Understanding the Relationship Between Patient-Reported Function and Actual Function in the Upper Limb Prosthesis User Population: A Preliminary Study.

OBJECTIVE

To understand how perceived function relates to actual function at a specific stage in the rehabilitation process for the population using upper limb prostheses.

DESIGN

Quantitative clinical descriptive study.

SETTING

Clinical offices.

PARTICIPANTS

A sample of 61 participants (N=61; mean age, 43.0±12.8y; 51 male/10 female) with upper limb amputation who use a prosthetic device and were in the definitive stage of a prosthesis fitting process.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

A patient-reported outcome measure, the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and 2 performance-based outcome measures, Box and Blocks Test (BBT) and Capacity Assessment of Prosthesis Performance for the Upper Limb (CAPPFUL), were used as variables in multiple linear regression models.

RESULTS

The multiple linear regression models, which controlled for prosthesis type and amputation level, did not show evidence that changes in the independent variable (DASH) are significantly associated with changes in the dependent variables (log(BBT) (=-0.007; 95% confidence interval [CI], -0.015 to 0.001; =.0937) and CAPPFUL (=-0.083, 95% CI, -0.374 to 0.208; =.5623)). In both models, individuals with elbow, transhumeral (above elbow), and shoulder disarticulation showed a significant negative association with the dependent variable (CAPPFUL or logBBT). In the CAPPFUL model, there was a significant negative association with individuals using a hybrid prosthesis (=-20.252; 95% CI, -36.562 to -3.942; =.0170). In the logBBT model, there was a significant positive association with individuals using body-powered prostheses (=0.430; 95% CI, 0.089-0.771; =.0157).

CONCLUSIONS

Although additional data and analyses are needed to more completely assess the association between self-reported measures and performance-based measures of functional abilities, these preliminary results indicate that patient-reported outcomes alone may not provide a complete assessment of an upper limb prosthesis users' functional ability and should be accompanied by population-specific performance-based measures.