Do existing patient-report activity outcome measures accurately reflect day-to-day arm use following adult traumatic brachial plexus injury?

Abstract

Adults with a brachial plexus injury report a range of activities that are limited following injury, and are under-represented in currently used patient-reported outcome measures. The activities reported in this study could be used to inform the development of a new brachial plexus injury targeted questionnaire.

Preliminary Psychometric Evaluation of the Brachial Assessment Tool Part 2: Construct Validity and Responsiveness

“…(5,6) While a few patient-reported outcome measures have been used to evaluate function following BPI, most do not contain items that assess the full range of ability of adults with a BPI . (7,8) Further, none have been psychometrically evaluated for this population. (7,9,10) The Brachial Assessment Tool (BrAT) is a new unidimensional, targeted, 31-item patient-reported outcome measure, with each item quantified on a 4-point scale.…”

“…(11) Items are important to people with BPI, regularly performed and appear to represent the spectrum of ability of this population. (8,12) The BrAT is comprised of 3 subscales: i) M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 eight 'Dressing and grooming' items, ii) 17 'Whole arm and hand' items, iii) six 'No hand' items; or alternatively all 31-items may be added to produce a summed score.…”

“…The DASH contains 30 items and is known to be multidimensional, (19,20) with only 16 items specific to activity as defined by the ICF. (7,8,21) These 16 items have been shown to contain two further dimensions, variously reported as 'gross motor activities' and 'fine motor activities' (20) or 'shoulder range of motion' and 'manual functioning'. (19) Moreover, unlike the BrAT the DASH is not limb specific with respondents able to answer irrespective of the strategy they use to complete the activities, including compensatory mechanisms or altering hand dominance.…”

The challenge of assessment in rehabilitation

“…We read with interest the paper of hill et al (1), who addresses some relevant questions about functional assessment in rehabilitation. in particular, they question the content of assessment for patients with brachial plexus injury.…”

“…multidimensional questionnaires that simultaneously assess several domains should be avoided, as they could give misleading results. hill et al (1) clearly explain this limitation for the Disabilities of arm, shoulder and hand scale (Dash), although this is not an isolated case. for example, the Disability assessment scale (Das), developed to assess spastic stroke patients, also covers several icf domains.…”