Validation of the Liverpool Elbow Score for evaluation of elbow stiffness

The Liverpool Elbow Score, patient-answered section: Cultural adaptation, validity and reliability of Turkish version

BACKGROUND

The use of self-assessment questionnaires in addition to clinical evaluations is gradually increasing. Liverpool Elbow Scale (LES) is an elbow-specific outcome score that provides a comprehensive assessment of by both the clinicians and patients. However, it has not been adapted and validated to Turkish language.

OBJECTIVE

To conduct the translation, cross-cultural adaptation and validation of Liverpool Elbow Score-patient answered outcome (LES-PAQ) into Turkish for patients with elbow fracture.

DESIGN

Study of diagnostic accuracy/assessment scale.

METHODS

This study was carried out in three consecutive phases: translation, cross-cultural adaptation and validation. In the third phase, we used the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH), Mayo Elbow Performance Score (MEPS) and 12-Item Short Form Survey (SF-12) physical health score.

RESULTS

Sixty-one patients were included for the analysis. Neither a ceiling nor a floor effect was observed. Cronbach's α coefficient was 0.89. Intraclass correlation coefficient was 0.94 (95% CI 0.89 to 0.96; p < 0.001). SEM was 0.28 and MDC₉₅ was 0.79. The LES-PAQ showed a high negative correlation with the Quick-DASH (r = -0.72, p < 0.001) and high positive correlation with MEPS (r = 0.77, p < 0.001), and with SF-12 physical health subscale (r = 0.73, p < 0.001).

CONCLUSIONS

The Turkish version of the LES-PAQ is a reliable and valid tool for the assessment of the patients with elbow fracture.

The stiff elbow: Current concepts

Elbow stiffness is defined as any loss of movement that is greater than 30° in extension and less than 120° in flexion. Causes of elbow stiffness can be classified as traumatic or atraumatic and as congenital or acquired. Any alteration affecting the stability elements of the elbow can lead to a reduction in the arc of movement. The classification is based on the specific structures involved (Kay’s classification), anatomical location (Morrey’s classification), or on the degree of severity of rigidity (Vidal’s classification). Diagnosis is the result of a combination of medical history, physical examination (evaluating both active and passive movements), and imaging. The loss of soft tissue elasticity could be the result of bleeding, edema, granulation tissue formation, and fibrosis. Preventive measures include immobilization in extension, use of post-surgical drain, elastic compression bandage and continuous passive motion. Conservative treatment is used when elbow stiffness has been present for less than six months and consists of the use of serial casts, static or dynamic splints, CPM, physical therapy, manipulations and functional re-education. If conservative treatment fails or is not indicated, surgery is performed. Extrinsic rigidity cases are usually managed with an open or arthroscopic release, while those that are due to intrinsic causes can be managed with arthroplasties. The elbow is a joint that is particularly prone to developing stiffness due to its anatomical and biomechanical complexity, therefore the treatment of this pathology represents a challenge for the physiotherapist and the surgeon alike.

Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study

Background

Following trauma, the elbow is the most susceptible to restricted motion among all joints. Open arthrolysis is often performed for post-traumatic elbow stiffness if that stiffness does not improve with non-operative management. However, the optimal timing for performing an open arthrolysis remains controversial. The purpose of this study was to compare the outcome (elbow motion and function) and the rate of complications among patients who had undergone early, median and late release procedures to establish an optimal time interval following the injury, after which, an effective open arthrolysis can be performed.

Methods

In this retrospective cohort study, we included total 133 patients, who had undergone open arthrolysis for post-traumatic elbow stiffness. The subjects were divided into 3 groups, with 31 patients in the early release group (arthrolysis performed at 6–10 months after injury), 78 patients in the median release group (at 11–20 months), and 24 patients in the late release group (at > 20 months). The release procedure in all patients was performed by the same surgeon, using the same technique. The general data, functional performance, and complications, if any, were retrospectively documented for all patients and statistically analysed.

Results

The demographic data and disease characteristics of all patients were comparable at baseline. Postoperatively, no significant differences were found among the three groups with respect to the range of motion (p = 0.067), Mayo Elbow Performance Score (p = 0.350) and its ratings (p = 0.329), visual analog scale score for pain (p = 0.227), Dellon classification for ulnar nerve symptoms (p = 0.497), and each discrete complication (all p values > 0.05).

Conclusions

At the final follow-up, our results showed no significant difference in the postoperative elbow motion capacities, functional scores and the rates of complications among patients who had undergone an early, median, and late release. Therefore, we have recommended that an early arthrolysis would be preferable due to its multiple advantages, and the conventionally observed interval of > 1 year after the injury, could be shortened.

Level of evidence

Level III; Retrospective Cohort Design; Therapeutic Study.