Chapman Ted T, Richard Reg L, Hedman Travis L, Renz Evan M, Wolf Steve E, Holcomb John B
United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA.
J Hand Ther. 2008 Apr-Jun;21(2):150-8; quiz 159. doi: 10.1197/j.jht.2007.12.003.
This study evaluated the use of the American Medical Association (AMA) impairment guides and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in U.S. military casualties recovering from burn injury to the hand. Study sample included patients with burns to at least one hand and complete evaluations of impairment and disability upon discharge from the hospital and at a follow-up visit less than four months later. AMA and DASH scores were calculated for each visit and standardized response means (SRMs) were calculated to indicate responsiveness. Correlation between impairment and disability was assessed at discharge and follow-up and scores were examined for ability to discriminate between casualties returned to duty (RTD) and casualties not returned to duty (N-RTD). Both outcome instruments revealed a statistically significant change in scores between visits (p<0.001) with corresponding SRM indexes greater than 0.8 (large effect). There was a moderate correlation (r=0.50) between impairment and disability at discharge and a moderately high correlation (r=0.74) at follow-up. Both AMA and DASH scores clearly discriminated between casualties RTD (AMA 10+/-10 and DASH 12+/-12) and casualties N-RTD (AMA 39+/-19 and DASH 41+/-17) with improved accuracy at follow-up visit. The AMA and DASH can provide a comprehensive assessment of impairment and disability and may be used to detect changes in patient health status over time while clearly discriminating between RTD and N-RTD in combat casualties recovering from burn injury to the hand(s).
本研究评估了美国医学协会（AMA）损伤指南和上肢、肩部和手部功能障碍（DASH）问卷在美国手部烧伤军事伤员康复过程中的应用。研究样本包括至少一只手烧伤的患者，以及在出院时和出院后不到四个月的随访时对损伤和残疾情况进行的完整评估。每次就诊时计算AMA和DASH评分，并计算标准化反应均值（SRM）以表明反应性。在出院时和随访时评估损伤与残疾之间的相关性，并检查评分区分重返工作岗位（RTD）伤员和未重返工作岗位（N-RTD）伤员的能力。两种结果工具均显示就诊之间评分有统计学显著变化（p<0.001），相应的SRM指数大于0.8（效果显著）。出院时损伤与残疾之间存在中度相关性（r=0.50），随访时相关性较高（r=0.74）。AMA和DASH评分均能明确区分RTD伤员（AMA 10±10和DASH 12±12）和N-RTD伤员（AMA 39±19和DASH 41±17），随访时准确性有所提高。AMA和DASH可对手部烧伤军事伤员的损伤和残疾情况进行全面评估，可用于检测患者健康状况随时间的变化，同时能清晰区分RTD和N-RTD。
