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Ward CM, Kuhl TL, Adams BD. Early complications of volar plating of distal radius fractures and their relationship to surgeon experience. Hand (NY). 2011, 6: 185-9.

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Introduction: Evaluation of hand function has traditionally focused on objective measurements involving strength and range of movement measurements. The World Health Organisation International Classification of Disability, Functioning and Health (ICF) framework has introduced a more patient-orientated approach to assessment, incorporating four distinct areas of body structures, body functions, environment and activity limitation. These can be evaluated with both questionnaires and functional tests. Whereas there seems to be agreement over adult hand assessment, children's hand assessment leaves involved therapists and clinician often wondering, which test to perform. The objective of this review was to evaluate the currently available childrens' hand and upper limb assessment tools within the framework of the ICF. Method: A review of 19 of the most commonly used paediatric hand and upper limb assessment tools in the context of the components of the ICF. The International Classification of Disability, Functioning and Health linking rules composed by Cieza et al. were used in order to map each of the meaningful concepts in these assessment tools to the domains of the ICF. Results: The activities domain of the ICF was found to be well represented in all assessment tools. Four out of 19 assessment tools had items that mapped to the environment domain. The highest number of different concepts mapped was found in musculoskeletal questionnaires. The lowest number of concepts was found in the pegboard tests. Conclusion: Tests are often combined to attempt to cover as many aspects of the ICF yet our findings show that this may not always be achieved. Clinicians and therapists must be aware that in order to get a more complete overview of a child's hand and upper limb functioning sometimes time-and resource-consuming tests have to be combined.

Background/Purpose: A wide variety of diseases affect the hands in children and adolescents, ranging from relatively static congenital structural abnormalities to progressively destructive inflammatory conditions including juvenile idiopathic arthritis (JIA). Measuring the natural history of such conditions, and the clinical utility of the surgical or pharmacological treatment, requires standardised, age appropriate hand function assessment tools, but there are relatively few of these available. The aim of our research programme was to develop and evaluate a new standardised hand function assessment tool, the PizzaPutty™ test, in a cohort of subjects with a wide range of hand conditions including congenital hand deformities, inherited metabolic diseases and juvenile idiopathic arthritis with evidence of upper limb involvement. Here we present the initial development details and preliminary evaluation of test feasibility and acceptability in a cohort of children and adolescents with juvenile idiopathic arthritis. Methods: As part of a research collaborative programme led by plastic surgery and occupational therapy, an assessment tool was developed, the PizzaPutty™ test, that objectively evaluates hand dexterity in children and adolescents. It is a play based, standardised grip function test that can be used for children of all ages. It comprises easily obtainable theraputty, a variety of bead sizes, and a set of instructions to guide patients through a series of activities leading to the creation of a simulated pizza. An occupational therapist administers the test, provides patient and family support, and obtains a detailed evaluation of 7 different grip functions and a derived score from grip function score. In some cases, videos were taken for inter‐observer reliability analysis. Results: 34 patients with Juvenile Idiopathic Arthritis (JIA), ranging in age from 2–17 years, (25 girls and 9 boys) were recruited after informed consent from routine rheumatology outpatient clinics at a tertiary referral children's hospital. All patients must have had features of upper limb involvement. JIA subtype distribution: 10 extended oligoarthritis (2 had chronic anterior uveitis without any abnormality of visual acuity), 9 polyarthritis (RF negative), 4 JIA polyarthritis (RF positive), 6 systemic onset, 1 psoriatic arthritis, 3 oligoarthritis, 1 undifferentiated. All patients were able to complete the PizzaPutty™ test in 20 minutes or less (mean 15 minutes, range 10–20 minutes), with the children over 10 years of age accomplishing the test in the fastest times. All participants found it enjoyable, although patients older than 15 years felt that it was “childish” and patients under 3 had some difficulty in maintaining their concentration without encouragment. Unsolicited feedback from the subjects and/or parents was that the test was stimulating and fun. Conclusion: The PizzaPutty™ test appears to be feasible and acceptable for monitoring hand disease in a clinical outpatient setting.