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Persaud D, Hutchison T, Anthony SJ, Davidge KM, Clarke HM, Ho ES. Mental health and psychosocial support for children with upper limb musculoskeletal conditions. J Hand Surg Eur Vol 2024; 49:885-891. [PMID: 37987683 PMCID: PMC11264536 DOI: 10.1177/17531934231214138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
This study describes mental health and psychosocial screening processes, access to care and interventions provided to children with upper limb musculoskeletal conditions. A cross-sectional e-survey study was conducted of 107 healthcare professionals who work with children with congenital hand and upper limb differences and brachial plexus birth injuries. Of them, 41 (38%) reported that they routinely screen for mental health and psychosocial concerns. Few (12%) reported the use of standardized outcome measures. In total, 51 (48%) healthcare professionals reported that there was a waiting list for mental health services at their institution. Collectively, healthcare professionals were unsatisfied with the staffing, access to care and types of interventions available. Reported barriers to care included the growing need for mental health support, lack of resources and poor continuity of care after referrals. Future research should focus on identifying and validating a mental health screening tool and investigating the processes affecting access to mental health care.Level of evidence: IV.
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Affiliation(s)
- Deanna Persaud
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Tamsen Hutchison
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Samantha J. Anthony
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kristen M. Davidge
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Howard M. Clarke
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Emily S. Ho
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
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Goldfarb CA, Torres B, Steinman S, Wang A, Vuillermin C, Wall LB. Patient and Caregiver Impressions of the Impact of Madelung Deformity: A CoULD Registry Analysis. J Hand Surg Am 2024:S0363-5023(24)00053-4. [PMID: 38430094 DOI: 10.1016/j.jhsa.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE This study seeks to investigate demographics of patients with Madelung deformity in a large, geographically diverse sample and understand patient and caregiver perceptions of the impact of this condition. We hypothesized that patients with untreated Madelung deformity have greater pain and lower function compared to the normal population but are less affected than the chosen control group, namely, patients with proximal radioulnar synostosis (PRUS). METHODS This retrospective study queried the Congenital Upper Limb Differences (CoULD) Registry, a multicenter registry of patients treated in tertiary care pediatric hospitals. We searched patients enrolled as of July 2022 and identified 3,980 total patients and 66 (1.7%) with a diagnosis of Madelung deformity. We reviewed demographics and Patient-Reported Outcomes Measurement Information System (PROMIS; peer relations, depressive symptoms, pain interference, and upper extremity function domains) scores at time of enrollment. We used a matched cohort comparison with propensity scoring for 50 patients with Madelung deformity and 50 patients with PRUS (control cohort). RESULTS Patients with Madelung deformity presented at an average age of 13.1 years (± 2.1 years). Ninety-eight percent were female, and 82% were White. Seventy-four percent had distal radius-only deformity. Upper extremity PROMIS scores in both the Madelung deformity and the PRUS groups were significantly "worse" than normal, confirming our hypothesis. The Madelung deformity and PRUS cohort scores were not consistently different from one another. PROMIS scores from all other domains, including pain interference, were similar to, or better than normal for both groups, disproving the second part of our hypothesis. CONCLUSIONS Patients with Madelung deformity averaged 13 years of age and were nearly all female, and the majority had only distal involvement of the radius. Patients with Madelung deformity had lower function based on PROMIS scores, similar to the control cohort, whereas all other PROMIS measures were similar to or better when compared to normal values. Pain interference scores in both cohorts were lower than normal values. Patients with Madelung deformity have decreased function, similar to the comparative cohort of patients with PRUS, but do not present with increased pain. TYPE OF STUDY/LEVEL OF EVIDENCE Symptom prevalence III.
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Affiliation(s)
- Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.
| | - Beltran Torres
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Suzanne Steinman
- Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Angela Wang
- Department of Orthopaedic Surgery, University of Utah, Shriners Hospital for Children, Salt Lake City, UT
| | | | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
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Burger E, 't Hart J, Hovius S, Van Nieuwenhoven C. Quality of life in children with preaxial polydactyly of the foot in comparison to adults, postaxial polydactyly and healthy controls. J Pediatr Orthop B 2023; 32:27-33. [PMID: 36125884 DOI: 10.1097/bpb.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The effect of preaxial polydactyly of the foot on health-related quality of life (HR-QoL) has not been investigated in current literature. To improve counseling, we investigated HR-QoL in this patient group. A patient-control study was performed with children with preaxial polydactyly ( n = 20), adults with preaxial polydactyly ( n = 15), children with postaxial polydactyly ( n = 15) and healthy controls ( n = 62). The primary outcome was the difference in the foot-specific quality of life (FS-QoL) between children with preaxial polydactyly and adults with preaxial polydactyly, children with postaxial polydactyly and controls, using the Oxford Ankle and Foot Questionnaire (OxAFQ-c) and five foot-specific visual analogue scales (VAS). The secondary outcome was the difference in general HR-QoL, using the Pediatric Quality of Life Inventory (PedsQL). Outcomes were compared with the Mann-Whitney-U test. Comparison between children with preaxial polydactyly and healthy controls and postaxial polydactyly showed worse outcomes in all OxAFQ-c domains. The foot-specific VAS score was significantly worse in children with preaxial polydactyly compared to postaxial polydactyly and controls. Only the PedsQL physical domain showed a lower outcome in children with preaxial polydactyly than in postaxial polydactyly and controls. Children and adults with preaxial polydactyly scored the same in all domains. The OxAFQ-c and the PedsQL physical domain showed significantly worse outcomes in children with preaxial polydactyly compared with healthy controls and postaxial polydactyly. However, large variation was observed, suggesting large differences between patients. In children and adults, the foot and scar appearance seems to be the biggest problem, while diminished foot function seems less of an issue.
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Affiliation(s)
- Elise Burger
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam
| | - Judith 't Hart
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam
| | - Steven Hovius
- Department of Plastic, Reconstructive and Hand surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Zurich Appearance Score for Hands: Development and Validation of an Instrument for Assessing Hand Appearance in Congenital Upper Limb Differences. J Hand Surg Am 2022; 47:1181-1191. [PMID: 36273942 DOI: 10.1016/j.jhsa.2022.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 07/20/2022] [Accepted: 08/17/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The appearance of the hand is relevant to individual activity and participation. Improving appearance is often one of the essential goals of hand surgery. The aim of this study was to describe and validate an instrument for quantitatively assessing hand appearance in congenital upper limb differences (CULD). METHODS The Zurich Appearance Score for Hands (ZASH) was developed as a summed score of 6 items: 1 for overall appearance and 5 specific items for the skin, proportions of the hand, the number of digits, the shape of fingers and the thumb, and the position of the thumb. Each item can be rated on an 11-point Likert scale. Here, 448 participants (age, 14-83 years) were asked to rate the images of 17 hands, including standardized 3-dimensional photorealistic computer graphics and photographs of children's hands with or without CULDs, some after surgical correction. The sociodemographic characteristics of the participants were measured using a short questionnaire. RESULTS The ZASH score for all CULDs was significantly lower than the ZASH score for normal hands. Correlations for overall appearance and the ZASH score were high (r = 0.77-0.87). The internal consistency of all ZASH scores was good to excellent (Cronbach α = 0.82-0.94). The test-retest reliability in a subgroup of 54 participants was good (r = 0.53-0.79). The interrater reliability of the ZASH score was moderate (intraclass correlation = 0.47). CONCLUSIONS The ZASH is a valid and moderately reliable instrument for assessing hand appearance in children with CULDs. CLINICAL RELEVANCE Achieving the best possible appearance is the one of the most relevant goals of hand surgery. Assessment with validated instruments provides evidence on how to approach this goal. Further studies may clarify whether the ZASH can be recommended for all hand conditions and to what extent observers' sociocultural and professional backgrounds affect perception.
