Prosthetic Outcome Measures for Use With Upper Limb Amputees: A Systematic Review of the Peer-Reviewed Literature, 1970 to 2009

Abstract

The overall goal was to perform a systematic literature search and structured review of the state of outcome measurement in the field of upper limb prosthetics and to propose future directions for research in this area. The review is based on systematic searches of Medline, Cumulative Index to Nursing and Allied Health Literature, and RECAL electronic databases from 1970 to March 2009 and on subsequent review of the reference lists of the identified publications (citation tracking), as well as articles in the author's personal collection. Each article was independently reviewed by two readers. Publications were initially screened for relevance, and then fully reviewed to extract relevant data and review the methodological quality of the study. A quality rating form, based on guidelines provided by Terwee et al. (J Clin Epidemiol. 2006;60:34–42), was devised for evaluation of the clinimetric properties of the identified outcome measures. 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. In the adult literature, seven outcome measures (4 amputees specific and 3 generic) were revealed. This compares with 25 measures identified in the lower limb adult amputee outcomes review by Condie et al. (J Prostht Orthot. 2006;18:13–45). In the pediatric review, nine distinct outcome measures (5 amputees specific and 4 generic) were found. Two of the pediatric measures also have younger child versions. There was overlap of one measure, the Assessment of Capacity for Myoelectric Control (ACMC), between adult and pediatric studies. The use of standardized outcome measures with adult upper limb amputees is sparse in the published studies with this clinical population, and upper limb prosthetic-specific measures are few in number. Attention needs to be paid to all aspects of measurement development and validation across the International Classification of Functioning, Disability, and Health. The measures with greatest psychometric promise for use in upper limb prosthetics are the ACMC, the Upper Extremity Functional Status Module of the Orthotics and Prosthetics User Survey, the Disabilities of Arm, Shoulder, and Hand Questionnaire, and the Trinity Amputation and Prosthesis Experience Scales. Greater strides toward measure development and validation have been made with pediatric upper limb amputees. The emphasis that is currently needed is on the determination of the test-retest reliability and responsiveness of the most promising measures (ACMC, University of New Brunswick Test, the Assisting Hand Assessment, Prosthetic Upper Extremity Functional Index, and the ABILHAND-Kids) and discussion on how best to approach the measurement of participation and quality of life.