Comparison of Instruments to Assess Hand Function in Children With Radius Deficiencies

doi:10.1016/j.jhsa.2007.01.011

The Journal of Hand Surgery

Volume 32, Issue 4, April 2007, Pages 531-540

https://doi.org/10.1016/j.jhsa.2007.01.011 Get rights and content

Purpose

For treatment evaluation of children with radius deficiencies (RDs), standardized assessment of hand function in performing activities is required. Instruments to measure hand function have been developed for other diagnoses. The current study aimed to find additional evidence for validity, reliability, and usefulness of these instruments for children with RDs.

Methods

In this study, 20 children with RDs (aged 4–12 years) participated; 16 were boys, and 13 children were unilaterally affected. Children were assessed using the Assisting Hand Assessment, the Unilateral Below Elbow Test, the Prosthetic Upper Extremity Functional Index, and ABILHAND-Kids. Construct and convergent validity of the instruments were studied focusing on predefined hypotheses and relationships with other instruments and the therapist’s global assessment. Test-retest reliability was assessed in 10 children by means of the intraclass correlation coefficients and the smallest detectable differences.

Results

For children with RDs, the Assisting Hand Assessment and the Prosthetic Upper Extremity Functional Index appeared to be the most valid function test and questionnaire according to the relationships found with type of RD, functional hand grips, and the therapist’s global assessment of hand function. Regarding test-retest reliability, intraclass correlation coefficients ranged from 0.82 to 0.91, and smallest detectable differences were acceptably small.

Conclusions

The current results contribute to the evidence that the instruments, especially the Assisting Hand Assessment and the Prosthetic Upper Extremity Functional Index, provide valid and reliable results in children with RDs.

Type of study/level of evidence

Diagnostic I.

Section snippets

Patients

From March to October 2004, children with RDs aged 4 to 12 years were consecutively recruited. To attain a sample of children with a variety in type and severity of RDs, we approached the parents of children who were known to have a unilateral deficiency and a sample of bilaterally affected children with different types of RD. A total of 28 children were invited via their parents to participate in the study, and 20 children participated. Lack of time was the main reason given by the parents for

Results

Table 2 presents data on grip and pinch strength and sum scores on functional hand grips, function tests, and questionnaires. All children without a thumb and 3 other children were not able to perform all grips and had missing values on these tests. Because no differences were found between boys and girls, between unilaterally and bilaterally affected children, and between children with and without a thumb for AHA, UBET, PUFI, and ABILHAND-Kids (Table 3), we described further results for the

Discussion

Hand function of children with RDs has rarely been measured with standardized tools.¹ To evaluate activities, the Disability of the Arm, Shoulder and Hand (DASH) has been used in adults with RDs,³¹ but the DASH is not applicable for children.¹⁴ Using a standardized instrument to measure functional activities could be useful in evaluating whether the patient can perform certain activities he or she was not able to do before treatment.⁴

