Kraft George H, Amtmann Dagmar, Bennett Susan E, Finlayson Marcia, Sutliff Matthew H, Tullman Mark, Sidovar Matthew, Rabinowicz Adrian L
University of Washington, Seattle, WA.
Postgrad Med. 2014 Sep;126(5):102-8. doi: 10.3810/pgm.2014.09.2803.
Upper extremity (UE) dysfunction may be present in up to ~80% of individuals with multiple sclerosis (MS), although its importance may be under-recognized relative to walking impairment, which is the hallmark symptom of MS. Upper extremity dysfunction affects independence and can impact the ability to use walking aids. Under-recognition of UE dysfunction may result in part from limited availability of performance-based and patient self-report measures that are validated for use in MS and that can be readily incorporated into clinical practice for screening and regularly scheduled assessments. In addition to the 9-Hole Peg Test, which is part of the Multiple Sclerosis Functional Composite, there are several performance-based measures that are generally used in the rehabilitation setting. These measures include the Box and Block Test, the Action Research Arm Test, the Test d'Evaluation de la performance des Membres Supérieurs des Personnes Agées, and the Jebsen-Taylor Test of Hand Function. Several of these measures were developed for use in stroke, although in contrast to stroke, which is characterized by unilateral dysfunction, UE impairment in MS is generally bilateral, and should be assessed as such. Similarly, patient-reported UE measures are available, including Disabilities of the Arm, Shoulder, and Hand (DASH) and its shorter version, QuickDASH, the Manual Ability Measure, and ABILHAND, although none has been psychometrically validated for MS. Recently, item response theory was used to develop a Neuro-QOL (Quality of Life) UE measure and a Patient-Reported Outcomes Measurement Information System UE measure; neither of these have demonstrated sensitivity to change, limiting their use for longitudinal assessment. Consequently, although work is still needed to develop and validate performance-based and patient-reported measures of UE function that are suitable for use in daily MS clinical practice, currently available UE measures can be recommended for incorporation into MS management, albeit with an understanding of their limitations.
高达约80%的多发性硬化症（MS）患者可能存在上肢（UE）功能障碍，尽管相对于行走障碍而言，其重要性可能未得到充分认识，而行走障碍是MS的标志性症状。上肢功能障碍会影响独立性，并可能影响使用助行器的能力。对上肢功能障碍认识不足，部分原因可能是基于表现的和患者自我报告的测量方法有限，这些方法在MS中使用时经过验证，并且可以很容易地纳入临床实践用于筛查和定期评估。除了作为多发性硬化症功能综合评估一部分的9孔插钉试验外，还有几种基于表现的测量方法通常用于康复环境。这些测量方法包括箱块试验、动作研究臂试验、老年人上肢功能评估试验和杰布森 - 泰勒手功能试验。其中一些测量方法是为中风患者开发的，不过与以单侧功能障碍为特征的中风不同，MS患者的上肢损伤通常是双侧的，应如此进行评估。同样，也有患者报告的上肢测量方法，包括手臂、肩部和手部功能障碍（DASH）及其简短版本快速DASH、手动能力测量法和ABILHAND，尽管这些方法均未在MS患者中进行心理测量学验证。最近，项目反应理论被用于开发神经生活质量（Neuro-QOL）上肢测量法和患者报告结局测量信息系统上肢测量法；这两种方法均未显示出对变化的敏感性，限制了它们在纵向评估中的应用。因此，尽管仍需要开展工作来开发和验证适用于MS日常临床实践的基于表现的和患者报告的上肢功能测量方法，但目前可用的上肢测量方法可推荐纳入MS管理，不过要了解其局限性。
