Rehabilitation intervention for patients with upper extremity dysfunction: challenges of outcome evaluation

Upper extremity (UE) dysfunction attributed to overuse is an increasingly prevalent problem managed with interdisciplinary rehabilitation. Outcome evaluation of these programs is limited by a number of factors. First, patients with UE dysfunction include a wide variety of pathophysiologic processes and diagnoses that are associated with multiple secondary impairments, disabilities, and handicaps that limit personal performance. Second, the particular experience of disablement and expectations each person brings to the rehabilitation process necessitates an individualized program with unique goals. Successful outcome measurement of the rehabilitation process must take into account the achievement of individual goals as well as objective scalar quantification of impairments, disabilities, and handicaps that are comparable between groups. Understanding of the relationships between UE impairments and given functional outcomes will come from controlled, dosed treatment studies in "pure" diagnostic patient groups. Outcomes research applied to UE rehabilitation as it is currently practiced should include individually devised patient assessments of accomplishment and satisfaction in addition to long-term quantitative reassessment of the person under all domains of disablement and work performance.