Functional Capacity Evaluation in Upper Limb Reduction Deficiency and Amputation: Development and Pilot Testing

C K Van Der Sluis,M F Reneman,R M Bongers,S G Postema

doi:10.1007/s10926-017-9703-4

Abstract

Purpose To develop and pilot test a functional capacity evaluation (FCE) for individuals with upper limb absence (ULA) due to reduction deficiency or amputation, and to examine the relationship between FCE results and presence of musculoskeletal complaints (MSC). Method Five tests (overhead lifting, overhead working, repetitive reaching, fingertip dexterity, and handgrip strength) were selected and adapted if necessary. The newly developed FCE, called FCE-One-Handed (FCE-OH), was pilot tested in 20 adults individuals with ULA, and 20 matched controls. MSC were assessed via a questionnaire. Results Adaptations were considered necessary for all tests, except the handgrip strength test. The repetitive overhead lifting test of the non-affected limb was added. On the overhead lifting test, individuals with above-elbow ULA (ten males), performed similar to controls using one hand. When lifting bimanually using the prosthesis, a trend for lower lifting capacity of individuals with below-elbow ULA (seven males, three females) was observed compared to controls. On the overhead working test, individuals with above-elbow ULA performed worse compared to controls. Other tests showed no significant differences between groups. Relationships between FCE results and presence of MSC were non-significant. Conclusion The FCE-OH can be used to test functional capacity of one-handed individuals. Individuals with ULA generally showed similar functional capacity as two-handed individuals. FCE results were not related to MSC. It was discussed that a higher physical load on the non-affected limb might reflect a relative deficit of functional capacity.

Highlights

Musculoskeletal complaints (MSC) appear to occur approximately twice as often in individuals with a congenital reduction deficiency or amputation of the upper limb [hereafter referred to as upper limb absence (ULA)] [1, 2]
The researchers, who have experience in the fields of functional capacity evaluation (FCE), upper limb reduction deficiency and amputation rehabilitation care or movement sciences, discussed the original tests to decide which adaptations were necessary so that the tests could be performed by one-handed individuals with or without a prosthesis, and would measure functional capacity rather than prosthesis handling skills
Discussions were held until consensus between all researchers was reached (Table 1). As these tests are adapted for use in one-handed individuals, we propose the name Functional Capacity Tests-One-Handed (FCE-OH)

Summary

Introduction

Musculoskeletal complaints (MSC) appear to occur approximately twice as often in individuals with a congenital reduction deficiency or amputation of the upper limb [hereafter referred to as upper limb absence (ULA)] [1, 2]. Individuals with ULA are exposed to an unequal distribution of physical demands over both limbs, back and neck. The higher load on the non-affected limb, back and neck may result in overuse injuries of these sites. The number of repetitions, the magnitude of produced force and posture have been described extensively as risk factors for MSC in the general population [3,4,5], which may be increased in individuals with ULA. In. J Occup Rehabil (2018) 28:158–169 addition, the higher burden on the non-affected limb may go along with a higher repetition of movements. Compensatory movements when wearing a prosthesis may possibly relate to overuse injuries of the affected limb

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