Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Häraldsgatan 16, 431 30 Mölndal, Sweden.
Institute of Clinical Sciences, Department of Hand Surgery at Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80 Mölndal, Sweden.
Occup Ther Int. 2022 Oct 14;2022:8741660. doi: 10.1155/2022/8741660. eCollection 2022.
Spasticity is generally caused by damage to the spinal cord or the areas of the brain that controls movements, which poses significant limitations in occupational tasks.
The aims of the study were to (I) describe prioritized occupational performance problems (POPP) among patients who underwent upper limb spasticity-correcting surgery and map them to the International Classification of Function, Disability, and Health (ICF); (II) assess outcomes postsurgery; (III) assess whether the results are influenced by the diagnosis, gender, and residual muscle function; and (IV) assess correlation between changes in COPM and gains in grasp ability and grip strength.
In this retrospective study, assessments occurred pre- and postsurgery, including the Canadian Occupational Performance Measure (COPM), grip strength, and grasp ability. POPP were transformed to prioritized occupational performance goals (POPG) during subsequent rehabilitation.
60 patients with a history of spinal cord injury (SCI) ( = 42; 59%), stroke ( = 25; 34%), traumatic brain injury (TBI) ( = 4; 6%), and reason unknown ( = 1; 1%) were included, with a mean age of 57 (±13) years. Of those, 11 had bilateral surgery, generating 71 COPM forms and 320 POPG. The POPG were mapped to the ICF activity and participation chapter, most often to self-care ( = 131; 41%), domestic life ( = 68; 21%), and mobility ( = 58; 18%). COPM scores were significantly increased postsurgery, irrespective of diagnosis, gender, and muscle function. No clear correlation between COPM improvement and hand function gains was shown.
Patients who underwent spasticity-correcting upper limb surgery identified difficulties with a wide range of occupational tasks that they considered as important to regain. Treatment-induced gains in occupational performance were significant but had no clear correlation with gains in grasp ability and hand strength. Independent of diagnosis, gender, and residual muscle function, it seems important to address the activity- and participation-specific aspects in the assessment and rehabilitation of patients.
痉挛通常是由脊髓或控制运动的大脑区域受损引起的，这给职业任务带来了重大限制。
本研究的目的是：(I)描述接受上肢痉挛矫正手术后患者的优先职业表现问题（POPP），并将其映射到国际功能、残疾和健康分类（ICF）；(II)评估手术后的结果；(III)评估结果是否受诊断、性别和残留肌肉功能的影响；以及(IV)评估 COPM 变化与抓握能力和握力增益之间的相关性。
在这项回顾性研究中，在手术前后进行评估，包括加拿大职业表现测量（COPM）、握力和抓握能力。在随后的康复过程中，将 POPP 转化为优先职业表现目标（POPG）。
共纳入 60 例脊髓损伤（SCI）（=42；59%）、中风（=25；34%）、创伤性脑损伤（TBI）（=4；6%）和原因不明（=1；1%）的患者，平均年龄为 57（±13）岁。其中 11 例接受双侧手术，共生成 71 份 COPM 表格和 320 份 POPG。POPG 被映射到 ICF 活动和参与章节，最常见的是自我护理（=131；41%）、日常生活（=68；21%）和移动（=58；18%）。手术后 COPM 评分显著增加，与诊断、性别和肌肉功能无关。未显示 COPM 改善与手部功能增益之间有明显相关性。
接受上肢痉挛矫正手术的患者确定了在广泛的职业任务中存在困难，这些任务被认为是他们需要恢复的重要任务。治疗引起的职业表现增益是显著的，但与抓握能力和手部力量的增益没有明显的相关性。独立于诊断、性别和残留肌肉功能，在评估和康复患者时，似乎重要的是要解决与活动和参与相关的特定方面。