In this study, we tested a broad variety of children with

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Combined clinic and home-based therapeutic approach for the treatment of bilateral radial deficiency for a young child with Holt-Oram syndrome: A case report
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In a small sample of children with radial longitudinal deficiencies, the AHA was found to be valid, however validation in a larger sample is recommended. In children with bilateral involvement, it is recommended to consider the more involved hand to be the “assisting” hand” or affected side.16 In this case report, the child's left, more impaired upper extremity was considered the affected side and therefore assessed.
Holt-Oram syndrome (HOS) is a rare, genetic condition characterized by the combination of congenital heart defect and hypoplasia in one or both upper extremities. Children with HOS commonly present with varied joint and limb involvement including radial longitudinal deficiency impacting hand function. Evidence-based guidelines regarding orthotic wear and therapeutic techniques are lacking.
The aim of this case report was to present the results of a long-term occupational therapy program for a patient with HOS pre and postpollicization.
Case report.
A 4-month-old patient with bilateral radial longitudinal deficiencies began outpatient occupational therapy for custom orthosis fabrication and treatment which included long term clinic and home-based intervention. Techniques included passive range of motion, orthosis wear, therapeutic taping, and modified constraint induced movement therapy. Longitudinal assessment of musculoskeletal alignment and functional hand use was performed using goniometry for passive and active range of motion, the Assisting Hand Assessment (AHA), and The Thumb Grasp and Pinch Assessment (T-GAP).
Improvement in passive and active range of motion was achieved as well as improved activity level function as measured by the AHA and T-GAP postpollicization and intervention.
A combined clinic and home-based therapeutic approach can be effective for children with HOS to improve alignment and function pre and postpollicization to further enhance hand function. Comprehensive, long-term assessment is necessary to fully evaluate and communicate improvement.
Outcome measures
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The assessment of upper extremity limitations in children requires careful attention to the components of the test and their measurement properties. The purpose of assessment in children includes screening, evaluation, benchmarking, goal setting, reimbursement, monitoring outcomes, comparing outcomes, data-driven decision making, and long-term monitoring across the lifespan. This chapter provides an overview of different types of outcome instruments and a detailed description of the measurement properties along with their interpretation. The chapter then describes the considerations for therapists during administration, scoring, interpretation, and selection of outcome measures. An overview of the functional outcome measures used for the pediatric upper extremity is provided for measures available in the traditional format using classical and modern methods of measurement, the contemporary dynamic computerized adaptive format, and fixed-length short forms. Finally, the chapter provides resources for therapists to maintain ongoing competency in assessment of the pediatric upper extremity.
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Functional activities were assessed with a functional test (the AHA14) and with a questionnaire (the PUFI15,16). Selection of these instruments was based on an extensive literature review13 and evaluation of the validity and reliability of the instruments when used for children with longitudinal radial deficiency19. A certified hand therapist administered the AHA.
The effects of treatment of children with longitudinal radial deficiency are generally evaluated by measuring grip and pinch strength and joint mobility. Insight into limitations of activities of children with radial deficiency is scarce. In this study, we used standardized instruments to assess impairments in hand function and activity limitations and explored the relationship between the two.
We evaluated the hand function of twenty children with radial deficiency who were between four and twelve years of age. Impairments in hand function were assessed by measuring grip and pinch strength and the active range of motion of the wrist and of the metacarpophalangeal and proximal interphalangeal joints of the second digit. Functional activities were assessed with use of the Assisting Hand Assessment (AHA), to measure the effectiveness of the affected hand, and the Prosthetic Upper Extremity Functional Index (PUFI), to evaluate the ease of activity performance. The relationship between hand function and activity performance and the relationship of those measures with the type of radial deficiency were determined.
The average grip and pinch strengths were 36% and 30% of reference values. We found reductions in the active range of motion, particularly of the metacarpophalangeal and proximal interphalangeal joints. The mean AHA score was 85.5 points and the mean PUFI score was 81.8 points, with both measured on a 0 to 100-point scale. Grip and pinch strength, the active range of joint motion, and the sum scores on the two functional tests were related to the type of radial deficiency. Significant relationships were found between impairments in hand function and activity performance. There was a large variation in the activity performance of the children with poor strength, whereas a more linear relationship was found between the active ranges of motion of the wrist and finger joints and activity performance.
Despite marked impairments in hand function, children with radial deficiency performed functional activities fairly well. Relationships between impairments in hand function and limitation of activities were not linear. We recommend that evaluations of the results of treatment include assessment of both aspects of hand function.
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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Supported by the Johanna Children’s Fund (JKF) and the Children’s Fund Adriaanstichting (KFA).

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Functional assessment-RLDComparison of Instruments to Assess Hand Function in Children With Radius Deficiencies

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Patients

Results

Discussion

J Hand Ther

J Hand Surg

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

J Hand Surg

J Clin Epidemiol

Arch Phys Med Rehabil

Pain

Arch Phys Med Rehabil

J Chronic Dis

J Chronic Dis

J Hand Ther

J Hand Surg

J Hand Surg

Assessment of the functional gain of various operations in the complex hand

Rheumatology

The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment

Stroke

Functional assessment-RLD
Comparison of Instruments to Assess Hand Function in Children With Radius Deficiencies