Impact of prostheses on function and quality of life for children with unilateral congenital below-the-elbow deficiency

Michelle James, Anita M. Bagley, Katherine Brasington, Cheryl Lutz, Sharon McConnell, Fred Molitor

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: Children with unilateral congenital below-the-elbow deficiency present a dilemma to clinicians. Parents want the child to have a prosthesis and, because it seems that the deficiency will cause functional problems, one is customarily prescribed for infants. Use of the prosthesis is then encouraged throughout childhood. However, these children frequently abandon the prosthesis. There are no evidence-based guidelines regarding prescription of prostheses or standard methods for assessing use and function. Methods: A multicenter outcomes study was done to assess the quality of life and function of 489 children with a unilateral congenital below-the-elbow deficiency; 321 wore a prosthesis, and 168 did not. The Unilateral Below-the-Elbow Test (UBET) was designed, validated, and administered to these children along with several outcomes measures, including the Pediatric Outcomes Data Collection Instrument (PODCI), the Pediatric Quality of Life Inventory (PedsQL), and the Prosthetic Upper Extremity Functional Index (PUFI). Results: Use of a prosthesis was not associated with any clinically relevant differences in PODCI or PedsQL scores. Non-wearers performed either the same as or better than wearers on the UBET. When queried (with use of the PUFI) about performance of various tasks, non-wearers scored themselves higher than wearers. Children with a unilateral congenital below-the-elbow deficiency scored the same as or higher than the general population on the PedsQL. They scored significantly lower than the general population on the PODCI Upper Extremity Physical Function Domain and higher on the Happiness Domain, but the differences were small. Conclusions: Prostheses may help with social acceptance or may be useful as tools for specialized activities, but they do not appear to improve function or quality of life, which are nearly normal for children with unilateral congenital below-the-elbow deficiency regardless of whether they wear a prosthesis. These findings call into question the standard practices of fitting infants with prostheses and encouraging young children to wear the prosthesis. Level of Evidence: Therapeutic Level II.

Original languageEnglish (US)
Pages (from-to)2356-2365
Number of pages10
JournalJournal of Bone and Joint Surgery - Series A
Volume88
Issue number11
DOIs
StatePublished - Nov 2006
Externally publishedYes

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Elbow
Prostheses and Implants
Quality of Life
Upper Extremity
Pediatrics
Outcome Assessment (Health Care)
Social Distance
Happiness
Task Performance and Analysis
Population
Multicenter Studies
Prescriptions
Parents
Guidelines
Equipment and Supplies

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Impact of prostheses on function and quality of life for children with unilateral congenital below-the-elbow deficiency. / James, Michelle; Bagley, Anita M.; Brasington, Katherine; Lutz, Cheryl; McConnell, Sharon; Molitor, Fred.

In: Journal of Bone and Joint Surgery - Series A, Vol. 88, No. 11, 11.2006, p. 2356-2365.

Research output: Contribution to journalArticle

James, Michelle ; Bagley, Anita M. ; Brasington, Katherine ; Lutz, Cheryl ; McConnell, Sharon ; Molitor, Fred. / Impact of prostheses on function and quality of life for children with unilateral congenital below-the-elbow deficiency. In: Journal of Bone and Joint Surgery - Series A. 2006 ; Vol. 88, No. 11. pp. 2356-2365.
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abstract = "Background: Children with unilateral congenital below-the-elbow deficiency present a dilemma to clinicians. Parents want the child to have a prosthesis and, because it seems that the deficiency will cause functional problems, one is customarily prescribed for infants. Use of the prosthesis is then encouraged throughout childhood. However, these children frequently abandon the prosthesis. There are no evidence-based guidelines regarding prescription of prostheses or standard methods for assessing use and function. Methods: A multicenter outcomes study was done to assess the quality of life and function of 489 children with a unilateral congenital below-the-elbow deficiency; 321 wore a prosthesis, and 168 did not. The Unilateral Below-the-Elbow Test (UBET) was designed, validated, and administered to these children along with several outcomes measures, including the Pediatric Outcomes Data Collection Instrument (PODCI), the Pediatric Quality of Life Inventory (PedsQL), and the Prosthetic Upper Extremity Functional Index (PUFI). Results: Use of a prosthesis was not associated with any clinically relevant differences in PODCI or PedsQL scores. Non-wearers performed either the same as or better than wearers on the UBET. When queried (with use of the PUFI) about performance of various tasks, non-wearers scored themselves higher than wearers. Children with a unilateral congenital below-the-elbow deficiency scored the same as or higher than the general population on the PedsQL. They scored significantly lower than the general population on the PODCI Upper Extremity Physical Function Domain and higher on the Happiness Domain, but the differences were small. Conclusions: Prostheses may help with social acceptance or may be useful as tools for specialized activities, but they do not appear to improve function or quality of life, which are nearly normal for children with unilateral congenital below-the-elbow deficiency regardless of whether they wear a prosthesis. These findings call into question the standard practices of fitting infants with prostheses and encouraging young children to wear the prosthesis. Level of Evidence: Therapeutic Level II.",
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