Outcome assessment for Brachial Plexus birth injury. Results from the iPluto world‐wide consensus survey

Abstract

There is no consensus regarding strategies to optimally treat children with a brachial plexus birth injury (BPBI). Comparison of outcome data presented by different centers is impossible due to the use of (1) many different outcome measures to evaluate results; (2) different follow‐up periods after interventions; and (3) different patient ages at the time of assessment. The goal of iPluto (international PLexus oUtcome sTudy grOup) was to define a standardized dataset which should be minimally collected to evaluate upper limb function in children with BPBI. This dataset must enable comparison of the treatment results of different centers if prospectively used. Three rounds of internet surveys were used to reach consensus on the dataset. A Delphi‐derived technique was applied using a nine point Likert scale. Consensus was defined as having attained a rating of 7/8/9 by > = 75% of the participants. A total of 59 participants from five continents participated in the Second and Third Rounds of the survey. Consensus was reached regarding four elements: (1) evaluation should take place at the age of 1/3/5/7 years; range of motion in degrees should be measured for (2) passive joint movement; (3) active range of motion; and (4) the Mallet score should be determined. Consensus on how to asses and report outcome for BPBI was only reached on motor items from the “Body Function and Structure” domain. Consensus regarding additional ICF domains to obtain a more elaborate set of outcome items, should be addressed in future research. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:2533–2541, 2018.

Inter- and intra-rater reliability and clinical utility of the Brachial Plexus Outcome Measure: A pilot study

“…The statements were directly adapted from ‘iPluto’, a previously published international Delphi study. 4 Agreement with a statement is expressed on a 10-point Likert scale where 0 corresponds to no opinion, scores of 1–3 indicate disagreement, scores of 4–6 indicate neutral opinions and scores of 7–9 indicate agreement. 4 Participants were invited to make comments where appropriate to support these statements.…”

“…2 When assessing children with BRPI, it is widely recognised that best practice is to utilise tools which focus on both the biomechanical and functional limitations within the upper limb. 3,4 The World Health Organisation International Classification of Functioning, Disability and Health (WHO-ICF) encourages that a child’s impairments are considered alongside their limitations in activities and ability to participate in everyday life. 5 Two components, ‘ performance ’ and ‘ capacity ’, can be used in outcome measurement to assess the activities and participation domains.…”

“…In addition, a recent international Delphi study highlighted that there is a lack of consensus regarding which measures are best used within this cohort. 4 Those which were advocated focus on the impairment level of the WHO-ICF offering specific analysis of individual joints; such as, the Mallet score, which assesses shoulder range of movement with little focus on the way in which the child is able to integrate the arm into functional activities. 3,6,7 This limitation was noted by Pondaag and Malessy who reflected that their findings may be due to participants predominantly being surgeons; with an underrepresentation of rehabilitation practitioners.…”

“…3,6,7 This limitation was noted by Pondaag and Malessy who reflected that their findings may be due to participants predominantly being surgeons; with an underrepresentation of rehabilitation practitioners. 4 Neither of the two upper limb functional outcome measures assessed in their study gained consensus for use.…”

Response to the “letter to editor”: Critical appraisal of systematic review

“…The goal of the iPluto study group was to define a universal, minimal clinical dataset which could be easily implemented worldwide to report outcomes in children. 8 We hope that our article allows stakeholders to move the field forward and reduce the controversy that exists in the interpretation of evidence about EDX in NBPP.…”