Dexterity, activity performance, disability, quality of life, and independence in upper limb Veteran prosthesis users: a normative study

Resnik, Linda; Borgia, Matthew; Cancio, Jill M.; Heckman, Jeffrey; Highsmith, Jason; Levy, Charles E.; Phillips, Sam L.; Webster, Joseph B.

doi:10.1080/09638288.2020.1829106

Cited by 17 publications

(16 citation statements)

References 33 publications

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“…Finally, to examine whether the PROMIS UE versions differed for subgroups as expected based on clinical observation and previous research, 25 we compared scores of the six various configurations of the PROMIS measure for prosthesis users and nonusers and for persons of varying amputation level. Because of potential confounding of amputation level and prosthesis use (persons with more proximal amputation are less likely to be prosthesis users), we also stratified the data by prosthesis use and compared scores within amputation level.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Patient-Reported Physical Function in Persons with Upper Extremity Amputation: Comparison of Short Form instruments drawn from the PROMIS v2.0 Upper Extremity item bank

Resnik

Stevens

et al. 2022

Am J Phys Med Rehabil

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ObjectiveThe aim of the study was to compare psychometric properties of the Patient-Reported Outcomes Measurement Information System upper extremity measure (PROMIS UE) 7-item short form with 6- and 13-item versions for persons with upper limb amputation.DesignThe study used a telephone survey of 681 persons with upper limb amputation. Versions were scored two ways: PROMIS health measure scoring (PROMIS UE HMSS) and sample-specific calibration (PROMIS UE AMP). Factor analyses and Rasch analyses evaluated unidimensionality, monotonicity, item fit, differential item functioning, and reliability. Known group validity was compared for all versions.ResultsModel fit was acceptable for PROMIS-6 UE AMP and marginally acceptable for PROMIS-13 UE AMP and PROMIS-7 UE AMP. Item response categories were collapsed because of disordered categories. A total of 91.4% of participants had PROMIS-13 UE AMP scores with reliability greater than 0.8, compared with 70.4% for PROMIS-7 UE AMP, and 72.1% for PROMIS-6 UE AMP versions. No differences were observed by prosthesis use. Scores differed by amputation for all measures except the HMSS scored 13- and 7-item versions.ConclusionsThe PROMIS-13 UE AMP short form was superior to the health measures scoring system scored PROMIS-7 UE or PROMIS-6 UE, and to the PROMIS-7 UE AMP and PROMIS-6 UE AMP. Issues with known group validation suggest a need for a population-specific measure of upper extremity function for persons with upper limb amputation.

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Section: Discussionmentioning

confidence: 99%

Assessment of Patient-Reported Physical Function in Persons with Upper Extremity Amputation: Comparison of Short Form instruments drawn from the PROMIS v2.0 Upper Extremity item bank

Resnik

Stevens

et al. 2022

Am J Phys Med Rehabil

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“…The DIF analyses suggested that bilateral amputees found tasks requiring fine force regulation with the prosthesis easier than unilateral amputees, but certain dexterous bilateral activities, such as tying a knot, more difficult than unilateral amputees. Neither of these results are surprising, given that bilateral amputees cannot rely on their intact limb for fine force regulation and thus develop more dexterity on their dominant prosthetic side [27]. Further, bilateral amputees cannot use an intact limb during bilateral activities, making these activities more difficult.…”

Section: Difficulty Of Items Within Each Scalementioning

confidence: 97%

Structural validity and reliability of the patient experience measure: A new approach to assessing psychosocial experience of upper limb prosthesis users