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Wessel LE, Goldfarb CA, Vuillermin C, Hutchinson DT, Bohn D, Steinman S, Wall LB. The Impact of Isolated Versus Multiple Osteochondromas: Analysis of the CoULD Registry. J Pediatr Orthop 2022; 42:387-392. [PMID: 35749762 DOI: 10.1097/bpo.0000000000002167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The burden of upper extremity (UE) osteochondromas on function and self-perception among pediatric patients is unclear. The purpose of our study was to study the impact of osteochondromas in comparison to population norms and to evaluate solitary versus multiple osteochondromas on subjective UE function as measured by patient rated outcomes. METHODS We utilized the CoULD (Congenital Upper Limb Differences) Registry to review all pediatric patients presenting with osteochondromas between January 2014 and February 2021. Demographic information was collected and patients were classified as having either single or multiple osteochondromas. Patient-Reported Outcome Measurement Information System (PROMIS) and Pediatric Outcomes Data Collection Instrument (PODCI) tools were utilized for assessment. Scores for PODCI subscales of UE function, Pain/comfort, and Happiness and PROMIS domains of UE Function, Pain, Depression, Anxiety, and Peer Relations were reviewed. Differences between groups were analyzed using the Student t test. RESULTS Ninety-nine patients met inclusion criteria for the study with an average age of presentation of 9.3 years and 61 patients (62%) were male. Overall, patients demonstrated worse UE Function as well as greater Anxiety and Depression in comparison to the population normals on PROMIS assessment. Patients also demonstrated worse patient and parent reported PODCI UE, Sports and Physical Functioning, Pain/Comfort and Global Functioning scores compared with population norms but demonstrated better than average happiness scores. Patients with multiple osteochondromas demonstrated greater PROMIS pain interference and more disability in PODCI Sports and Physical Functioning, Pain/Comfort and Global Functioning compared with those with solitary osteochondromas. CONCLUSION Patients with UE osteochondromas have worse overall function in comparison to population norms, exceeding established minimally clinically important difference values. In addition, patients with multiple osteochondromas reported more pain and poorer physical function than those with solitary osteochondromas. Physicians should be alert to the physical and psychosocial burden of this disease. LEVEL OF EVIDENCE Level II-prognostic.
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Affiliation(s)
- Lauren E Wessel
- Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, CA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Carley Vuillermin
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA
| | | | - Deborah Bohn
- Department of Orthopedics, Gillette Children's Specialty Healthcare, Saint Paul, MN
| | - Suzanne Steinman
- Department of Orthopedic Surgery, Seattle Children's Hospital, Seattle, WA
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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Battraw MA, Fitzgerald J, Joiner WM, James MA, Bagley AM, Schofield JS. A review of upper limb pediatric prostheses and perspectives on future advancements. Prosthet Orthot Int 2022; 46:267-273. [PMID: 35085179 DOI: 10.1097/pxr.0000000000000094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
Many complex factors affect whether a child with a congenital upper limb deficiency will wear a prosthetic limb. Ultimately, for a child to wear and use their prosthesis, it must facilitate the effective performance of daily tasks and promote healthy social interactions. Although numerous pediatric devices are available, most provide a single open-close grasp (if a grasping function is available at all) and often offer nonanthropomorphic appearances, falling short of meeting these criteria. In this narrative review, we provide a critical assessment of the state of upper limb prostheses for children. We summarize literature using quality of life measures and categorize driving factors affecting prosthesis use into two main groupings: psychosocial and physical functioning. We define psychosocial functioning as factors related to social inclusion/exclusion, emotional function, independence, and school functioning. Physical functioning is defined as factors associated with the physical use of a prosthesis. The reviewed literature suggests that psychosocial domains of quality of life may be influenced by a congenital limb deficiency, and currently available prostheses provide little benefit in the physical functioning domains. Finally, we discuss technological advancements in adult prostheses that have yet to be leveraged for pediatric devices, including describing recently developed adult electric hands that may improve physical functioning through multiple grasping configurations and provide more hand-like cosmesis. We outline actions necessary to translate similar technologies for children and discuss further strategies to begin removing barriers to pediatric device adoption.
