Extremity Functional Index Research Articles

A prospective study on transfer of pronator teres to extensor carpi radialis brevis for forearm and wrist deformity in children with cerebral palsy.

We prospectively evaluated the clinical and functional outcomes of pronator teres to extensor carpi radialis brevis transfer in children with cerebral palsy. Patients were followed-up at 6 months postoperatively, and functionally assessed using the House classification, Manual Ability Classification System (MACS) and Upper Extremity Functional Index (UEFI). Fifteen children with a mean age of 8.1 years underwent tendon transfers. All patients were of Gschwind and Tonkin Grade 2 for pronation deformity; eight patients were of Zancolli's classification Group 1 and seven, Group 2 for wrist flexion deformity. The average gain in active supination was 67°, and wrist extension 15°. An increase of 7.0 in the UEFI score was recorded, although no significant improvement in MACS and House classification was observed. We conclude that the pronator teres to extensor carpi radialis brevis transfer improves upper limb function through effective correction of forearm pronation and wrist flexion deformities.Level of evidence: II.

Impacto funcional y psicosocial del uso de prótesis de bajo costo en impresión 3D en amputado unilateral de antebrazo: estudio de un caso

Introducción: Los pacientes que presentan una amputación a nivel trans-radial cuentan con oferta reducida de dispositivos protésicos (gancho y mano cosmética). Postulamos que disponer de nuevos sistemas protésicos 3D de bajo
 
 
 
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 IMPACTO FUNCIONAl y PSICOSOCIAl DEl USO DE PRóTESIS DE BAJO COSTO EN IMPRESIóN 3D
 
 
 costo y la experiencia de su uso, permitirá aumentar las opciones para mejorar funcionalidad, actividad y participación. Objetivo: Evaluar el impacto fun-cional y psicosocial del uso de mano protésica manufacturada con impresión 3D. Método: Se seleccionó un paciente Teletón con amputación transradial de antebrazo izquierdo nivel tercio medio, 15 años de edad, con consentimiento informado. Se tomó molde en yeso y confeccionó prótesis 3D fabricada en acrilonitrilo butadieno estireno (ABS) y ácido poli-láctico (PLA); el pulgar tiene dos articulaciones y los demás dedos tres articulaciones. La prótesis la constituyen también el antebrazo y muñeca. El usuario recibió cuatro sesiones de entrenamiento con la prótesis en el lapso de un mes. Las evaluaciones con pauta de funcionalidad de mano Bilan 400 points modificada, índice funcio-nal de las extremidades superiores (UEFI) y escala del impacto psicosocial de la asistencia tecnológica (PIADS), se aplicaron previo al ingreso, a tres y once meses de seguimiento. Resultados: La funcionalidad de mano mostró un incremento de alrededor de 30% con ambos instrumentos. En medición PIADS, competencia, autoestima y adaptabilidad, variaron de ningún efecto de la asistencia tecnológica, hasta el máximo de 3 puntos para adaptabilidad en el seguimiento a 11 meses. Conclusión: Este estudio de caso destaca poten-ciales beneficios del uso de prótesis de extremidad superior en el desempeño funcional y calidad de vida.

The effect of platelet-rich plasma on fracture healing in long-bone pseudoarthrosis.

The aim of this study was to investigate the effects of platelet-rich plasma (PRP) on fracture union rate and fracture union time in pseudoarthrosis surgery and to evaluate the clinical and functional results of the patients. The patients who were undergone pseudoarthrosis surgery between 2011 and 2014 were evaluated retrospectively. Twenty-four patients were included in the study. Patients were divided into two groups with used PRP and not used PRP during surgery. There were 14 patients in the PRP group and 10 patients in the control group. The two groups were compared in terms of demographic characteristics, fracture union time, and functional scores of the Lower Extremity Functional Scale and Upper Extremity Functional Index. Fractures were healed in both groups, and no complications were encountered. A statistically significant difference was found between the two groups in terms of fracture union time. The mean time of union was 5.3months in the PRP group and 11.3months in the control group (p: 0.000). There was no statistically significant difference between the two groups in terms of functional scores (p: 0.250). As a result of our study, we concluded that PRP is an effective and safe method in pseudoarthrosis surgery that reduces fracture union time. Controlled studies with more patient numbers are needed.

