Measuring What Matters: Validating the HANDFULS Tool with Pediatric Burn Survivors

Hand and finger burns are common in children and often cause functional limitations. Despite the importance of hand function during development, few outcome measures are validated for pediatric burn survivors. Hand Accumulation and Dexterity Functional Limits- Shriners (HANDFULS) is a measure that uses marbles to measure in-hand manipulation (IHM) and palmar workspace volume (PWV)- two frequent impairments after burn injury. This study aimed to validate HANDFULS with pediatric patients with hand burns and establish functional recovery trajectories relative to age-matched non-injured peers. This prospective longitudinal study assessed hand function in 119 children (165 hands) for 2 years post-burn. Mixed-effects models with random intercepts for hand clustering evaluated change over time while controlling for confounders. PWV and HANDFULS scores were compared with non-injured peers and analyzed by surgical status. PWV scores improved by 1.5 marbles (p = 0.005) and HANDFULS scores by 1.2 sec/marble (p = 0.002) over two years, with the greatest gains observed between 2-6 months. Surgical patients had lower PWV at 2 and 6 months (-2.22, p = 0.001; -1.28, p = 0.036), but no difference in HANDFULS scores (which incorporate both PWV and IHM), indicating preserved dexterity despite reduced PWV. Compared to non-injured peers, 45.2% (PWV) and 31.8% (HANDFULS) of children with hand burns were within normal limits at 2 months, increasing to 77.6% and 78.1%, respectively, by 24 months. HANDFULS is a simple, feasible, and burn-specific hand outcome measure that demonstrates validity and reliability in the pediatric burn population. HANDFULS provides objective outcome information about recovery from hand burns to support clinical decision-making and guide rehabilitation.