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Affiliation(s)
- Marcus A Battraw
- Department of Mechanical and Aerospace Engineering, University of California, Davis, CA
| | - Justin Fitzgerald
- Departments of Neurobiology, Physiology and Behavior, Neurology, University of California, Davis, CA
| | - Wilsaan M Joiner
- Departments of Neurobiology, Physiology and Behavior, Neurology, University of California, Davis, CA
| | - Michelle A James
- Shriners Hospital for Children, Northern California, Sacramento, CA
| | - Anita M Bagley
- Shriners Hospital for Children, Northern California, Sacramento, CA
| | - Jonathon S Schofield
- Department of Mechanical and Aerospace Engineering, University of California, Davis, CA
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Lightdale-Miric N, Tuberty S, Nelson D. Caring for Children With Congenital Upper Extremity Differences. J Hand Surg Am 2021; 46:1105-1111. [PMID: 34548182 DOI: 10.1016/j.jhsa.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/21/2021] [Accepted: 07/02/2021] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to provide information about the changing landscapes in research, treatment, civil rights' protection, disability awareness, and accepted terminology in the care of children with congenital upper limb differences. This knowledge can guide clinical and nonclinical conversations between patients and their families.
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Affiliation(s)
- Nina Lightdale-Miric
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
| | - Sarah Tuberty
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Danielle Nelson
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
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Lake A, Cerza SP, Butler L, Oishi S, Brown A. The impact of therapeutic camp on children with congenital hand differences. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2021.1938439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Amy Lake
- Department of Therapy Services, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Shelby Parker Cerza
- Department of Clinical and Orthopaedic Research, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Lesley Butler
- Department of Clinical and Orthopaedic Research, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Scott Oishi
- Center of Excellence in Hand Disorders & Department of Hand Surgery, Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Andrea Brown
- Department of Child Life Services, Scottish Rite Hospital for Children, Dallas, Texas, USA
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Miller R, Samarendra H, Hotton M. A systematic review of the use of psychological assessment tools in congenital upper limb anomaly management. J Hand Ther 2021; 33:2-12.e1. [PMID: 30857895 DOI: 10.1016/j.jht.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 07/01/2018] [Accepted: 11/02/2018] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN This study is a systematic review. INTRODUCTION Congenital upper limb anomalies (CULAs) are often associated with psychosocial difficulties including negative body image, low self-esteem, and withdrawal from social activities. PURPOSE OF THE STUDY The purpose of the study was to identify, describe, and evaluate all published psychosocial assessment tools used in the assessment and management of CULAs, to direct the use of these tools in clinical practice, and to identify areas requiring development. METHODS A systematic search of Medline, EMBASE, Pubmed, and PsychInfo databases was performed. In total, 23 studies were included for analysis. Data extracted included study and population characteristics, psychosocial measures utilized, psychosocial outcomes reported, and the reliability and validity of measures. RESULTS Seventeen patient-reported measures were identified. The most commonly used tool was a Likert scale (n =7) with satisfaction with appearance and function, the most commonly evaluated outcome (n = 18). Other evaluated domains included quality of life or psychosocial functioning (n = 9), self-image (n = 2), and psychological well-being (n = 5). DISCUSSION AND CONCLUSIONS There is no well-established, validated assessment tool in regular use to effectively address psychosocial outcomes for children with CULAs. Although the majority of children born with a CULA appear to adjust well, this is by no means the case for all children. There is a need for routine psychosocial evaluation preoperatively and postoperatively with long-term follow-up data to help direct patient-orientated management. A clear understanding of these, and how to measure them, is needed to help for a patient-centred, multidisciplinary, evidence-driven approach to CULA management.
