Outcome Measures and Upper Limb Prosthetic Rehabilitation

Outcome measures can be an effective way to assess patient progress and improve patient outcomes. However, due to the small percentage of people with upper limb loss, assessment tools designed specifically for this patient population are scarce.1

This makes it challenging for upper limb prosthetic providers to identify obstacles to rehabilitation and optimize each patient’s plan. As a result, people with upper limb loss are less likely to receive appropriate, high-quality prosthetic rehabilitation.
Insufficient outcome measure data for these patients has also led to a lack of support for evidence-based patient care and insurance justification. Consequently, some patients don’t receive insurance authorization for the prosthetic devices that meet their specific needs and goals.
Historically, upper limb prosthetic providers have used assessment tools that were actually designed for people with other types of upper limb conditions.
For example:
  • The Disabilities of the Arm, Shoulder and Hand (DASH): developed for patients with musculoskeletal disorders
  • The Box and Blocks Test: developed for patients with neurological diagnoses (stroke, multiple sclerosis)
  • The Jebsen Hand Function Test: developed for patients with arthritis, joint conditions and neurological diagnoses
While these assessments can provide rudimentary data for upper limb prosthesis users, they don’t address population-specific factors such as:
  • Upper limb loss or limb difference
  • The impact of prosthetic technologies
  • Prosthetic component capabilities
  • Psychosocial issues
  • Body mechanics
  • Functional use of the prosthesis
  • Use of the prosthesis in all planes of movement
  • Grasping objects of various size and shape
  • The impact of amputation on the unaffected limb
  • Overuse syndromes
  • Residual limb pain and phantom pain

Solving the Problem

In response to the clear need for more useful outcome measures designed specifically for the upper limb loss patient population, Arm Dynamics clinicians developed and tested CAPPFUL®CAPROQ®, CAPROQ-S, and Wellness Inventory assessments that when combined, offer a broader understanding of the person and the challenges they’re facing.
Population-specific outcome measures improve outcomes for upper limb patients by:
  • Evaluating their physical, psychosocial, and functional status
  • Assessing prosthetic prescriptive recommendations and identifying needed improvements to optimize function
  • Objectively analyzing their functional progress
  • Guiding modifications to the rehabilitation plan
  • Identifying problematic body mechanics that lead to injury
  • Increasing satisfaction and use of the prosthesis
  • Providing scientific evidence that informs the regulation and review of prosthetic devices (e.g. FDA and DARPA)

1: CAPPFUL® Assessment Tools

CAPPFUL outcome measures are psychometrically validated, peer-reviewed assessment tools designed exclusively to measure upper limb prosthetic performance during common activities created by Arm Dynamics clinicians in collaboration with the Food and Drug Administration (FDA) and the Defense Advanced Research Projects Agency (DARPA). Administering CAPPFUL assessments enable our therapists to identify a patient’s functional challenges and then modify the treatment plan to improve outcomes. As a result, patients reach their maximum rehabilitation potential as quickly as possible. CAPPFUL assessments have been administered to patients more than 120 times and are completed at key points in the rehabilitation process.

CAPPFUL AdministrationCAPPFUL shoe tie

Assesses factors impacting the functional use of a prosthesis:

  • Control skills
  • Adaptive compensatory movements
  • Component utilization
  • Task completion
  • Maladaptive compensatory movements
  • Completion time

2: CAPROQ® & CAPROQ-S Assessment Tools

CAPROQ® and CAPROQ-S are psychometrically validated, patient-reported outcome measure tools presented in a question and answer format. They focus on the use of an upper limb prosthesis and the person’s perceptions of their prosthetic rehabilitation. CAPROQ and CAPROQ-S assessments have been administered to patients more than 900 times at key points in the rehabilitation process.

CAPROQ-2FIT Survey-1

Assesses patient’s rehabilitation status related to:

  • Demographic/work status
  • Daily prosthesis wear time
  • Perceived need for upper limb prosthesis
  • Pain/numbness including phantom limb pain
  • Satisfaction with prosthesis and rehab
  • Perceived function in activities of daily living

Wellness Inventory

The Wellness Inventory is a patient screening tool that helps identify psychosocial challenges that could have a negative impact on a person’s prosthetic rehabilitation process. Feedback from this survey helps us identify if additional specialized services may be helpful. The Wellness Inventory has been administered to patients more than 400 times at key points in the rehabilitation process.

Wellness-2FIT Survey-1

Screens for challenges that are related to:

  • Resilience
  • Pain
  • Post-traumatic anxiety
  • Drug use
  • Health-related quality of life
  • Depression
  • Alcohol use

Our Arm Dynamics centers are committed to continuously improving prosthetic outcomes for people with upper limb loss or limb difference. 
The use of these three assessment tools provides objective data that helps us evolve our clinical care model, maximize our patients’ rehabilitation potential and improve the odds of gaining insurance approval. Our data also contributes to the development of new prosthetic technologies and techniques through our collaborations with medical professionals and prosthetic device manufacturers.

1: Wang S., et al: Evaluation of performance-based outcome measures for the upper limb: a comprehensive narrative review. PM&R. 2018; 10:951–962.e3.