Upper Limb Absence: Predictors of Work Participation and Work Productivity.

OBJECTIVES: To analyze work participation, work productivity, contributing factors, and physical work demands of individuals with upper limb absence (ULA). DESIGN: Cross-sectional study: postal survey (response rate, 45%). SETTING: Twelve rehabilitation centers and orthopedic workshops. PARTICIPANTS: Individuals (n=207) with unilateral transverse upper limb reduction deficiency (RD) or acquired amputation (AA), at or proximal to the carpal level, between the ages of 18 and 65 years, and a convenience sample of control subjects (n=90) matched on age and sex. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Employment status, self-reported work productivity measured with the Quality-Quantity method, and self-reported upper extremity work demands measured with the Upper Extremity Work Demands scale. RESULTS: Seventy-four percent of the individuals with RD and 57% of the individuals with AA were employed (vs 82% of the control group and 66% of the general population). Male sex, younger age, a medium or higher level of education, prosthesis use, and good general health were predictors of work participation. Work productivity was similar to that of the control group. Higher work productivity was inversely related to musculoskeletal complaint-related pain. When having predominantly mentally demanding work, individuals with ULA perceived higher upper extremity work demands compared with controls. CONCLUSIONS: Work participation of individuals with RD was slightly higher compared with that of the general population, whereas employment rates of individuals with AA were slightly lower. Furthermore, work productivity did not differ between individuals with RD, AA, and controls.

Musculoskeletal Complaints in Transverse Upper Limb Reduction Deficiency and Amputation in The Netherlands: Prevalence, Predictors, and Effect on Health.

OBJECTIVE: (1) To determine the prevalence of musculoskeletal complaints (MSCs) in individuals with upper limb absence in The Netherlands, (2) to assess the health status of individuals with upper limb absence in general and in relation to the presence of MSCs, and (3) to explore the predictors of development of MSCs and MSC-related disability in this population. DESIGN: Cross-sectional study: national survey. SETTING: Twelve rehabilitation centers and orthopedic workshops. PARTICIPANTS: Individuals (n=263; mean age, 50.7±16.7y; 60% men) ≥18 years old, with transverse upper limb reduction deficiency (42%) or amputation (58%) at or proximal to the carpal level (response, 45%) and 108 individuals without upper limb reduction deficiency or amputation (n=108; mean age, 50.6±15.7y; 65% men) (N=371). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Point and year prevalence of MSCs, MSC-related disability (Pain Disability Index), and general health perception and mental health (RAND-36 subscales). RESULTS: Point and year prevalence of MSCs were almost twice as high in individuals with upper limb absence (57% and 65%, respectively) compared with individuals without upper limb absence (27% and 34%, respectively) and were most often located in the nonaffected limb and upper back/neck. MSCs were associated with decreased general health perception and mental health and higher perceived upper extremity work demands. Prosthesis use was not related to presence of MSCs. Clinically relevant predictors of MSCs were middle age, being divorced/widowed, and lower mental health. Individuals with upper limb absence experienced more MSC-related disability than individuals without upper limb absence. Higher age, more pain, lower general and mental health, and not using a prosthesis were related to higher disability. CONCLUSIONS: Presence of MSCs is a frequent problem in individuals with upper limb absence and is associated with decreased general and mental health. Mental health and physical work demands should be taken into account when assessing such a patient. Clinicians should note that MSC-related disability increases with age.

Cross-Cultural Validity and Differential Item Functioning of the Orthotics and Prosthetics Users' Survey With Swedish and United States Users of Lower-Limb Prosthesis.

OBJECTIVES: To investigate the cross-cultural validity of the Orthotics and Prosthetics Users' Survey (OPUS), to evaluate differential item functioning (DIF) related to country, sex, age, amputation level, and amputated side (unilateral, bilateral), and to determine known-group validity of the OPUS. DESIGN: Survey. SETTING: Outpatient clinics. PARTICIPANTS: The sample (N=321) consisted of Swedish (n=195) and U.S. (n=126) adults using lower-limb prostheses. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Four OPUS modules were used: lower extremity functional status, client satisfaction with device (CSD), client satisfaction with services (CSS), and health-related quality of life. Rasch analysis was used to calculate measures for persons and items. RESULTS: The cross-cultural validity was satisfactory. Many items demonstrated DIF related to country and demographic characteristics, but the impact on mean person measures was negligible. The rating scales of CSD and CSS needed adjustments, and the unidimensionality of CSD and CSS was weak. The differences between the mean measures of known patient groups were statistically significant for 2 out of 6 comparisons. CONCLUSIONS: This study supports the validity of OPUS measure comparisons between Sweden and the United States and between subgroups with different demographic characteristics. Some of the country-related DIF may reflect the different health care financing systems. The findings demonstrate that the OPUS can discriminate between certain patient groups. The results also challenge some of our preconceptions about persons with bilateral amputation, indicating that we might know these persons less well than we think.

