Sat., 10/20/07 Upper Extremity, Paper #56, 10:55 am OTA-2007
Correspondence between Objective Physical Impairment and Patient-Rated Disability after Elbow Trauma
Anneluuk Lindenhovius, MSc1 (a-Annafonds, Stichting Professor Michael van Vloten Fonds, Stichting Wetenschappelijk Onderzoek Orthopaedie, AO Foundation, Small Bone Innovations, Smith+Nephew Richards, Wright Medical, Joint Active Systems, Biomet); Geert Buijze, MSc2; Peter Kloen, MD, PhD2 (n); David Ring, MD, PhD1 (a-AO Foundation, Small Bone Innovations, Joint Active Systems, Biomet; c-Hand Innovations; a,e-Smith+Nephew Richards, Wright Medical);
1Orthopaedic Hand Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA;
2Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Purpose: Patient-perceived disability may vary substantially among patients with similar levels of impairment. Pain is one of the dominant predictors of self-rated disability after elbow trauma. We tested the hypothesis that objective elbow motion impairment predicts self-rated task-specific disability after elbow trauma.
Methods: 158 patients were evaluated an average of 64 months after elbow trauma and completed the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Predictors of the total DASH score and responses to single DASH questions that were expected to relate to elbow function were evaluated in univariate and multivariate analyses.
Results: Motion accounted for 35% of the variability in total DASH scores, for 11% to 12% of the variability in responses to questions specific to hand-based activities, and 24% to 33% of the variability in responses to questions regarding tasks that depend on elbow motion. Pain accounted for 41% of variability in the total DASH score, and was a stronger predictor than motion for three questions (opening a tight jar, 24% vs 11%; pushing open a door, 25% vs 12%; and placing an object overhead, 28% vs 25%). None of the multivariate models accounted for more than 53% of the variability in DASH.
Conclusion and Significance: (1) Objective physical elbow impairment correlated with expected disability on specific tasks and explained disability associated with tasks dependent on elbow motion better than hand-based activities. (2) Self-reported disability corresponds with objective impairment and pain, but a large proportion of perceived disability remains unexplained. (3) There is substantial discrepancy between objective physical impairments and perceived disability in the injured elbow. The majority of variability in scores could not be explained by our best multivariate models—even those including measures of pain. (4) Further research is needed to evaluate the role of psychosocial factors in perception of symptoms, and to better understand discrepancies between objective impairment and perceived disability.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.