Article

OBJECTIVES: To describe physical function in adult acquired major upper-limb
amputees (ULAs) by combining self-assessed arm function and physical measures
obtained by clinical examinations; to estimate associations between background
factors and self-assessed arm function in ULAs; and to assess whether clinical
examination findings may be used to detect reduced arm function in unilateral
ULAs. DESIGN: Survey: postal questionnaires and clinical examinations. SETTING:
Norwegian ULA population. Clinical examinations performed at 3 clinics.
PARTICIPANTS: Questionnaires: population-based sample (n=224; 57.4% response
rate). Clinical examinations: combined referred sample and convenience sample of
questionnaire responders (n=70; 83.3% of those invited). Survey inclusion
criteria: adult acquired major upper-limb amputation, resident in Norway,
mastering of spoken and written Norwegian. INTERVENTIONS: Not applicable. MAIN
OUTCOME MEASURES: The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome
Questionnaire, and clinical examination of joint motion and muscle strength with
and without prostheses. RESULTS: Mean DASH score was 22.7 (95% confidence
interval [CI], 20.3-25.0); in bilateral amputees, 35.7 (95% CI, 23.0-48.4); and
in unilateral amputees, 22.1 (95% CI, 19.8-24.5). A lower unilateral DASH score
(better function) was associated with paid employment (vs not in paid employment:
adjusted regression coefficient [aB]=-5.40, P=.033; vs students: aB=-13.88,
P=.022), increasing postamputation time (aB=-.27, P=.001), and Norwegian
ethnicity (aB=-14.45, P<.001). At clinical examination, we found a high frequency
of impaired neck mobility and varying frequencies of impaired joint motion and
strength at the shoulder, elbow, and forearm level. Prosthesis wear was
associated with impaired joint motion in all upper-limb joints (P<.006) and with
reduced shoulder abduction strength (P=.002). Impaired without-prosthesis joint
motion in shoulder flexion (ipsilateral: aB=12.19, P=.001) and shoulder abduction
(ipsilateral: aB=12.01, P=.005; contralateral: aB=28.82, P=.004) was associated
with increased DASH scores. CONCLUSIONS: Upper-limb loss clearly affects physical
function. DASH score limitation profiles may be useful in individual clinical
assessments. Targeted clinical examination may indicate patients with extra
rehabilitational needs. Such examinations may be of special importance in
relation to prosthesis function.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS