Measurement of Functional Outcome With Individuals Who Use Upper Extremity Prosthetic Devices: Current and Future Directions

In Brief Since the mid-1990s, there has been considerable activity internationally on development and validation of pediatric prosthetic functional status measures for use with children with an upper extremity limb loss. In contrast, there are few prosthesis-specific functional status measures available specifically for use with adults with upper limb loss. The recent emphasis on outcome measurement across rehabilitation reflects the recognition that understanding of outcome results is an essential part of an effective health care system. From an outcomes perspective, the prosthetic community needs to systematically and prospectively gather information using validated functional status measures for both adult and pediatric groups. The purpose of this article is to provide measurement information to help clinicians and researchers in the identification and selection of “activity” and “participation” outcome measures that relate to upper extremity function and use of a prosthetic device. This review investigates: intended use of the measure, condition-specific (disease-specific) versus generic measures, age/life-stage considerations, observational measures versus client/parent-report questionnaires, psychometric properties of the measure, evaluation of change, use of individualized measures, choosing a measure or a core set of measures, and aspects of clinical utility. Three key recommendations were made by the author for future work: 1) Given the relative lack of prosthetic-specific measures available for adults, it is important to begin their development and validation. It may be possible to use existing pediatric prosthetic measures as a starting structural and content framework; 2) The building of a core set of outcome measures is recommended to provide a comprehensive picture of different aspects of hand function and prosthetic use. This core set should include an individualized measure of outcome; and 3) Because the numbers of upper limb amputees in any one center are often limited, formation of networks across rehabilitation facilities and use of the similar core sets of measures would facilitate capture of outcome data within large cooperative databases. There is a tremendous opportunity for the prosthetic service providers and researchers to make use of the recently validated functional measures and contribute ground-breaking knowledge on upper extremity outcomes. Few prosthesis-specific functional status measures are available specifically for use with adults with upper limb loss. The recent emphasis on outcome measurement across rehabilitation reflects the recognition that understanding of outcome results is an essential ingredient in the development and maintenance of an effective health care system. This article attempts to provide measurement information to help clinicians and researchers in the identification and selection of “activity” and “articipation” outcome measures that relate to upper extremity function and use of a prosthetic device.