ICF Linking of Patient-Reported Therapy Goals for Children with Acquired Upper Extremity Impairment

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

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Impairment Tutorial: Functionally Limiting Upper Extremity Pain: Controversies in Impairment Rating

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.sepoct02 ◽

2003 ◽

Vol 8 (5) ◽

pp. 4-12

Author(s):

Lorne Direnfeld ◽

James Talmage ◽

Christopher Brigham

Keyword(s):

Upper Extremity ◽

Radicular Pain ◽

Illness Behavior ◽

Orthopedic Surgeon ◽

First Case ◽

Clinical Presentations ◽

Whole Person ◽

Physical Examinations ◽

Upper Extremity Impairment ◽

The Individual

Abstract This article was prompted by the submission of two challenging cases that exemplify the decision processes involved in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In both cases, the physical examinations were normal with no evidence of illness behavior, but, based on their histories and clinical presentations, the patients reported credible symptoms attributable to specific significant injuries. The dilemma for evaluators was whether to adhere to the AMA Guides, as written, or to attempt to rate impairment in these rare cases. In the first case, the evaluating neurologist used alternative approaches to define impairment based on the presence of thoracic outlet syndrome and upper extremity pain, as if there were a nerve injury. An orthopedic surgeon who evaluated the case did not base impairment on pain and used the upper extremity chapters in the AMA Guides. The impairment ratings determined using either the nervous system or upper extremity chapters of the AMA Guides resulted in almost the same rating (9% vs 8% upper extremity impairment), and either value converted to 5% whole person permanent impairment. In the second case, the neurologist evaluated the individual for neuropathic pain (9% WPI), and the orthopedic surgeon rated the patient as Diagnosis-related estimates Cervical Category II for nonverifiable radicular pain (5% to 8% WPI).

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Quick Reference: Checklist for Upper Extremity Impairment Evaluations

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1999.novdec06 ◽

1999 ◽

Vol 4 (6) ◽

pp. 14-15

Author(s):

James B. Talmage

Keyword(s):

Upper Extremity ◽

Upper Extremity Impairment

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Evaluating Shoulder Impairment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1998.sepoct01 ◽

1998 ◽

Vol 3 (5) ◽

pp. 1-3

Author(s):

Richard T. Katz ◽

Sankar Perraraju

Keyword(s):

Peripheral Nerve ◽

Upper Extremity ◽

Sensory Loss ◽

Motor Deficits ◽

Nerve Lesion ◽

Fourth Edition ◽

Specific Patient ◽

Industrial Medicine ◽

Shoulder Motion ◽

Upper Extremity Impairment

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, offers several categories to describe impairment in the shoulder, including shoulder amputation, abnormal shoulder motion, peripheral nerve disorders, subluxation/dislocation, and joint arthroplasty. This article clarifies appropriate methods for rating shoulder impairment in a specific patient, particularly with reference to the AMA Guides, Section 3.1j, Shoulder, Section 3.1k, Impairment of the Upper Extremity Due to Peripheral Nerve Disorders, and Section 3.1m, Impairment Due to Other Disorders of the Upper Extremity. A table shows shoulder motions and associated degrees of motion and can be used in assessing abnormal range of motion. Assessments of shoulder impairment due to peripheral nerve lesion also requires assessment of sensory loss (or presence of nerve pain) or motor deficits, and these may be categorized to the level of the spinal nerves (C5 to T1). Table 23 is useful regarding impairment from persistent joint subluxation or dislocation, and Table 27 can be helpful in assessing impairment of the upper extremity after arthroplasty of specific bones of joints. Although inter-rater reliability has been reasonably good, the validity of the upper extremity impairment rating has been questioned, and further research in industrial medicine and physical disability is required.

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“I...Got my Nose-Print. But it Wasn’t Accurate”: How People with Upper Extremity Impairment Authenticate on their Personal Computing Devices

Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems ◽

10.1145/3411764.3445070 ◽

2021 ◽

Author(s):

Brittany Lewis ◽

Krishna Venkatasubramanian

Keyword(s):

Upper Extremity ◽

Personal Computing ◽

Upper Extremity Impairment

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The extent of altered digit force direction correlates with clinical upper extremity impairment in chronic stroke survivors

Journal of Biomechanics ◽

10.1016/j.jbiomech.2014.11.046 ◽

2015 ◽

Vol 48 (2) ◽

pp. 383-387 ◽

Cited By ~ 3

Author(s):

Na Jin Seo ◽

Leah R. Enders ◽

Binal Motawar ◽

Marcella L. Kosmopoulos ◽

Mojtaba Fathi-Firoozabad

Keyword(s):

Upper Extremity ◽

Chronic Stroke ◽

Stroke Survivors ◽

Force Direction ◽

Upper Extremity Impairment

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The Influence of Psychological Factors on the Michigan Hand Questionnaire