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Affiliation(s)
- Robert Miller
- Plastic Surgery Department, The Royal Free Hospital, London
| | | | - Matthew Hotton
- Specialist Surgery Psychology Team, Psychological Medicine Centre, John Radcliffe Hospital, Oxford
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11
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Wall LB, Vuillermin C, Miller PE, Bae DS, Goldfarb CA. Convergent Validity of PODCI and PROMIS Domains in Congenital Upper Limb Anomalies. J Hand Surg Am 2020; 45:33-40. [PMID: 31543292 DOI: 10.1016/j.jhsa.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/08/2019] [Accepted: 08/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This study evaluates the perceived functional and psychosocial impact of upper limb congenital anomalies prior to surgical intervention, utilizing the Pediatric Outcomes Data Collection Instrument (PODCI) and Patient-Reported Outcomes Measure Information System (PROMIS) domains. We hypothesized that scores will be in the normal range and that the 2 outcomes measures will have strong convergent validity. METHODS A multicenter prospectively collected database of congenital upper limb patients, the CoULD (Congenital Upper Limb Differences) study group, was utilized. Demographic information was collected, and anomalies were classified by the Oberg-Manske-Tonkin (OMT) classification. Scores for PODCI subscales of Upper Extremity (UE) function, Pain/comfort, and Happiness and PROMIS domain of UE function, Pain, Depression, Anxiety, and Peer relations were collected. Ceiling and floor effects and convergent validity for PODCI and PROMIS domains were calculated. RESULTS Three hundred fifty-nine patients, average age 10 years and 55% male, were included. Two hundred forty-one patients had a malformation of the entire limb and 231 had a hand plate malformation. Four patients had a deformation, 118 dysplasia, and 45 a syndrome. There was no difference between the PODCI and the PROMIS ceiling or floor effects for the UE domains. The ceiling effect for PROMIS Pain domain (46%) was similar to the floor effect of the PODCI Pain subscale and no difference was seen between the floor effect of PODCI Happiness and PROMIS Depression domains. Convergent validity was obtained for the UE and Pain domains, and also between PODCI Happiness and PROMIS Depression subscales. CONCLUSIONS The PROMIS domains for UE function, Pain, and Depression are comparable with PODCI scores in congenital upper extremity anomalies. CLINICAL RELEVANCE Given the large burden placed on patients with the lengthy PODCI questionnaire, consideration of replacing the PODCI with the more quickly obtained PROMIS scores may reduce patient burden and provide similar information in this population.
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Affiliation(s)
- Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
| | - Carley Vuillermin
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Patricia E Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Donald S Bae
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO
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Qualitative analysis of impact of congenital hand differences on children visiting a tertiary care hospital. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Yeung CM, Choi AKY, Tong JWS, Fok W, Chan YF, Chow YY. Long-Term Results of Surgically Treated Radial Polydactyly - An Outcome Correlation Study. J Hand Surg Asian Pac Vol 2019; 24:264-269. [PMID: 31438788 DOI: 10.1142/s2424835519500322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Thumb polydactyly is one of the commonest congenital hand differences. Traditional surgeon-based outcome scores capture outcomes mainly on bodily structure and function. Outcomes on the long-term well-being of the patients in the domains of activity and participation are not fully studied. Methods: Forty-eight thumbs in forty-five Chinese patients with radial polydactyly underwent surgical treatment at or before 3 years old were recruited. Mean follow-up was 11.6 years. Surgical outcomes were collected and compared to the normal opposite thumb. The results were compiled into the Japanese Society for Surgery of the Hand (JSSH) score, Cheng score and Tada score. Patients' activity involving hands were assessed by both objective tools and patient-reported outcome measure while their health-related quality of life (HRQoL) was assessed by Patient- and Parent-reported Pediatric Quality of Life Inventory (PedsQL). Correlations between outcomes were analysed. Results: Overall, both parents and patients themselves reported good quality of life with mean score of 86.6% and 92.1% respectively in PedsQL. The combined surgical scores ranged from 52% good or excellent results using JSSH score to 100% good result using Cheng score. None of the outcomes on bodily structure and function showed positive correlation with patient's well-being. Negative correlation was noted in total passive range of movement, active movement and Cheng score. All patients reported no activity restriction. Writing test did not show significant slowing. The operated hands had significantly poorer fine motor dexterity than normal. No significant correlation is noted between activity outcomes and PedsQL. Conclusions: Outcomes on bodily structure, function and activity showed little correlation with patients' well-being after thumb polydactyly correction. It should be careful in using or analysing patient/parent-reported outcome measures on HRQoL as outcome assessment of surgical treatment of radial polydactyly.
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Affiliation(s)
- Ching Man Yeung
- Department of Orthopaedics & Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | | | | | - Winnie Fok
- Department of Occupational Therapy, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Yat Fai Chan
- Department of Orthopaedics & Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Yuk Yin Chow
- Department of Orthopaedics & Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Chaudhry S. Upper Extremity Care for Children: Unique Medical and Psychosocial Aspects. J Hand Surg Am 2019; 44:606-609. [PMID: 30551917 DOI: 10.1016/j.jhsa.2018.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023]
Abstract
Hand surgeons encountering pediatric patients should be attuned to both technical and practical facets of caring for congenital and traumatic pathologies. Psychosocial aspects include engaging children in conversation and factoring in both self and external perception of deformity. Medical considerations are also unique, from including child abuse in the differential to having techniques to assess active motion and sensation in the nonverbal child. Certain universal principles, such as minimizing radiation exposure and limiting needle sticks, have higher emphasis in pediatric patients than in adults. With these aspects in mind, treating children and their families can be a mutually rewarding experience.