Validity evidence for a modified version of the Orthotics and Prosthetics Users' Survey.

PURPOSE: To evaluate the validity of a modified version of the Orthotics and Prosthetics Users' Survey (OPUS) with persons using different prosthetic and orthotic (P&O) devices. METHOD: Two-hundred-and-eighty-two adults using prosthesis, orthosis, shoe insoles or orthopaedic shoes completed OPUS. OPUS comprises five modules - Lower and Upper Extremity Functional Status, respectively (LEFS and UEFS), Client Satisfaction with Device and Services, respectively (CSD and CSS), and, Health-Related Quality of Life (HRQoL). Eight new items were added to LEFS and six to UEFS. Rasch analysis was used for data analyses. RESULTS: Rating scales functioned satisfactory after some modifications. All modules demonstrated a ceiling effect. Unidimensionality was satisfactory after deleting some items and dividing HRQoL into two subscales, although somewhat weak on CSD and CSS. Item reliability was excellent for all modules and person reliability good for all but CSD and CSS. Some items demonstrated differential item functioning related to sex and age, but the impact on person measures was small. CONCLUSIONS: This study supports the validity of a modified version of OPUS for persons using different P&O devices, but also reveals limitations to be addressed in future studies. OPUS could be useful in clinical rehabilitation and research to evaluate P&O outcomes.

Body structures and physical complaints in upper limb reduction deficiency: a 24-year follow-up study.

OBJECTIVE: To describe upper body structures associated with upper limb reduction deficiency and the development of these structures over time, to examine the presence of physical complaints in this population, and to compare body structures and complaints between groups based on prosthesis use. DESIGN: Prospective cohort study with a follow-up period of 24 years, with matched able-bodied controls. SUBJECTS: Twenty-eight patients with unilateral below-elbow reduction deficiency fitted with myoelectric prostheses, aged 8-18 years at inclusion. METHOD: Measurements of upper arm, trunk and spine were performed and study-specific questionnaires were answered at baseline and follow-up; the Brief Pain Inventory and the Quick Disability of Arm, Shoulder, and Hand questionnaires were answered at follow-up. RESULTS: Both at baseline and follow-up, within-subjects differences in structures of the arm and trunk were shown in patients but not in controls. Spinal deviations, although small, were greater in patients compared to controls. Self-reported disability was higher in patients compared to controls. Differences in back pain and effect of prostheses use could not be shown. CONCLUSIONS: Patients with unilateral below-elbow reduction deficiency have consistent differences in upper body structures. Deviations of the spine, probably of functional origin, do not progress to clinically relevant scoliosis.

Assessment of capacity for myoelectric control: evaluation of construct and rating scale.

OBJECTIVE: To examine the construct and rating scale of the Assessment of Capacity for Myoelectric Control, an assessment to evaluate ability in using a prosthetic hand. DESIGN: Cross-sectional study. SUBJECTS: Upper limb prosthesis users with different prosthetic levels/sides and prosthetic experience were included (n = 96). METHODS: Subjects' assessments with the Assessment of Capacity for Myoelectric Control were collected by 6 raters during their regular hospital visits. Rasch analysis was used, since it allowed an analysis of the data at the item and category levels. Dimension, item hierarchy and item fit statistics were used to examine the construct. Different Rasch parameters were used to examine rating scale structure and its use. RESULTS: The consistency of item difficulties with clinical knowledge and the unidimensionality confirmed that the construct is valid. Two items functioned unexpectedly (misfit), but the misfit was idiosyncratic to the sample, not systematic to the items. The 4-point rating scale usefully differentiated the subjects on the basis of their abilities. The use of category 2 was somewhat redundant. CONCLUSION: The Assessment of Capacity for Myoelectric Control is a valid assessment that evaluates ability in using a prosthetic hand. Revision of the category 2 definition would improve the functioning of the rating scale.