rehabilitation outcomes measures which have been utilized. Davis AM, Beaton DE, Hudak PL, et al. The UEFS module from the OPUS 42 was the single prosthetic-specific measure that was available in this category. Measures of Upper Limb Functional Abilities Adults. 1 . Once treatment has commenced, the same instrument can be used to determine progress and treatment efficacy. More responsive than generic measures for patients with upper extremity … Advantages. Outcome Measures and Upper Limb Prosthetic Rehabilitation Outcome measures can be an effective way to assess patient progress and improve patient outcomes. Since a prosthetist produces them by slightly modifying casts taken by wrapping plaster bandages around the limb, the sockets are usually circular in cross section and thus encapsulate the limb. Therefore, we aimed to measure physiologic UE function of SMA patients with different functional abilities and evaluate the relation between these physiologic measures and functional UE scales. The GAS Evaluation of Outcome in Upper Limb Spasticity (GASeous) tool The GAS-eous tool has been developed to address some of the criticisms of GAS as a tool for measurement of outcome in the treatment of upper limb spasticity. The American Journal of Sports Medicine. Validate the concept of assessing upper limb sensorimotor impairments with a physical, instrumented 3D object manipulation task (PPIT) by comparing the intra-subject variability, validity, reliability, and sensitivity of the approach to the one of an established, virtual instrumented 3D object manipulation task (VPIT). Functional outcome could include factors such as function, acceptance, usage, satisfaction, adaptation, and ability; and Review of validated outcome measures in upper limb … Upper limb disability is a common musculoskeletal condition frequently associated with neck pain. Most sockets simply contain the tissue of the remaining limb. reporting a clear objective to identify outcome measures specific for the upper extremity and/or include measures with a specific separate subsection for the upper extremity, report on and/or evaluate the psychometric properties of the outcome measures, participants older than 18 years, publication year 2004 or later (up to February 2014) THE UPPER EXTREMITY FUNCTIONAL INDEX (UEFI) We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your upper limb problem for which you are currently seeking attention. This measure has been recommended by the international Stroke Rehabilitation and Recovery Roundtable as a core data element [ … They can be categorized into broad categories listed below: 4.2.1 Upper Extremity Asessement and Outcome Measures Category Rationale Individual Assessment Tools Motor Function Assess gross motor The selection of measures for clinical evaluation will depend on the patient’s level of function and goals for treat-ment. There needs to be a change in score of 10 to 19 points for the change to represent clinically important change (MCID). One such measure that has been proposed is the FAFC . OBJECTIVE To identify valid and reliable outcome measures reflective of "real-life" active and passive function for application following focal rehabilitation interventions in the hemiparetic upper limb after stroke or brain injury. Reference for Score: Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. 1996 Jun;29(6):602-8. Physiotherapy Canada 2001;53(4):259-67. Key words: Upper limb, assessment, function, rehabilitation Introduction Useful and reliable assessment of the upper limb is important in both research and clinical practice. To date, the ICF can be used to classify upper limb outcome measures according to 3 levels6, 7: body functions and structures, activity, and participation ().8, 9 By using outcome measures on the different ICF levels, one may be able to measure the complex and multidimensional character of the upper limb more completely and understand the impact of the underlying symptoms on ADL. life” function in the hemiparetic upper limb. life” function in the hemiparetic upper limb. Advantages. Manual muscle testing can be used when measuring total upper extremity or wrist strength in children with CP who have very limited muscle strength (below grade 4). Journal of … psychometric evidence and comparison with upper limb prosthetic outcome measures. These measures were separated into stroke-specific clinician-rated and PRO measures. Subramanian, SK, Cross, MK, Hirschhauser, CS, Johnson, VBK & Reistetter, TA 2019, Post-stroke upper limb rehabilitation using virtual reality interventions: Do outcome measures assess extent or type of motor improvement? 1 In response, several measures have been created and proven They attempted to identify key issues in the deployment of assessment techniques and tried to identify a more consistent means of making assessment of outcomes from … The following five tools areexamples of self-report measures: 1. 12 male and 5 female SMA patients … The measure includes three domains which are important in describing hand function. The first is the inclusion of multiple one-handed activities in the … CONCLUSIONS: The current evidence encourages the use of TMS outcome measures, especially MEP latency and map area to investigate plastic changes in the brain after upper-limb physical training post-stroke. For this purpose, we have selected for review only some of the more commonly used measures in stroke rehabilitation. This study validated a battery of upper extremity measures in … FIT-HaNSA protocol; Pain and Disability Scales and User Manuals; Patient-Rated Wrist Evaluation (PRWE) Regional and condition specific PROs enable the quantification of patient impairment [ 1 ]. Gathering and validating outcome measures that are specific to the patient population is a key strategy for optimizing upper-limb