Alphonsus Chong's Personal Wiki

• 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.

• 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

• 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

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

1. 2021-06-23: created as org-mode and then copied over