Real-World Evidence-Based Outcomes to Measure Upper Extremity Activity in The Brachial Plexus Injury Population

Area of Science:

• Orthopedics
• Neurosurgery
• Rehabilitation Medicine

Background:

• Traumatic brachial plexus injuries significantly impair upper extremity function.
• Traditional outcome measures are often clinic-based or survey-reliant, lacking real-world context.
• Objective, long-term functional assessment in the patient's environment is crucial for evaluating surgical outcomes.

Purpose of the Study:

• To develop and validate a novel objective outcome measure for assessing upper extremity function after brachial plexus reconstruction.
• To compare a new real-world activity monitoring method with traditional clinical outcome measures.

Main Methods:

• A novel method was developed to monitor and compare the activity of the injured arm against the unimpaired contralateral arm in the patient's home environment.
• A dynamic asymmetry index (DASI) was calculated from activity data.
• Data from healthy individuals established a normative range for comparison.
• Graphical representations aided visual assessment of bilateral arm function.

Main Results:

• The postoperative DASI showed statistically significant differences compared to control groups.
• No significant correlation was found between DASI and traditional measures like the Disabilities of the Arm, Shoulder and Hand (DASH) or Manual Muscle Testing (MMT) grade.
• This highlights the limitations of conventional, non-real-world outcome measures.

Conclusions:

• The DASI serves as an objective outcome measure for evaluating patient function recovery in real-world settings over extended periods.
• It offers a more realistic and comprehensive assessment of functional outcomes post-brachial plexus reconstruction compared to traditional methods.
• The DASI captures the patient's volitional use of the injured limb during daily activities.