Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil.
Clinical Research, Hand and Upper Limb Centre, St Joseph's Health Centre, Western University, London, ON, Canada.
Syst Rev. 2018 Oct 27;7(1):175. doi: 10.1186/s13643-018-0836-0.
Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair.
This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence.
Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity.
Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective.
手部神经修复后的结果需要经过标准化的心理测量学稳健评估。本研究旨在系统性地回顾可用于评估神经修复后功能、运动和感觉的现有评估工具的心理测量学特性。
本系统的健康测量仪器研究检索了 1966 年至 2017 年的数据库。两位评估者使用临床测量研究结构化工具进行数据提取和质量评估。在达成共识之前，kappa 相关性用于定义个体项目的一致性，组内相关系数（ICC）用于评估评估者之间的可靠性。叙述性综合描述了证据的质量和内容。
纳入的 16 项研究最终进行了关键评估评分。kappa 值范围为 0.31 至 0.82，ICC 值为 0.81。运动域采用手动肌肉测试，kappa 值为 0.72 至 0.93，测力计 ICC 可靠性为 0.92 至 0.98。感觉域中触觉阈值 Semmes-Weinstein 单丝（SWM）是最敏感的测量方法，而两点辨别（2PD）是最不敏感的方法（效应量为 1.2 和 0.1）。一项立体知觉测试，形状和纹理识别（STI），kappa 测试-再测试可靠性为 0.79，组内相关系数为 0.61，具有良好的敏感性和特异性。手动触觉测试与 2PD 和 SWM 具有中度至轻度相关性。功能域呈现 Rosén-Lundborg 评分，总评分的 Spearman 相关系数为 0.83。患者报告的结局测量指标的 ICC 为 0.85，内部一致性为 0.88 至 0.96，患者自评手腕和手评估的可靠性较高，相关性为 0.38 至 0.89，有效性较好。
少数研究将神经修复纳入样本进行结果测量的心理测量学分析，因此可以确认中度证据。手动肌肉测试和鹿特丹内在手测力计具有极好的可靠性，但有效性或敏感性数据不足。触觉阈值测试比 2PD 测试更敏感。定位认知测试和 STI 具有有限但积极的有效性相关数据。Rosén-Lundborg 评分作为神经修复后的综合结果，具有可靠性和有效性的新兴证据。很少有问卷被认为可以可靠和有效地评估对寒冷的不耐受。没有从患者角度全面评估症状和功能的神经修复后患者报告的结局测量。