3D-printed hand prostheses function in adolescents with congenital hand amputation: A case series

To describe the effect of the 3D-printed Cyborg Beast prosthesis on upper limbs function in adolescents with congenital hand amputation. Five patients aged between 12 and 17 years, with congenital hand amputation were selected. All patients were from the Teletón Institute in Santiago, Chile. The patients were trained for prosthesis use in four sessions. Hand function was evaluated without prosthesis, at 1 and 4 months of use with the modified Bilan 400 points scale, and upper limb function perception was evaluated with the 'Upper Extremity Functional Index (UEFI)'. At 1 month and 4 months of use, the percentage change for hand functionality for the unaffected limbs was between -11% and -4%; and -9% and -2% for the affected limb. The percentage change for the upper limbs perceived function was -62%. The use of the 3D-printed Cyborg Beast prosthesis was not a functional solution for the 5 patients included in this study. Future research is needed to improve the functionality of these types of 3D-printed hand prostheses.

Head Posture and Functional Ability of Upper Extremity in Adolescents Use Smartphone

Objective: This study aimed to determine the impact of smartphone use in head posture and functionalability of upper extremity in adolescents and the correlation between them.Design: Cross sectional design.Method: Forty adolescents divided into two groups (group I and group II) based on the smartphonetime use per day. They were assessed for neck pain by Visual analogue scale (VAS), the disability of theupper extremity by Upper Extremity Functional Index (UEFI) and the head posture angles by AutoCADphotographic analysis.Results: The results of this study represented significant differences in all measurable variablesinthe group(II) as compared to the group (I). Also, the results of this study represent there were significant strongrelationships between the measurable variables.Conclusion: We could conclude that the prolonged duration of smartphone use had significant effects on thehead posture and functional ability of adolescents.

Assessment of Functional Recovery and Subjective Donor-Site Morbidity Following Radial Forearm Flap Reconstruction in Small- to Moderate-Sized Palatal Defects.

Palatal defects are encountered following tumor extirpation, trauma, or congenitally. Among the known alternatives, radial artery free forearm flap (RAFF) is a versatile flap that confers good results in head and neck reconstruction, but donor-site morbidity has been an issue of discontent among the plastic surgeons. This limitation needs to be studied further and addressed considering the unmatched quality of this tissue. This study aims to weigh the impact of the functional edge of this flap against the unpopular donor-site morbidity on a group of patients. This is a retrospective analysis of recuperation of palatal function and patient concerns with the donor-site function and cosmesis on 7 consecutive patients with small-to-moderate palatal defects reconstructed with RAFF. Postoperative recovery of speech, palatal movement, and restoration of oromaxillary interface was assessed using objective tests, such as speech intelligibility testing and articulation studies. Simultaneously, subjective donor-site function and cosmesis were assessed using Patient Scar Assessment Scale (PSAS), Upper Extremity Functional Index (UEFI), and donor limb sensory testing. Mean PSAS score was 8.28/60, and UEFI score reported was 77/80, which reflect high patient satisfaction with the donor site. Nasoendoscopy shows remarkable restoration of palate anatomy. Intelligibility testing depicts near-normal speech understandability, whereas articulation studies revealed distortions post-palatal reconstruction with RAFF. Radial artery free forearm flap should be considered as the forerunner of reconstruction in palatal defects involving less than 50%.

Effectiveness of Rhythmic Chopping & Lifting Pattern on Shoulder Range of Motion and Upper Extremity Functional Index in Post:Mastectomy Patients

Objective: T o determine the effect of Rhythmic chopping & lifting pattern on shoulder range of motion in Post-mastectomy patients. Method: A total 40 subjects were taken according to inclusion and exclusion criteria. Each subject was assessed by using Shoulder goniometry and UEFI questionnaire. Result: A statistical analysis showed that Rhythmic chopping and lifting PNF exercises showed significant improvement in the outcome variables concluding that it improves shoulder ROM and functional activities. Conclusion: Analysis of all the data obtained through the outcome measures (UEFI Questionnaire and shoulder ROM) shows that Rhythmic chopping and lifting PNF exercises showed significant improvement in the outcome variables concluding that it improves shoulder ROM and functional activities.