prosthetic rehabilitation. Erratum in: Am J Ind Med 1996 Sep;30(3):372. Other measures that were responsive to change were Box and Block test, Jebsen … Therapeutic management of the upper extremity (UE) function of people with spinal muscular atrophy (SMA) requires sensitive and objective assessment. Highly Responsive (Sensitive) to Change Over Time. A license is required to use the QUEST. After a presentation of the evidence based review and discussions on the history of the field and the various perspectives from the various professions, the panel reviewed those outcome measures found to be recommended and those thought to be worth consideration by the Evidence Based Review and the Upper Limb Prosthetics Outcome Measures Group. The primary outcome will be used to assess the improvement of upper limb function in stroke patients, and secondary results will be used to assess the ability to perform activities of daily living. A., et al. Subramanian, SK, Cross, MK, Hirschhauser, CS, Johnson, VBK & Reistetter, TA 2019, Post-stroke upper limb rehabilitation using virtual reality interventions: Do outcome measures assess extent or type of motor improvement? In mixed (motor and sensory) upper limb (distal to brachial plexus and proximal to wrist) nerve injury studies, there was a much broader spread of outcome measure use with 41 outcome measures used across 59 studies (Figure 4). Traditional upper-limb prosthetic sockets share certain problems. However, there is a lack of clear guidance about the suitability of available measures, which may impede utilisation. Key words: functional assessment, upper limb, outcome mea-sure… Subjective motor assessment, the MRC Motor Scale, was the most commonly used single outcome measure (21/59 studies). For the review of timing and efficacy, the clinical outcome that is considered to best reflect recovery of upper limb impairment is the Fugl Meyer Upper Limb (FMUL) . Introduction: Outcome measure development has long been recognized as a need in the field of upper limb prosthetic rehabilitation to map individual patient progress, highlight needs for component development and cost justification. (1998). • A variety of QOL instruments have been used to capture outcomes in lymphedema patients, but… Measures pain and function in the upper limb and the effect of treatment on pain and shoulder function. Systematic tracking and evaluation of outcome measures can be used to assess treatment effectiveness, monitor function, and assess value of rehabilitation services for persons with upper limb amputation. The development and validation of a functional assessment tool for the upper extremity in the overhead athlete. For example, Ashford et al7 reviewed measures for the hemiparetic upper limb, identified 6 scales that met their selection criteria, but concluded that currently there was no single reliable and valid measure available to capture the full range of functional tasks in the hemiparetic upper limb. outcome measure and its shortened version (QuickDASH) are 2 region-specific measures of disability and symptoms in people with musculoskeletal disorders of the upper limb. This article provides a generalized overview of amputation classifications and the idealized outcomes for upper and lower amputations at their respective levels. Measuring the results of intervention is an important component of the occupational therapy process, and obtaining reliable and valid information through the use of standard assessments provides … Archives of Physical Medicine and Rehabilitation 79(12): 1512-1521. Clinical trials are conducted on specific important clinical issues in upper extremity surgery and rehabilitation and uses the following tools: Outcome Measures. The outcome measure should be designed to assess or evaluate the functional outcome among upper limb prosthesis users. 4,18. However, more studies involving rigorous and standardized TMS procedures are needed to validate these observations. The An outcome measure is the result of a test that is used to objectively determine the baseline function of a patient at the beginning of treatment. to assess the functional impairment in individuals with musculoskeletal upper limb dysfunction.The motor outcomes with upper limb FES [27]. Outcome measures Feasibility properties of the identified outcome measures. the field of upper limb prosthetic research, to illuminate the technical outcomes measures from many perspectives. Significance: The strive for novel remyelination strategies in MS points to the need for quantitative conduction measurements in addition to clinical outcomes. RIMS. The three best measures, depending on the purpose of research, included the standardised Nordic Musculoskeletal Questionnaire, the Upper Extremity Questionnaire, and the Neck and Upper Limb Instrument. Validated tools are particularly required for passive and lower level func-tion. Raters demonstrated excellent reliability in assessing upper extremity SVMC in a group of children with hemiplegic, diplegic, and quadriplegic CP using the Ttest of arm selective control Outcome measures that were stroke-specific, performance based, assessed the motor behavior and volitional control, evaluated the upper extremity components or had the subsection for upper extremity and were commonly used in the past 10 years in clinical and research practice were included in the study (Baker et al., 2011). outcome measures might be classified and selected for use, based upon their measurement qualities. There needs to be a change in score of 10 to 19 points for the change to represent clinically important change (MCID). A systematic review about this issue suggested that Jamar dynamometer can be used to measure grasping force and handheld dynamometer can be used to measure the force of other upper extremity muscles.