PURPOSE: This study evaluated patient-reported outcome and the factors associated with disability after an upper extremity nerve injury. We hypothesized that patients at least 6 months after injury would report considerable disability and that pain would be the strongest predictor of the Disabilities of the Arm, Shoulder, and Hand (DASH) score. METHODS: After research ethics board approval, the medical charts of patients with these inclusion criteria were reviewed: adults; presenting to a nerve surgeon; 6 months or greater after nerve injury. Patients completed the DASH questionnaire and the Short Form-36 (SF-36) as a routine part of the initial evaluation. These data were reviewed retrospectively to determine predictors of the DASH score. RESULTS: There were 84 patients (mean age, 39 years; SD, 14 years) with brachial plexus (n=27) and peripheral nerve (n=57) injuries. The mean time after injury was 38 months (SD, 47). For all SF-36 domains, the mean values of the nerve-injured patients were significantly lower than the normative data, indicating a lower health status. The mean DASH score was 52 (SD, 22) of 100. Significantly more disability was associated with more SF-36 bodily pain and with brachial plexus injuries. In the final regression model, SF-36 bodily pain, age, and nerve injured were significant predictors of the DASH score. SF-36 bodily pain accounted for 35% of the variance. CONCLUSIONS: Substantial long-term disability (high DASH scores) was found in patients after nerve injury that was predicted by higher pain, older age, and brachial plexus injury. Further investigation of this pain and the associated factors may provide the opportunity for improved health-related quality of life. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
PURPOSE: This study evaluated patient-reported outcome and the factors associated with disability after an upper extremity nerve injury. We hypothesized that patients at least 6 months after injury would report considerable disability and that pain would be the strongest predictor of the Disabilities of the Arm, Shoulder, and Hand (DASH) score. METHODS: After research ethics board approval, the medical charts of patients with these inclusion criteria were reviewed: adults; presenting to a nerve surgeon; 6 months or greater after nerve injury. Patients completed the DASH questionnaire and the Short Form-36 (SF-36) as a routine part of the initial evaluation. These data were reviewed retrospectively to determine predictors of the DASH score. RESULTS: There were 84 patients (mean age, 39 years; SD, 14 years) with brachial plexus (n=27) and peripheral nerve (n=57) injuries. The mean time after injury was 38 months (SD, 47). For all SF-36 domains, the mean values of the nerve-injured patients were significantly lower than the normative data, indicating a lower health status. The mean DASH score was 52 (SD, 22) of 100. Significantly more disability was associated with more SF-36 bodily pain and with brachial plexus injuries. In the final regression model, SF-36 bodily pain, age, and nerve injured were significant predictors of the DASH score. SF-36 bodily pain accounted for 35% of the variance. CONCLUSIONS: Substantial long-term disability (high DASH scores) was found in patients after nerve injury that was predicted by higher pain, older age, and brachial plexus injury. Further investigation of this pain and the associated factors may provide the opportunity for improved health-related quality of life. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
Authors: Danielle M Wojtkiewicz; James Saunders; Leahthan Domeshek; Christine B Novak; Vicki Kaskutas; Susan E Mackinnon Journal: Hand (N Y) Date: 2015-06