Ann Arbor, Mich. From the Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, and the University of Michigan Medical School.
Plast Reconstr Surg. 2014 Nov;134(5):746e-755e. doi: 10.1097/PRS.0000000000000591.
Disability ratings after finger amputations are based on anatomical injury according to the American Medical Association's Guides to the Evaluation of Permanent Impairment. These ratings determine disability and compensation, without considering validated outcomes measures. The authors hypothesize that patient-reported outcomes reflect function and health-related quality of life after traumatic finger amputations, and that Guides scoring does not accurately rate postamputation disability.
Patients were classified by amputation: single finger, thumb, multifinger, or multifinger plus thumb. Eighty-four patients completed functional tests, the Jebsen-Taylor Hand Function Test, and patient-reported outcomes [Brief Michigan Hand Questionnaire (MHQ), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Short Form-36 health-related quality-of-life questionnaire). Patients were given disability scores according to the Guides. Pearson correlations between outcomes metrics were calculated, and linear regression evaluated associations between amputation group, Guides score, and outcomes measures.
The Brief MHQ and Quick DASH questionnaires had significant correlation with functional tests, the Jebsen-Taylor test, and the physical component summary of Short Form-36. Only the Brief MHQ correlated with the mental component summary of the Short Form-36 (r=0.29, p=0.02). The Guides score only correlated with the Jebsen-Taylor test (r=0.47, p<0.001). Regression results indicate that the Brief MHQ, Quick DASH, and Guides score predict Jebsen-Taylor test score; however, amputation group and Guides score do not predict patient-reported outcomes.
The American Medical Association Guides score represents anatomical and functional outcomes without addressing mental health and other components of disability. As a result, Guides scoring is inadequate for determining postamputation disability. In evaluating composite amputation outcomes, Brief Michigan Hand Questionnaire outperformed other metrics.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
根据美国医学协会的《永久性损伤评估指南》，手指截肢后的残疾评级基于解剖损伤。这些评级确定了残疾和赔偿，而没有考虑经过验证的结果测量。作者假设患者报告的结果反映了创伤性手指截肢后的功能和健康相关生活质量，而指南评分并不能准确评估截肢后的残疾程度。
根据截肢类型对患者进行分类：单指、拇指、多指或多指加拇指。84 名患者完成了功能测试、Jebsen-Taylor 手功能测试和患者报告的结果[简明密歇根手问卷（MHQ）、快速残疾程度问卷（DASH）和简短 36 项健康相关生活质量问卷（SF-36）]。根据指南给患者分配残疾评分。计算了结果指标之间的 Pearson 相关性，并通过线性回归评估了截肢组、指南评分和结果测量之间的关联。
简明 MHQ 和快速 DASH 问卷与功能测试、Jebsen-Taylor 测试和 SF-36 的物理成分综合评分有显著相关性。只有简明 MHQ 与 SF-36 的心理成分综合评分相关（r=0.29，p=0.02）。指南评分仅与 Jebsen-Taylor 测试相关（r=0.47，p<0.001）。回归结果表明，简明 MHQ、快速 DASH 和指南评分可以预测 Jebsen-Taylor 测试评分；然而，截肢组和指南评分不能预测患者报告的结果。
美国医学协会指南评分代表解剖和功能结果，而不涉及心理健康和残疾的其他方面。因此，指南评分不足以确定截肢后的残疾程度。在评估复合截肢结果时，简明密歇根手问卷优于其他指标。
临床问题/证据水平：风险，II。
