The Toronto Extremity Salvage Score in Unoperated Controls: An Age, Gender, and Country Comparison

Abstract

The Toronto Extremity Salvage Score (TESS) is widely used for the functional assessment of patients following surgery for musculoskeletal tumours. The aim of this study was to determine if there are gender and/or age-specific changes, unrelated to surgery, that may influence this score and the appropriateness of the questions. The TESS for lower limb was carried out in two different countries to see if there was variation between them. There were no statistically significant differences between the scores obtained between the respondents from Australia or Britain either in total or between the corresponding age groups. There were statistically significant differences in the TESS obtained between age groups with a lower score at older age groups but there was no difference between the sexes. Patients in the age group 70+ were more likely to record activities as “not applicable” and also have a lower score. This study has shown that age is the major factor in determining the TESS in both an Australian and British populations of otherwise healthy people. As there were no differences between the two populations, it supports the TESS as an international scoring system. There may be also an argument for age-specific questions.

Patient factors affecting the Toronto extremity salvage score following limb salvage surgery for bone and soft tissue tumors

“…It is simple enough to accept why some of these variables will affect physical functioning following limb salvage. With increasing age, physical function also deteriorates , as shown in Clayers paper. Females have less muscle mass and strength compared to males ; rehabilitation and being reliant on upper body strength (in the case of a lower limb salvage) and may explain why they experience more disability.…”

“…In the same study, Davis looked at patient age and gender but no significant difference was found between groups. Clayers paper looked at the TESS of healthy individuals looking at the variations in outcome score by age, sex, and nationality . They found that the TESS score decreases with age in normal individual but found no difference in patient gender or nationality.…”

“…Davis et al have reported on lower limb soft tissue sarcoma characteristics which affect the score; increasing tumor size, high grade and having a motor nerve deficit were all shown to be associated with a statistically significant lower TESS score . In 2012, Clayer et al looked at the normal variation of TESS scores in healthy individuals and found that there is a normal decrease in physical functioning with age but patient gender and nationality had no effect.…”

Patient-Reported Functional and Quality of Life Outcomes in a Large Cohort of Long-Term Survivors of Ewing Sarcoma

“…It is difficult to discern whether patients who are diagnosed and treated at an older age are truly at risk for poorer functional outcomes, as age at diagnosis and age at time of survey are strongly correlated. Loss of physical function is common with the normal process of aging, as demonstrated in a study of healthy, unoperated adults that revealed increasing age was correlated with lower TESS scores . However, it must also be considered that patients undergoing treatment for ES at a younger age are better able to accommodate psychologically and physically to their treatment‐related changes and thus report an elevated self‐perception of function.…”

Isolated limb infusion: Efficacy, toxicity and an evolution in the management of in-transit melanoma

“…Some patients mentioned their associated comorbidities and age-related decreased functional status. As a baseline, in an otherwise healthy population TESS demonstrates an age-related decline, with scores of 98% in people in their 30s and 76% to 88% for those in their 70s (18). The most common physical complaint in our patients was mild edema, especially after prolonged standing.…”