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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
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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 has developed and tested three novel assessment tools:
  1. The Comprehensive Assessment of Prosthetic Performance for Upper Limb (CAPPFUL)
  2. The Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire (CAPROQ)
  3. The Wellness Inventory
Each of these tools provides a body of specific patient information, that when combined, offers a broader understanding of the person and the challenges they’re facing.  This holistic view makes it possible for us to refine each patient’s rehabilitation plan to improve outcomes.
 
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)
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1: CAPPFUL

The Comprehensive Assessment of Prosthetic Performance for Upper Limb (CAPPFUL) is a psychometrically validated, peer-reviewed assessment tool designed exclusively to measure upper limb prosthetic performance during common activities. It was created by Arm Dynamics in collaboration with the Food and Drug Administration (FDA) and the Defense Advanced Research Projects Agency (DARPA).

Administering the CAPPFUL enables 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.

The CAPPFUL has been administered to patients more than 120 times and is completed at key points in the rehabilitation process.

CAPPFUL Testing

Assesses factors impacting functional use of a prosthesis:

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

2: CAPROQ

The Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire (CAPROQ) is a psychometrically validated, patient-reported outcome measure presented in a question and answer format. It focuses on the use of an upper limb prosthesis and the person’s perceptions of their prosthetic rehabilitation.

The CAPROQ has been administered to patients more than 900 times at key points in the rehabilitation process.

CAPROQ Survey
Assesses the 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

3:  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 then 400 times at key points in the rehabilitation process.

Wellness Inventory
Screens for challenges related to:
  • Resilience
  • Pain
  • Post-traumatic anxiety
  • Drug use
  • Health-related quality of life
  • Depression
  • Alcohol use

For detailed information about the Wellness Inventory, go to The Wellness Inventory.

Arm Dynamics is 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.

References
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.