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Affiliation(s)
- Sonia Chaudhry
- Department of Pediatric Orthopaedic and Hand Surgery, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, CT.
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Bae DS, Canizares MF, Miller PE, Waters PM, Goldfarb CA. Functional Impact of Congenital Hand Differences: Early Results From the Congenital Upper Limb Differences (CoULD) Registry. J Hand Surg Am 2018; 43:321-330. [PMID: 29241842 DOI: 10.1016/j.jhsa.2017.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 08/31/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize the functional, emotional, and social impact of congenital upper limb differences on affected children and families before treatment, using validated functional outcome instruments. METHODS From June 2014 to March 2016, 586 children with congenital upper limb differences from 2 pediatric hospitals were enrolled in the Congenital Upper Limb Differences registry. Demographic, clinical, and radiographic data were collected, and diagnoses categorized according to the Oberg-Manske-Tonkin classification. Functional outcomes were assessed in 301 patients using the Pediatric Outcomes Data Collection Instrument (PODCI) and Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) function, pain, anxiety, depression, and peer relationships modules. RESULTS The cohort had high median PODCI scores in all domains, ranging from 83 to 100 in children and adolescents. Patients had decreased PROMIS UE scores compared with population norms; however, they showed low scores for pain, anxiety, depression and higher scores in the peer relationship domain, respectively. Patients with entire limb involvement had higher PROMIS pain scores and lower PODCI UE and global functioning than those with differences limited only to the hand. Compared with those with bilateral involvement, patients with unilateral differences reported higher scores for PODCI sports global functioning, better PROMIS UE function, and lower pain scores. Additional orthopedic conditions and medical comorbidities negatively influenced all PODCI scores and PROMIS pain and UE function domains. CONCLUSIONS Children with congenital hand differences report decreased upper limb function but better peer relationships and positive emotional states compared with population norms. CLINICAL RELEVANCE The Congenital Upper Limb Differences registry is a valid source of information related to congenital upper limb differences in clinical practice. With continuous enrollment and longitudinal follow-up, the registry will increase the understanding of UE function and psychosocial aspects of health in pediatric population.
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Affiliation(s)
- Donald S Bae
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA.
| | - Maria F Canizares
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA
| | - Patricia E Miller
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA
| | - Peter M Waters
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-St. Louis, St. Louis, MO; Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO
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Melis-Schrijver LM, den Hollander-Ardon MS, Janssen WG, van der Veen R. Gemstracker Expertise team Rotterdam arm and hand: Web-based monitoring of physical, social and emotional functioning in patients with upper limb amputations. Prosthet Orthot Int 2018; 42:50-55. [PMID: 29412088 DOI: 10.1177/0309364617744082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Patient-reported outcome measures are increasingly used to evaluate effectiveness of treatment. However, the use of 'paper and pencil' questionnaires is time-consuming for both patients and healthcare specialists. Therefore, the aim of this project was to develop a custom-built web-based monitoring system. TECHNIQUE We incorporated reliable and valid questionnaires on all domains of human functioning as described in the World Health Organization's Classification of Functioning, Disability and Health (ICF and ICF-CY). The method of remote follow-up enables long-term evaluation of PROMs. We specified monitoring protocols for both children and adults, split for different age groups with emphasis on health-related quality of life. DISCUSSION Time-efficient evaluation of PROMs may lead to higher compliance and an increase of client-centred practice. Moreover, evaluating PROMs facilitates patient empowerment and enables patients to make informed decisions about their treatment and healthcare needs. Clinical relevance We developed a web-based system for evaluation of PROMs. The system has enabled better informed decision-making for our clients.