et al. 2021

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Recent advances in upper limb prosthetics include sensory restoration techniques and osseointegration technology that introduce additional risks, higher costs, and longer periods of rehabilitation. To inform regulatory and clinical decision making, validated patient reported outcome measures are required to understand the relative benefits of these interventions. The Patient Experience Measure (PEM) was developed to quantify psychosocial outcomes for research studies on sensory-enabled upper limb prostheses. While the PEM was responsive to changes in prosthesis experience in prior studies, its psychometric properties had not been assessed. Here, the PEM was examined for structural validity and reliability across a large sample of people with upper limb loss (n = 677). The PEM was modified and tested in three phases: initial refinement and cognitive testing, pilot testing, and field testing. Exploratory factor analysis (EFA) was used to discover the underlying factor structure of the PEM items and confirmatory factor analysis (CFA) verified the structure. Rasch partial credit modeling evaluated monotonicity, fit, and magnitude of differential item functioning by age, sex, and prosthesis use for all scales. EFA resulted in a seven-factor solution that was reduced to the following six scales after CFA: social interaction, self-efficacy, embodiment, intuitiveness, wellbeing, and self-consciousness. After removal of two items during Rasch analyses, the overall model fit was acceptable (CFI = 0.973, TLI = 0.979, RMSEA = 0.038). The social interaction, self-efficacy and embodiment scales had strong person reliability (0.81, 0.80 and 0.77), Cronbach’s alpha (0.90, 0.80 and 0.71), and intraclass correlation coefficients (0.82, 0.85 and 0.74), respectively. The large sample size and use of contemporary measurement methods enabled identification of unidimensional constructs, differential item functioning by participant characteristics, and the rank ordering of the difficulty of each item in the scales. The PEM enables quantification of critical psychosocial impacts of advanced prosthetic technologies and provides a rigorous foundation for future studies of clinical and prosthetic interventions.

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“…Participants in this analytic subsample were a subset of the sample recruited for a more comprehensive parent study described elsewhere. 2 These subjects were a convenience sample of service members, veterans, and civilians who had unilateral major ULA or limb deficiency at the above-elbow (AE) or below-elbow (BE) level. The AE levels included elbow disarticulation (ED) and transhumeral (TH) levels.…”

Section: Samplementioning

confidence: 99%

Understanding Implications of Residual Limb Length, Strength, and Range-of-Motion Impairments of Veterans With Upper Limb Amputation

Resnik

Borgia

Cancio

et al. 2021

Am J Phys Med Rehabil

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The aim of the study was to describe and quantify the relationship between limb impairment variables to key functional outcomes. Design: This was an observational study of 107 participants with unilateral above/at-elbow or below-elbow/wrist amputation. Demographics, prosthesis characteristics, residual limb length, and prevalence of passive range-of-motion restrictions, and strength impairments were described. Correlations between impairment variables were estimated. Linear regressions examined associations between impairment variables and activity performance, health-related quality of life, disability, and prosthesis satisfaction. Results: Prevalence of short/very short below-and above-elbow residua was 25.7% and 12.5%, respectively. Shorter below-elbow/wrist residual limb length was correlated with elbow flexion weakness (r = 0.30) and prevalence of passive range of motion (r = 0.25). Shoulder prevalence of passive range-of-motion restrictions were correlated with shoulder (r = 0.27-0.51) and elbow weakness (r = 0.25-0.46). In regressions, activity performance was worse for those with shoulder flexion prevalence of passive range-of-motion restrictions (B = −5.0, P = 0.03) and better for those with flexion restrictions (B = 3.3, P = 0.04) compared with normal prevalence of passive range of motion. Prosthetic satisfaction was lower for those with limited elbow prevalence of passive range of motion. Conclusions: Short below-elbow residual limb length was correlated with impairment of elbow flexion strength and prevalence of passive range of motion. Prevalence of passive range-of-motion restrictions were most prevalent at the shoulder and were strongly correlated with weakness in the same planes of motion. Few significant associations were found between impairment variables and outcomes.

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Dexterity, activity performance, disability, quality of life, and independence in upper limb Veteran prosthesis users: a normative study

Cited by 17 publications

References 33 publications

Assessment of Patient-Reported Physical Function in Persons with Upper Extremity Amputation: Comparison of Short Form instruments drawn from the PROMIS v2.0 Upper Extremity item bank

Assessment of Patient-Reported Physical Function in Persons with Upper Extremity Amputation: Comparison of Short Form instruments drawn from the PROMIS v2.0 Upper Extremity item bank

Structural validity and reliability of the patient experience measure: A new approach to assessing psychosocial experience of upper limb prosthesis users

Understanding Implications of Residual Limb Length, Strength, and Range-of-Motion Impairments of Veterans With Upper Limb Amputation

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