Evaluation of Performance-Based Outcome Measures for the Upper Limb: A Comprehensive Narrative Review

Sophie Wang; C Janice Hsu; Lauren Trent; Tiffany Ryan; Nathan T Kearns; Eugene F Civillico; Kimberly L Kontson

doi:10.1016/j.pmrj.2018.02.008

Evaluation of Performance-Based Outcome Measures for the Upper Limb: A Comprehensive Narrative Review

PM R. 2018 Sep;10(9):951-962.e3. doi: 10.1016/j.pmrj.2018.02.008. Epub 2018 Feb 21.

Authors

Sophie Wang¹, C Janice Hsu², Lauren Trent³, Tiffany Ryan⁴, Nathan T Kearns⁵, Eugene F Civillico⁶, Kimberly L Kontson⁷

Affiliations

¹ U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Labs, Division of Biomedical Physics, Silver Spring, MD; and University of Maryland, Department of Biomedical Engineering, College Park, MD(∗).
² Advanced Arm Dynamics, Redondo Beach, CA(†).
³ Advanced Arm Dynamics, Redondo Beach, CA(‡).
⁴ Advanced Arm Dynamics, Redondo Beach, CA(§).
⁵ Advanced Arm Dynamics, Redondo Beach, CA; and University of North Texas, Department of Psychology, Denton, TX(¶).
⁶ Department of Health and Human Services, Bethesda, MD(#).
⁷ U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Labs, Division of Biomedical Physics, 10903 New Hampshire Ave, Silver Spring, MD 20993(∗∗). Electronic address: Kimberly.Kontson@fda.hhs.gov.

Abstract

Objective performance-based outcome measures (OMs) have the potential to provide unbiased and reproducible assessments of limb function. However, very few of these performance-based OMs have been validated for upper limb (UL) prosthesis users. OMs validated in other clinical populations (eg, neurologic or musculoskeletal conditions) could be used to fill gaps in existing performance-based OMs for UL amputees. Additionally, a joint review might reveal consistent gaps across multiple clinical populations. Therefore, the objective of this review was to systematically characterize prominent measures used in both sets of clinical populations with regard to (1) location of task performance around the body, (2) possible grips employed, (3) bilateral versus unilateral task participation, and (4) details of scoring mechanisms. A systematic literature search was conducted in EMBASE, Medline, and Cumulative Index to Nursing and Allied Health electronic databases for variations of the following terms: stroke, musculoskeletal dysfunction, amputation, prosthesis, upper limb, outcome, assessments. Articles were included if they described performance-based OMs developed for disabilities of the UL. Results show most tasks were performed with 1 hand in the space directly in front of the participant. The tip, tripod, and cylindrical grips were most commonly used for the specific tasks. Few measures assessed sensation and movement quality. Overall, several limitations in OMs were identified. The solution to these limitations may be to modify and validate existing measures originally developed for other clinical populations as first steps to more aptly measure prosthesis use while more complete assessments for UL prosthesis users are being developed.

Level of evidence: Level III.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Review

MeSH terms

Activities of Daily Living*
Amputees / rehabilitation*
Artificial Limbs*
Humans
Movement / physiology*
Prosthesis Design
Task Performance and Analysis
Upper Extremity / physiopathology*

Grants and funding

FD999999/Intramural FDA HHS/United States