Body Structures and Physical Complaints in Upper Limb Reduction Deficiency: A 24-Year Follow-Up Study

Norling Hermansson LM (2012) Body Structures and Physical Complaints in Upper Limb Reduction Deficiency: A 24-Year Follow-Up Study. PLoS ONE 7(11): e49727. doi:10.1371/journal.pone.0049727 Body Structures and Physical Complaints in Upper Limb Reduction Deficiency: A 24-Year Follow-Up Study Sietke G. Postema 0 Corry K. van der Sluis 0 Kristina Waldenlo v 0 Liselotte M. Norling Hermansson 0 Efrat Monsonego-Ornan, The Hebrew University, Israel 0 1 Centre for Rehabilitation Research, O rebro County Council, O rebro, Sweden, 2 Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands , 3 Limb Deficiency and Arm Prosthesis Centre, Department of Paediatrics, O rebro University Hospital, O rebro, Sweden, 4 Department of Prosthetics and Orthotics, O rebro County Council, O rebro, Sweden, 5 School of Health and Medical Sciences, O rebro University , O rebro , Sweden Objective: To describe upper body structures associated with upper limb reduction deficiency and the development of these structures over time, to examine the presence of physical complaints in this population, and to compare body structures and complaints between groups based on prosthesis use. Design: Prospective cohort study with a follow-up period of 24 years, with matched able-bodied controls. Subjects: Twenty-eight patients with unilateral below-elbow reduction deficiency fitted with myoelectric prostheses, aged 8-18 years at inclusion. Method: Measurements of upper arm, trunk and spine were performed and study-specific questionnaires were answered at baseline and follow-up; the Brief Pain Inventory and the Quick Disability of Arm, Shoulder, and Hand questionnaires were answered at follow-up. Results: Both at baseline and follow-up, within-subjects differences in structures of the arm and trunk were shown in patients but not in controls. Spinal deviations, although small, were greater in patients compared to controls. Self-reported disability was higher in patients compared to controls. Differences in back pain and effect of prostheses use could not be shown. Conclusions: Patients with unilateral below-elbow reduction deficiency have consistent differences in upper body structures. Deviations of the spine, probably of functional origin, do not progress to clinically relevant scoliosis. - Very little is known about the development of the upper body structures of children with upper limb reduction deficiency (ULRD). Examinations of the spine have previously found significant scoliosis without congenital malformations of the spine in 1931% of children with ULRD [1,2]. However, the development of these spinal deviations over time is unclear. Current clinical practice encompasses examination of the spine to detect scoliosis, even though scientific evidence for the necessity of this procedure is lacking. Furthermore, little is known about back pain or other physical complaints that these patients may experience in adulthood. One may expect higher rates of physical complaints in the unaffected hand or arm of a person with ULRD after many years of one-handedness. Earlier studies on physical complaints in individuals with a short arm have reported rates of arm and back complaints of 4055% among the examined population [36]. These studies did not focus specifically on patients with ULRD, who differ from those with amputations in that they are more able to use both the affected and unaffected arm to perform daily tasks due to natural adaptation. Because of population aging, more insight into physical complaints in older patients is valuable. Currently, children with ULRD are fitted with a myoelectric prosthesis at an early age [7,8]. One of the reasons for this is the hypothesis that the weight and use of a prosthesis prevents physical problems at a later age. The use of a prosthesis may stimulate symmetrical movements and the weight may stimulate the growth of bone and soft tissue. However, no research has been performed to study the relation between myoelectric prosthesis use and the development of body structures and physical complaints in patients with ULRD. Hence, there is a need for further studies on this topic. Therefore this study aims to i) describe the body structures of the spine, trunk and arms in patients with unilateral ULRD compared to able-bodied controls, ii) describe the development of the structures of arms and trunk over time, iii) examine the presence of physical complaints in patients with ULRD compared to able-bodied controls, and iv) compare body structures and physical complaints between groups based on prosthesis use. Participants and procedure Patients. In 1987, all children with unilateral ULRD below the elbow aged 818 years, who were fitted with a myoelectric prosthesis at the Limb Deficiency and Arm Prostheses Centre in Orebro, Sweden, were invited to participate in the study. A further inclusion criterion was sufficient comprehension of the Swedish language. In 2011, the same patients were invited again to the clinic for follow-up measurements. Controls. In 1987, each patient was matched for age and gender with one control from a local school. In 2011, each patient was matched for age, gender, weight (610 kg), and height (610 cm) with two employees of the hospital or acquaintances of the researchers. The exclusion criterion for the controls was presence of unilateral upper limb health problems. In 1987, data were collected during a regular visit to the hospital; in 2011, patients were called in especially for this study. The data was obtained from physical measurements of the spine, trunk and arms, study-specific and validated questionnaires (Table 1). The 1987 data were collected by an occupational therapist and a physician and the 2011 data by a physical therapist and a researcher. Before joining the study, patients and controls received oral and written information and gave their written informed consent. For patients younger than 15 years, written informed consent was given by the parents. The study was approved by the Regional Ethical Review Board in Orebro, Sweden, in 1987 and Uppsala, Sweden, in 2011. Physical measurements Structures of the spine. In 1987, spinal deviations were measured using Moire topography [9]. The number of contour lines between the scapula and armpit were recorded for both sides. Measurements were performed with and without prosthesis. There was no correction for leg length inequality (LLI). Due to unavailability of the Moire topography equipment in 2011, scoliometry was used (Pedi-Scoliometer, Pedihealth Oy, Oulu, Finland). This is a validated method with very good to excellent inter- and intra-rater reliability that shows the angle of trunk rotation (ATR) [1014]. Significant correlations between the Cobb angle and the ATR, especially for the thoracic level, have been shown [15,16]. Scoliometer measurements were taken from costal level C7 till level L5, by moving dow (...truncated)