Background:
This study investigates the psychometric properties of patient-reported outcome instruments for assessing outcomes in postsurgical traumatic digit amputation patients. The authors hypothesize that the Michigan Hand Outcomes Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are the most valid and reliable instruments.
Methods:
The authors studied traumatic digit amputation patients as part of the Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness (FRANCHISE) study initiated by The Plastic Surgery Foundation. The MHQ, DASH questionnaire, Patient-Reported Outcomes Measurement Information System (PROMIS), and 36-Item Short-Form Health Survey were used to assess patients at least 1 year postoperatively. Internal consistency was measured by Cronbach’s alpha and criterion validity with Pearson correlation coefficient (r). Construct validity was tested with four predefined hypotheses. Discriminant validity was analyzed by receiver operating characteristic curves.
Results:
One hundred sixty-eight replantation and 74 revision amputation patients met the inclusion criteria. All instruments demonstrated fair to good internal consistency in both cohorts (0.7 < α < 0.9). The MHQ and DASH questionnaire scores correlated strongly (r > 0.60) in both cohorts. The 36-Item Short-Form Health Survey had moderate to weak correlation with the remaining instruments, and its mental component had poor discriminant validity (area under the curve, 0.64 to 0.67). The MHQ, DASH questionnaire, and PROMIS demonstrated good construct validity confirming 75 to 100 percent of predefined hypotheses, whereas the 36-Item Short-Form Health Survey confirmed only 25 percent.
Conclusions:
The authors recommend using the Michigan Hand Outcomes Questionnaire or the Disabilities of the Arm, Shoulder and Hand questionnaire when assessing patient-reported outcomes in digit amputation patients based on good internal consistency and validity. The Patient-Reported Outcomes Measurement Information System has fair validity and reliability but should be an adjunct instrument. The 36-Item Short-Form Health Survey should not be used as a primary assessment tool, but as an adjunct to assess overall quality of life.
This cross-sectional study examines associations of interfacility transfer and patient and hospital characteristics with thumb replantation attempts and success after traumatic thumb amputation.
he United States is a country with more guns than people. 1 Approximately one-third of U.S. residents are gun owners, and firearms are currently the second leading cause of injury death among citizens younger than 24 years. 2,3 The majority of firearm injury studies focus on mortality; firearm morbidity, however, is also devastating on individual and societal levels. More than 80,000 nonfatal firearm injuries are treated in U.S. emergency departments each year, the cost of which totals over $700 million annually in inpatient care. In addition, many will require rehabilitation and long-term care. 4,5 Among firearm-related injuries, 24 to 34 percent affect the upper extremity, and these injuries are more likely to be accidental. 2,6 Hutchinson et al. reported that 81 percent of upper extremity firearm-related injuries were accidental self-inflicted injuries that occurred in the context of cleaning or loading a gun; still, assault and intentional self-harm are also responsible for a number of upper extremity firearm injuries. 2,7
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