Modified Harris Hip Score as patient-reported outcome measure in osteoarthritic patients: psychometric properties of the Greek version.

This study explored the psychometric properties of the modified Harris Hip Score-Greek version (mHHS-Gr) as a patient-reported outcome (PRO) measure in osteoarthritic hip patients. Internal consistency, test-retest reliability and reproducibility were evaluated in 90 patients aged >55 years. Construct validity was tested against Greek versions of the Lower Extremity Functional Scale (LEFS-Greek) and WOMAC Index (WOMAC-Gr), and the Timed Up and Go (TUG) and 9-stairs-ascend/descend (9S-A/D) tests. Known-groups validity was examined using TUG score (cut-off 13.5 s) as an estimate variable. Responsiveness was examined before and 4 weeks after direct anterior minimal invasive surgery. Reliability: Internal consistency was moderate (Cronbach's a = 0.614, p < 0.001). Test-retest reliability was excellent (ICC = 0.881, 95% CI, 0.824-0.920). Reproducibility: Floor and ceiling effects were both 1.1%; measurement error was 3.54 (p < 0.05); minimal important change was lower than minimal detectable change.Validity: mHHS-Gr correlated strongly with both LEFS-Greek and WOMAC-Gr (Pearson's r 0.801 and -0.783, respectively; p < 0.001). The questionnaire's correlations with TUG and 9S-A/D were also significant but moderate (Spearman's ρ: -0.547 and -0.575, respectively; p < 0.001). Known-groups validity showed that mHHS-Gr scores were significantly higher in participants with TUG < 13.5 seconds than in those with TUG > 13.5 seconds (p < 0.001). In ROC analysis, the cut-off point of 52.5 yielded sensitivity 81% and specificity 71%.Responsiveness: Standardised response mean and Guyatt's responsiveness statistic were greater than 0.8. mHHS-Gr showed significant moderate to excellent reliability, significant moderate to strong validity properties and excellent responsiveness. Overall, mHHS-Gr could be a reliable and valid PRO measure for assessing patients with osteoarthritis of the hip.

Effects of McConnell taping combined with strengthening exercises of vastus medialis oblique in females with patellofemoral pain syndrome.

Objective of the study was to determine the effects of McConnell taping combined with strengthening exercises of vastus medialis oblique muscle in females with Patellofemoral Pain Syndrom. Females with Patellofemoral Pain Syndrome with an age group of 25-45 years having a less than 30/80 score on a Lower Extremity Functional Index (LEFI), anterior knee pain and painful/limited range of motion (ROM) at knee, were included in the study. A total of 51 subjects were randomly assigned into two groups. They were assigned a 30-40 minute per session for 5 days per week over a length of 2 weeks. Numeric Pain Rating Scale, Lower Extremity Functional Index and Goniometry tools were used to assess the measure of interest. These samples only comprised of females with a mean age of 36.04+7.35 years. After 2 weeks, significant improvement was recorded in the Numeric Pain Rating Scale (NPRS) (p<0.001) and Lower Extremity Functional Index (LEFI) (p<0.001). Flexion range of motion of the knee also improved significantly. No statistically significant difference in extension range of the knee was noted in either groups as it was normal at base line.

The effectiveness of hydrodistension and physiotherapy following previously failed conservative management of frozen shoulder in a UK primary care centre.