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Postoperative Patient- and Parent-Reported Outcomes for Children with Congenital Hand Differences. Plast Reconstr Surg 2017; 139:1422-1429. [DOI: 10.1097/prs.0000000000003358] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carlsson IK, Dahlin LB, Rosberg HE. Congenital thumb anomalies and the consequences for daily life: patients’ long-term experience after corrective surgery. A qualitative study. Disabil Rehabil 2016; 40:69-75. [DOI: 10.1080/09638288.2016.1243159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- I. K. Carlsson
- Department of Translational Medicine – Hand Surgery, Skane University Hospital, Lund University, Sweden
| | - L. B. Dahlin
- Department of Translational Medicine – Hand Surgery, Skane University Hospital, Lund University, Sweden
| | - H.-E. Rosberg
- Department of Translational Medicine – Hand Surgery, Skane University Hospital, Lund University, Sweden
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Hand Function and Appearance following Reconstruction for Congenital Hand Differences. Plast Reconstr Surg 2016; 138:73e-81e. [DOI: 10.1097/prs.0000000000002286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johansen H, Dammann B, Øinæs Andersen L, Andresen IL. Children with congenital limb deficiency in Norway: issues related to school life and health-related quality of life. A cross-sectional study. Disabil Rehabil 2016; 38:1803-10. [PMID: 26763295 DOI: 10.3109/09638288.2015.1107770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe clinical features, issues related to school life and health-related quality of life (HRQOL) for children with congenital limb deficiency (CLD) and compare these children to Norwegian school children on HRQOL. METHOD Cross-sectional study. In 2010, a postal questionnaire, designed for this study and the Paediatric Quality of Life Inventory (PedsQL), was sent to 154 eligible parents of children with CLD, aged 6-18 years and registered at TRS National Resource Centre for Rare Disorders in Norway. RESULTS Response rate 44% (n = 67), median age 11 years, 42% were girls. Of the total group, 46 had unilateral upper limb deficiency (UULD) and 21 had multiple/lower limb deficiency (MLD/LLD). The most common UULD was below-elbow deficiency, of these, 65% used grip-improving devices, and 35% used prostheses. Children with UULD-reported PedsQL score similar to Norwegian schoolchildren (NSC). The MLD/LLD group was heterogeneous; most had below-elbow/knee deficiency. In this group, PedsQL scores were reduced for physical and social functioning compared with NSC. Compared with children with UULD, more children with MLD/LLD were restricted in participation because of pain and fewer participated in physical education with peers. CONCLUSIONS Most children with CLD participated with their peers and managed well in everyday life. Children with MLD/LLD seemed to have more challenges than children with UULD. Approximately one-third of all the children had assistive devices and/or practical assistance in school. Implications for Rehabilitation Most children with upper-limb deficiency (UULD) in Norway manage well in everyday life and have HRQOL equal to other Norwegian children. Many choose grip-improving devices instead of prostheses. Their preferences should be respected and taken into account as the need for new assistive devices arise. For children with pronounced disabilities, access to, and use of, assistive devices, adaptions and practical assistance may be important for participation. Cooperation with the child and the parents is necessary to find useful measures. Physical education and practical subjects may provide special challenges, both for children and their teachers. Children themselves often find good solutions and the tasks should be planned ahead in cooperation with them.
