Obstetric brachial plexus injuries (OBPIs): health-related quality of life in affected adults and parents

Abstract

BackgroundObstetric brachial plexus injuries (OBPIs) are rare but can have significant implications for those affected, their caregivers and the health system. Symptoms can range from restricted movement to complete paralysis of the arm. We investigated health-related quality of life in adults with OBPIs and parents of children with permanent OBPIs, compared these with population norms, and investigated whether certain socio-demographic or clinical factors were associated with the quality of life in these cohorts.MethodsA cross-sectional study examined 50 affected adults and 78 parents. Participants completed EQ-5D-5 L and characteristics questionnaires. EQ-5D-5 L responses were mapped onto an EQ-5D-3 L value set to generate utility scores. Mean utility scores were compared with English population norms. Univariable and multivariable linear regression models were conducted to assess for associations between participant characteristics and the utility scores.ResultsThe overall mean utility scores for affected adults and parents were 0.56 (SD 0.28) and 0.80 (SD 0.19) respectively. Affected adults (95% CI (− 0.38, − 0.22), p < 0.001) and parents of children with permanent OBPIs (95% CI (− 0.10, − 0.02), p = 0.007) had lower mean utility scores, and therefore quality of life, compared to English population norms. For affected adults, previous OBPI surgery (95% CI (0.01, 0.25), p = 0.040), employment in non-manual work (95% CI (0.06, 0.30), p = 0.005) and having a partner (95% CI (0.04, 0.25), p = 0.009) appeared to be positively associated with the utility score. Affected adults receiving disability benefits related to OBPIs appeared to have worse utility scores than those not receiving any disability benefits (95% CI (− 0.31, − 0.06), p = 0.005). For parents, employment was associated with better utility scores (95% CI (0.02, 0.20), p = 0.024) but the presence of one or more medical condition appeared to be associated with worse utility scores (95% CI (− 0.16, − 0.04), p = 0.001).ConclusionsAdults with OBPIs and parents of children with permanent OBPIs reported worse utility scores, and therefore quality of life, compared to the English general population. We also identified certain characteristics as possible factors to consider when dealing with utility scores in these cohorts. The utility scores in this study can be used in future economic evaluations related to OBPIs.Electronic supplementary materialThe online version of this article (10.1186/s12955-018-1039-z) contains supplementary material, which is available to authorized users.

A model-based cost-utility analysis of multi-professional simulation training in obstetric emergencies

“…Utility scores and Quality Adjusted Life Years (QALYs). The mean utility scores for adults (aged 18 years and over) with OBPIs and parents of children with OBPIs was extracted from our previously published study [2]. The total affected adult QALYs per model year were calculated using the mean utility score for adults with OBPIs, the number of individuals with OBPIs and the number of years they would have been adults for by the end of the model's time horizon (30 years).…”

“…Shoulder dystocia is an obstetric emergency and occurs when the anterior shoulder of a baby is impacted against the mother's pelvic bone during birth [1]. Mismanagement of this childbirth emergency, such as excessive traction on a baby's neck, can cause permanent injuries to the nerves in the neck (known as obstetric brachial plexus injuries (OBPIs)) resulting in long term morbidity and loss of quality of life [2]. Although permanent OBPIs are relatively rare, with incidence rates of 0.192 per 1,000 births in the UK [3] and 0.11-0.22 per 1,000 births in the US [4], these injuries are important sources of litigation and therefore impact the wider health system as well as the affected individuals and their families.…”

Neonatal Brachial Plexus Paralysis: A Discussion on the Light of Literature

“…Dados da literatura mostram sequelas em 20 a 30% dos pacientes acometidos, o pode comprometer a qualidade de vida desses pacientes, e trazer implicações significativas para os familiares e para o sistema de saúde (Yau, 2018;Smith, 2018 (Borges, 2016).…”

“…Yau, 2018). O manejo adequado e precoce dos casos pode minimizar as potenciais complicações.O objetivo desse trabalho foi realizar uma revisão sobre a Paralisia do Plexo Braquial Neonatal e, além disso, apresentar uma proposta de atendimento para esses pacientes.…”

Clinical and Functional Outcome of Modified Quad Surgery in Adult Obstetric Brachial Plexus Injury Patients: Case Reports

“…OBPI in adults causes difficulties in completing daily tasks and therefore the quality of their life. 32 The long-term effects of OBPI include a high propensity for pain exacerbation and worsening ability to move the shoulder with advancing age. 33 These investigators also reported that many of these patients had developed arthritis in the joints and spine.…”