Developing a core outcome set for traumatic brachial plexus injuries: a systematic review of outcomes

Abstract

ObjectiveTo identify what outcomes have been assessed in traumatic brachial plexus injury (TBPI) research to inform the development of a core outcome set for TBPI.DesignSystematic review.MethodMedline (OVID), EMBASE, CINAHL and AMED were systematically searched for studies evaluating the clinical effectiveness of interventions in adult TBPIs from January 2013 to September 2018 updated in May 2021. Two authors independently screened papers. Outcome reporting bias was assessed. All outcomes were extracted verbatim from studies. Patient-reported outcomes or performance outcome measures were extracted directly from the instrument. Variation in outcome reporting was determined by assessing the number of unique outcomes reported across all included studies. Outcomes were categorised into domains using a prespecified taxonomy.ResultsVerbatim outcomes (n=1491) were extracted from 138 studies including 32 questionnaires. Unique outcomes (n=157) were structured into 4 core areas and 11 domains. Outcomes within the musculoskeletal domain were measured in 86% of studies, physical functioning in 25%, emotional functioning in 25% and adverse events in 33%. We identified 63 different methods for measuring muscle strength, 16 studies for range of movement and 63 studies did not define how they measured movement. More than two-thirds of the outcomes were incompletely reported in prospective studies.ConclusionThis review of outcome reporting in TBPI research demonstrated an impairment focus and heterogeneity. A core outcome set would ensure standardised and relevant outcomes are reported to facilitate future systematic review and meta-analysis.PROSPERO registration numberCRD42018109843.

Development of a core outcome set for traumatic brachial plexus injury

“…The findings from our consensus process highlighted differences between the outcomes reported in current TBPI studies and those prioritized as important by HCP and patient stakeholder groups. Strength is measured and reported in approximately 90% of studies including patients with a TBPI ( Dy et al., 2015 ; Miller et al., 2021 ). However, strength as a single domain was not prioritized by the stakeholders in our study.…”

“…The longlist of outcomes was generated from two sources: first, through a systematic review of outcomes reported in studies evaluating interventions for individuals with a TBPI ( Miller et al., 2021 ); and second, through patient interviews to identify outcomes important to adults with a TBPI (Miller et al., 2022). The outcomes extracted from the systematic review and identified from the interviews were grouped into domains and categorized into a taxonomy developed to support COS generation ( Dodd et al., 2018 ) by the lead author (CM) and reviewed by the co-authors.…”

“…There is uncertainty over which treatments are most effective for individuals with a traumatic brachial plexus injury (TBPI). Inconsistency in outcome selection across adult TBPI studies and peripheral nerve centres ( Dy et al., 2015 ; Miller et al., 2021 ) has limited the opportunity for data assimilation and meta-analysis ( Ayhan et al., 2019 ; Donnelly et al., 2020 ). Furthermore, clinicians and researchers have to date largely focused on measuring impairment ( Dy et al., 2015 ; Miller et al., 2021 ).…”

“…Inconsistency in outcome selection across adult TBPI studies and peripheral nerve centres ( Dy et al., 2015 ; Miller et al., 2021 ) has limited the opportunity for data assimilation and meta-analysis ( Ayhan et al., 2019 ; Donnelly et al., 2020 ). Furthermore, clinicians and researchers have to date largely focused on measuring impairment ( Dy et al., 2015 ; Miller et al., 2021 ). Therefore, it is difficult to make recommendations for care and there remains a risk that clinicians and researchers measure outcomes that are not a priority for patients ( Kirwan et al., 2003 ).…”

Return to work following brachial plexus injury: A cross-sectional study

“…Successful outcomes are commonly associated with objective measurements of muscle strength; with the Medical Research Council (MRC) grade and muscle dynamometry being the most frequently reported. 1,2 Typically, these studies examine isolated muscle strength, with the upper arm supported in a standardised position. When put in the context of everyday life, this information is not transferable to activities of daily living and does not consider the deficits in function that a loss of movement and sensation may contribute to.…”