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Affiliation(s)
- Heidi Johansen
- a Sunnaas Rehabilitation Hospital, TRS, National Resource Centre for Rare Disorders , Nesodden , Norway
| | - Brede Dammann
- a Sunnaas Rehabilitation Hospital, TRS, National Resource Centre for Rare Disorders , Nesodden , Norway
| | - Liv Øinæs Andersen
- a Sunnaas Rehabilitation Hospital, TRS, National Resource Centre for Rare Disorders , Nesodden , Norway
| | - Inger-Lise Andresen
- a Sunnaas Rehabilitation Hospital, TRS, National Resource Centre for Rare Disorders , Nesodden , Norway
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Do Patient- and Parent-reported Outcomes Measures for Children With Congenital Hand Differences Capture WHO-ICF Domains? Clin Orthop Relat Res 2015; 473:3549-63. [PMID: 26286444 PMCID: PMC4586230 DOI: 10.1007/s11999-015-4505-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient- and parent-reported outcome measures (PROMs) are increasingly used to evaluate the effectiveness of surgery for congenital hand differences (CHDs). Knowledge of an existing outcome measure's ability to assess self-reported health, including psychosocial aspects, can inform the future development and application of PROMs for CHD. However, the extent to which measures used among children with CHD align with common, accepted metrics of self-reported disability remains unexplored. QUESTIONS/PURPOSES We reviewed studies that used PROMs to evaluate surgery for CHD to determine (1) the number of World Health Organization-International Classification of Functioning, Disability and Health (WHO-ICF) domains covered by existing PROMs; (2) the proportion of studies that used PROMs specifically validated among children with CHD; and (3) the proportion of PROMs that targets patients and/or parents. METHODS We performed a comprehensive review of the literature through a bibliographic search of MEDLINE®, PubMed, and EMBASE from January 1966 to December 2014 to identify articles related to patient outcomes and surgery for CHD. We evaluated the 42 studies that used PROMs to identify the number and type of WHO-ICF domains captured by existing PROMs for CHD and the proportion of studies that use PROMs validated for use among children with CHD. The most common instruments used to measure patient- and parent-reported outcomes after reconstruction for CHD included the Prosthetic Upper Extremity Functional Index (PUFI), Disabilities of the Arm, Shoulder, and Hand questionnaire, Childhood Experience Questionnaire, and Pediatric Quality of Life Inventory. RESULTS Current PROMs that have been used for CHD covered a mean of 1.3 WHO-ICF domains (SD ± 1.3). Only the Child Behavior Checklist and the Piers-Harris Children's Self-Concept Scale captured all ICF domains (body functions and structures, activity, participation, and environmental factors). The PUFI, the only PROM validated specifically for children with congenital longitudinal and transverse deficiency, was used in only four of 42 studies. Only 13 of the 42 studies assessed patient-reported outcomes, whereas five assessed both patient- and parent-reported outcomes. CONCLUSIONS The PROMs used to assess patients after CHD surgery do not evaluate all WHO-ICF domains (ie, body structure, body function, environmental factors, and activity and participation) and generally are not validated for children with CHD. Given the psychological and sociological aspects of CHD illness, a PROM that encompasses all components of the biopsychosocial model of illness and validated in children with CHD is desirable. LEVEL OF EVIDENCE Level III, therapeutic study.
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Abstract
BACKGROUND Although functional outcomes following reconstruction for congenital hand differences are frequently described, much less is known regarding children's ability to cope with the psychosocial effects of these conditions. The authors qualitatively explored stress and coping mechanisms among children following reconstructive surgery for congenital hand differences. METHODS Forty patients and their parents participated in semistructured interviews examining children's stress related to hand functioning and appearance, emotional responses to stress, and coping strategies. Interviews were audio-taped, transcribed, and analyzed thematically. A consensus taxonomy for classifying content evolved from comparisons of coding by two reviewers. Themes expressed by participants were studied for patterns of connection and grouped into broader categories. RESULTS In this sample, 58 percent of children and 40 percent of parents reported stress related to congenital hand differences, attributed to functional deficits (61 percent), hand appearance (27 percent), social interactions (58 percent), and emotional reactions (46 percent). Among the 18 children who reported stress, 43 percent of parents were not aware of the presence of stress. Eight coping strategies emerged, including humor (12 percent), self-acceptance (21 percent), avoidance (27 percent), seeking external support (30 percent), concealment (30 percent), educating others (9 percent), support programs (21 percent), and religion (24 percent). CONCLUSIONS Although children with congenital hand differences often experience emotional stress related to functional limitations and aesthetic deformities, many apply positive coping mechanisms that enhance self-esteem. Clinicians caring for children with congenital hand differences should inform families about potential sources of stress to direct resources toward strengthening coping strategies and support systems.
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Ardon MS, Selles RW, Roebroeck ME, Hovius SE, Stam HJ, Janssen WG. Poor Agreement on Health-Related Quality of Life Between Children With Congenital Hand Differences and Their Parents. Arch Phys Med Rehabil 2012; 93:641-6. [DOI: 10.1016/j.apmr.2011.11.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 11/09/2011] [Accepted: 11/16/2011] [Indexed: 10/28/2022]
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