There is a lack of evidence on the clinical effectiveness of hydrodistension for frozen shoulder following failed conservative management. A total of 90 patients opted for hydrodistension following failed initial treatment which included physiotherapy and at least one corticosteroid injection. Shoulder pain and function were assessed at baseline, and 6, 12 and 24 weeks using the Shoulder Pain Disability Index (SPADI), The Upper Extremity Functional Index (UEFI) and a visual analogue scale (VAS) for pain. Active ranges of motion were assessed at baseline, post-24 hr and discharge. We observed clinically important improvements in pain (VAS -5.5; 90% confidence interval [CI] -6.0 to -5.0; SPADI pain, -20; 90% CI-23 to -17) and function (UEFI 23; 90% CI 19 to 26; SPADI disability, -32; 90% CI -36 to -28) at 6 weeks. These improvements remained clearly substantial at 24 weeks. Active range of motion improved substantially post-24 hr (flexion 20, 90% CI 18 to 23; lateral rotation 14, 90% CI 12 to 16; abduction 22, 90% CI 19 to 25) and at discharge (flexion 37, 90% CI 33 to 41; lateral rotation 24, 90% CI 21 to 27; abduction 44, 90% CI 38 to 50). This single-arm observational study suggests that hydrodistension is an effective treatment of frozen shoulder within a UK primary care setting when standard treatment has failed.

Shoulder UE Rehabits: Ca-calibrate Three Upper Extremity Functional Questionnaires

To co-calibrate the 30 Disabilities of the Arm, Shoulder and Hand (DASH) items, 37 Shoulder CAT items, and 18 Upper Extremity Functional Index (UEFI) items using item response theory (IRT), to compare measurement properties of the measures, and to explore the implications of these measurement properties on longitudinal studies of upper extremity functioning over time.

Psychometric Evaluation and Clinical Interpretation of the Upper Extremity Functional Index (UEFI)

Psychometric Evaluation and Clinical Interpretation of the Upper Extremity Functional Index (UEFI)

A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS)

ABSTRACT Objectives To investigate the proportion of patients that present with isolated extremity pain who have a spinal source of symptoms and evaluate the response to spinal intervention. Methods Participants (n = 369) presenting with isolated extremity pain and who believed that their pain was not originating from their spine, were assessed using a Mechanical Diagnosis and Therapy differentiation process. Numerical Pain Rating Scale, Upper Extremity/Lower Extremity Functional Index and the Orebro Questionnaire were collected at the initial visit and at discharge. Global Rating of Change outcomes were collected at discharge. Clinicians provided MDT ‘treatment as usual’. A chi-square test examined the overall significance of the comparison within each region. Effect sizes between spinal and extremity source groups were calculated for the outcome scores at discharge Results Overall, 43.5% of participants had a spinal source of symptoms. Effect sizes indicated that the spinal source group had improved outcomes at discharge for all outcomes compared to the extremity source group. Discussion Over 40% of patients with isolated extremity pain, who believed that their pain was not originating from the spine, responded to spinal intervention and thus were classified as having a spinal source of symptoms. These patients did significantly better than those whose extremity pain did not have a spinal source and were managed with local extremity interventions. The results suggest the spine is a common source of extremity pain and adequate screening is warranted to ensure the patients ́ source of symptoms is addressed.

Mirror therapy to improve hand function in spastic cerebral palsy children

Hand function is one of the important functional activities of the human being to perform a daily activity. One of the impairments is hand function commonly observed in spastic hemiplegics. Spasticity is one of the major factors affecting children, as a result of increased muscle tone, that influences hand movement. Children become more dependent when hand function is impaired. Normal muscle tone is a prerequisite for moving the hand to activity for normal hand function. Hand movement improves by reducing spasticity, which in daily living activity helps the child functionally independent. The aim of this research is therefore to enhance the hand function by using mirror therapy in children with spastic hemiplegic cerebral palsy. 46 subjects are studied and divided into two groups, namely the group of mirror therapy (Experimental) and the conventional group. The informed concern was taken from their parents. Conventional training was given to one group and mirror therapy was given to another group. Both groups were treated for 60 min/ each session, 5 days/week for the duration of 4 weeks. Modified Ashworth scale was used to evaluate spasticity, 9 hole pegboards were used to measure finger dexterity, Fegl Meyer assessment upper limb was used to assess changes in the motor improvement, and Upper Extremity Functional Index was self-evaluating questionnaire done my parents or caretakers. The independent "t" test was used to analyze the outcome measures, the effect of spasticity effect and ability to function by hand. The mean post-test values of all mirror therapy variables were better than those of the conventional group (p&lt;0.005). The study shows spasticity reduction and improvement in the function of the hand in children with spastic hemiplegic cerebral palsy using mirror therapy.