Hand ◽

10.1177/1558944716642765 ◽

2016 ◽

Vol 12 (2) ◽

pp. 197-201 ◽

Cited By ~ 6

Author(s):

Yekyoo Oh ◽

Tessa Drijkoningen ◽

Mariano E. Menendez ◽

Femke M. A. P. Claessen ◽

David Ring

Keyword(s):

Upper Extremity ◽

Emotional Health ◽

Pain Catastrophizing ◽

Pain Interference ◽

Measurement Information ◽

Web Based ◽

Psychological Measures ◽

Symptoms Of Depression ◽

Patient Reported ◽

Multivariable Regression

Background: Psychosocial factors help account for the gap between impairment and disability. This study examines the relationship between the Michigan Hand Questionnaire (MHQ) and commonly used psychological measures in patients with upper extremity illness. Methods: A cohort of 135 new or follow-up patients presenting to an urban academic hospital–based hand surgeon were invited to complete a web-based version of the MHQ, Abbreviated Pain Catastrophizing Scale (PCS), and two Patient-Reported Outcomes Measurement Information System (PROMIS)-based questionnaires: Pain Interference and Depression. Bivariate and multivariable analyses measured the correlation of these psychological measures with MHQ. Results: Accounting for potential confounding factors in multivariable regression, upper extremity disability as rated by the MHQ was independently associated with PROMIS Depression, PROMIS Pain Interference, visit type, and working status. The model accounted for 37% of the variability in MHQ scores, with PROMIS Pain Interference having the most influence. Conclusion: Among the non-pathophysiological factors that contribute to patient-to-patient variation in MHQ scores, the measure of less effective coping strategies and symptoms of depression were most influential. Our data add to the evidence of the pivotal role of emotional health in upper extremity symptoms and limitations and the importance of psychosocial considerations in the care of hand illness.

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Pediatric PROMIS Computer Adaptive Tests Are Highly Correlated With Adult PROMIS Computer Adaptive Tests in Pediatric Sports Medicine Patients

The American Journal of Sports Medicine ◽

10.1177/0363546520966034 ◽

2020 ◽

Vol 48 (14) ◽

pp. 3620-3625

Author(s):

David N. Bernstein ◽

Sreten Franovic ◽

D. Grace Smith ◽

Luke Hessburg ◽

Nikhil Yedulla ◽

...

Keyword(s):

Quality Improvement ◽

Depressive Symptoms ◽

Physical Function ◽

Upper Extremity ◽

Sports Medicine ◽

Pain Interference ◽

Adaptive Tests ◽

Care Research ◽

Patient Reported ◽

Computer Adaptive Tests

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is a powerful set of patient-reported outcome measures (PROMs) that are gaining popularity throughout orthopaedic surgery. The use of both adult and pediatric PROMIS questionnaires in orthopaedic sports medicine limits the value of the PROMIS in routine sports medicine clinical care, research, and quality improvement. Because orthopaedic sports medicine surgeons see patients across a wide age range, simplifying the collection of PROMIS computer adaptive tests (CATs) to a single set of questionnaires, regardless of age, is of notable value. Purpose/Hypothesis: The purpose was to determine the strength of the correlation between the pediatric and adult PROMIS questionnaires. We hypothesized that there would be a high correlation between the adult and pediatric versions for each PROMIS domain, thereby justifying the use of only the adult version for most sports medicine providers, regardless of patient age. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Between December 2018 and December 2019, all pediatric sports medicine patients presenting to a single, academic, orthopaedic sports medicine clinic were asked to participate in the present study with their parents’ consent. Patients were asked to complete a set of adult PROMIS domains (Physical Function and/or Upper Extremity, Pain Interference, and Depression) as well as a set of pediatric PROMIS domains (Mobility and/or Upper Extremity, Pain Interference, and Depressive Symptoms). Concurrent validity was assessed using Pearson correlation coefficients ( r). Ceiling and floor effects were determined. Results: A total of 188 patients met our inclusion criteria. The correlation between the adult and pediatric PROMIS Upper Extremity, Physical Function and Mobility, Pain Interference, and Depression and Depressive Symptoms forms were high-moderate ( r = 0.68; P < .01), high-moderate ( r = 0.69; P < .01), high ( r = 0.78; P < .01), and high ( r = 0.85; P < .01), respectively. Both adult and pediatric depression-related PROMIS domains demonstrated notable floor effects (adult: 38%; pediatric: 24%). The pediatric PROMIS Upper Extremity domain demonstrated a ceiling effect (20%). Conclusion: Adult PROMIS CATs may be used in an orthopaedic sports medicine clinic for both adult and pediatric patients. Our findings will help decrease the amount of resources needed for the implementation and use of PROMs for patient care, research, and quality improvement in orthopaedic sports medicine clinics.

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