=====Correlations Among Objectively Measured Impairment, Outcome Classification Systems, and Subjectively Perceived Disability After Flexor Tendon Repair=====

====Abstract====

**Purpose** Any loss of range of motion of the finger after flexor tendon repair is an impairment of function, but to what extent it causes disability is not properly understood. The aim of this study was to assess the correlation between perceived function (disability) and objectively measured loss of function (impairment), to understand what impairments are meaningful to patients.

**Methods** We assessed 49 patients who underwent flexor tendon repair an average of 38 months after repair. We measured the perceived function with the visual analog scale, the 4-step rating scale (poor, fair, good, or excellent), and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. The objective measurement of impairment included active range of motion at each joint, total active motion, grip strength, and 2-point discrimination.We also converted range of motion into 4 categories (poor, fair, good, and excellent) following guidelines from 3 different classification systems (American Society for Surgery of the Hand, Strickland-Glocovac, and revised Strickland). We used Spearman r and linear regression to assess the correlation.

**Results** Active range of motion at the distal interphalangeal joint had a strong correlation and total active range of motion of the finger joints had a moderate correlation with perceived function measured using the visual analog scale and DASH score. Other measured impairments did not correlate with perceived function. Objective classification categories also did not correlate with the patient’s own assessment.

**Conclusions** Our results validate the use of range of motion and the DASH questionnaire in assessing flexor tendon repairs. Classification of angular measurement according to the tested systems does not reflect the patient’s perspective; it limits the precision of the measurement and adds little value to the measurement itself. (J Hand Surg Am. 2019;44(5):361e365.


====Commentary====

  * Context: Finland is a well developed country with good hand surgery and access to healthcare. The repair and rehab techniques are not discussed. Would findings from this study generalize to other systems?
    *Rudge (UK 2014, and similar findings from Healy 2007) and Unsal (Turkey and International 2019) show that even in specialised units/ hand specialists, > 1/3 still using 2-strand repair techniques
  * Discussion about hand surgery measures: disability(patient-subjective), impairment (objective), resource use
  * 49 patients of 64 patients (76.5%) agreed to participate
  * average 38 months follow-up (9-71 months)
  * includes 2 patients with PL tendon grafting, 8 multiple digit injuries
  * 8 reoperations: 7 because of rupture (14%) and 1 for tendon adhesion (2%) that required tenolysis. All patients returned to work and there were no pending compensation claims at the time of data collection.
  * patient subjective assessment: VAS (0-100mm); 4 tier Likert, DASH
  * Spearman Classification
  * Bivariate analysis - linear regression model, ROC
  * nerve injury, sex, age, rupture did not seem to affect results – but few poor results
  * objective classifications correlated with each other, but not f-VAS or Likert (i.e. impairment does not seem to correlate with disability)
  * Most patients have normal DASH score
  * Their findings congruent with Farzad et al(7)
  * small number of poor results

==== Key takeaways ====

  * disability (as measured by DASH, f-VAS) doesn't seem to correlate well with widely used flexor tendon scoring systems, but does with AROM
  * use actual ROM data instead

====Source=====

Karjalainen, T., Jokinen, K., Sebastin, S. J., Luokkala, T., Kangasniemi, O.-P., & Reito, A. (2019). Correlations Among Objectively Measured Impairment, Outcome Classification Systems, and Subjectively Perceived Disability After Flexor Tendon Repair. The Journal of Hand Surgery, 44(5), 361–365. https://doi.org/10.1016/j.jhsa.2018.06.010

====See also====

  * Flexor tendon injury outcomes classification in Tang JB. Clinical outcomes associated with flexor tendon repair. Hand Clin. 2005;21(2):199e210. http://refhub.elsevier.com/S0363-5023(18)30794-9/sref3
  * DASH
  * [[md:flexor_tendon|Flexor Tendon Healing]]

==== History ====

  - 2021-06-23: created as org-mode and then copied over