Site-specific Patient-reported Outcome Measures for Hand Conditions: Systematic Review of Development and Psychometric Properties.

Background:There are a number of site-specific patient-reported outcome measures (PROMs) for hand conditions used in clinical practice and research for assessing the efficacy of surgical and nonsurgical interventions. The most commonly used hand-relevant PROMs are as follows: Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH (qDASH), Michigan Hand Questionnaire (MHQ), Patient Evaluation Measure (PEM), Upper Extremity Functional Index (UEFI), and Duruoz Hand Index (DHI). There has been no systematic evaluation of the published psychometric properties of these PROMs.Methods:A PRISMA-compliant systematic review of the development and validation studies of these hand PROMs was prospectively registered in PROSPERO and conducted to assess their psychometric properties. A search strategy was applied to Medline, Embase, PsycINFO, and CINAHL. screening was performed in duplicate. Assessment of psychometric properties was performed.Results:The search retrieved 943 articles, of which 54 articles met predefined inclusion criteria. There were 19 studies evaluating DASH, 8 studies evaluating qDASH, 13 studies evaluating MHQ, 5 studies evaluating UEFI, 4 studies evaluating PEM, and 5 studies evaluating DHI. Assessment of content validity, internal consistency, construct validity, reproducibility, responsiveness, floor/ceiling effect, and interpretability for each PROM is described.Conclusions:The psychometric properties of the most commonly used PROMs in hand research are not adequately described in the published literature. DASH, qDASH, and MHQ have the best-published psychometric properties, though they have either some poor psychometric performance or incompletely studied psychometric properties. There are more limited published data describing the psychometric properties of the UEFI, PEM, and DHI.

Physical Therapy Outcome Measures for Assessment of Lower Extremity Chronic Pain-Related Function in Pediatrics

To assess the clinical utility of 5 physical therapy (PT) outcome measures in quantifying functional changes in pediatric lower extremity chronic pain treated at a hospital-based interdisciplinary rehabilitation center. This was a cross-sectional study with retrospective review of 173 individuals, 8 to 18 years old, treated from June 2008 to 2013. The measures used were the Timed Up and Go, Timed Up and Down Stairs, Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, 6-minute walk test, and Lower Extremity Functional Scale. Participant performance was correlated with demographic characteristics, the Functional Disability Index, Multidimensional Anxiety Scale for Children, Child Depression Inventory, and Canadian Occupational Performance Measure. Scores from all 5 PT measures showed significant improvement following treatment. Functional Disability Index correlated to every PT measure except the 6-minute walk test. This study supports the clinical use of these PT measures to track functional progress after rehabilitative treatment of lower extremity chronic pain-related disability.

Forearm lengthening and prosthetic management in children with transverse congenital forearm deficiency

In cases of transverse congenital forearm deficiency, achieving a good prosthesis fit during childhood remains a challenge. Ulnar lengthening is a treatment option for improving the prosthesis fit. The objective of this study was to evaluate surgical ulnar lengthening and the subsequent prosthesis fit. We reviewed four cases of ulnar lengthening in children with transverse congenital forearm deficiency. The procedure was evaluated in terms of the duration of lengthening, increase in ulnar length and healing index. The elbow range of motion, functional outcome (Prosthetic Upper Extremity Functional Index, PUFI) and time spent using the prosthesis per day were evaluated. The mean age at the time of the lengthening procedure was 3.5 years, the mean duration of lengthening was 58.3 days, the mean length gain was 21 mm, and the mean healing index was 70.1 days/cm. Elbow range of motion was restricted in one patient (100°–140°) and full in the other three patients. Based on the PUFI, 88.4% of activities were performed without the prosthesis. Children only used their prosthesis to perform specific tasks. Given the high complication rate and the lack of prosthesis use during daily activities, the main indication for forearm lengthening is a very short forearm that prevents prosthesis fitting. This procedure should be performed later in life – in adolescence.

Exercise Therapy for a Patient With Parkinson Disease and Back Pain: A Case Report

ObjectiveThe purpose of this report is to describe an exercise intervention for an elderly patient with Parkinson disease with a chief complaint of lower back pain. Clinical FeaturesThe patient was an 85-year-old man who had been diagnosed with Parkinson disease and kyphosis. Back pain was preventing him from carrying out activities of daily living. He was referred for physical therapy for treatment to reduce lower back pain and increase function. An initial examination consisted of testing flexibility and range of motion and administering a pain severity scale and a Lower Extremity Functional Index (LEFI); the patient’s initial LEFI score was 14/80. Intervention and OutcomeClinical observation was made during each of the patient’s physical therapy sessions. After 5 weeks, the patient’s LEFI score improved to 30/80. The patient reported that he had no more reoccurring back pain, was able to move much easier, and was able walk more efficiently and with better posture. ConclusionThe patient in this case responded positively to a 5-week course of physical therapy that included exercise therapy. His back pain diminished and his function increased after the course of care.

Preliminary Psychometric Evaluation of the Brachial Assessment Tool Part 2: Construct Validity and Responsiveness

ObjectivesTo evaluate construct validity and responsiveness of the Brachial Assessment Tool (BrAT), a new patient-reported outcome measure for people with traumatic brachial plexus injury (BPI), and to compare it to the Disabilities of the Arm, Shoulder and Hand (DASH) and the Upper Extremity Functional Index (UEFI). DesignCross-sectional study. SettingOutpatient clinics. ParticipantsAdults (N=29; age range, 20–69y) with confirmed traumatic BPI. InterventionsParticipants completed the BrAT 3 times over an 18-month period together with 16 DASH activity items and the UEFI. Evaluations were undertaken of construct validity, known-groups validity, 1-way repeated analysis of variance, and effect size. Main Outcome MeasuresBrAT, DASH, and UEFI. ResultsThe BrAT demonstrated a moderate to low correlation with the DASH activity items (<0.7) and a large correlation with the UEFI (>0.7). According to known-groups validity, only the BrAT was able to discriminate between people who stated they could use their hand versus those who were unable to use their hand to perform activities. All measures indicated a significant effect for time with the exception of BrAT subscale 1. The effect size was highest for the BrAT but lower than expected (BrAT, .52–.40; DASH, .15; UEFI, .36). ConclusionsThese preliminary findings support the BrAT as a valid and responsive patient-reported outcome measure for adults with traumatic BPI. The BrAT activity items appear to be more targeted than the DASH or UEFI particularly for people with more severe BPI. The BrAT also appears to be measuring a different activity construct than the DASH and the UEFI. Further work is required to confirm these results with larger sample sizes.

Issues in management of fractures complicated by compartment syndrome

Introduction: Compartment syndrome has been identified as an acute devastating orthopaedic emergency and early fasciotomy is the only way to prevent any complications This retrospective study proposes to analyse the issues in management of fractures complicated by compartment syndrome occurring pre-operatively and post-operatively. Aim: To study the issues involved in the rationale for deciding the method of fracture stabilization following fasciotomy. To study the problems, complications and functional outcome of fracture stabilization. To analyze and establish methods to the optimally manage the issues involved. Materials and Methods: A review of patients admitted in the orthopaedic department at our institution who presented with or developed compartment syndrome and associated with fractures were chosen. Passive stretch pain and serve pain out of proportion were the main clinical indicators considered. Decision to perform fasciotomy was carried out based on the differential P value and were treated with double incision fasciotomy Patients were followed up every month for the first 6 months and then every 6 months. All the patients, who were reviewed, were functionally assessed based on Upper Extremity Functional Index (UEFI) and Lower Extremity Functional Scale (LEFS). Results: A high suspicion of compartment syndrome must be maintained for all cases. The early diagnosis and treatment within 12 hours is critical to reduce morbidity and prevent any long term sequale. Compartment syndrome causes delay in bone healing. Risk of infection is not increased.