PROVIDENCE, RI – A new, standardized measurement can help clinicians assess the effectiveness of teaching and learning for adults with prosthetics after upper-limb amputations.
The tool, the Activities Measure for Upper-Limb Amputees (the AM-ULA), was described in an article published online by the Archives of Physical Medicine and Rehabilitation.1
“Patients can’t just take a prosthesis out of the box and start using it skillfully,” said lead author Linda Resnik, PhD, PT, a research scientist at the Providence, RI, Veterans Affairs Medical Center and an associate research professor in public health at Brown University.
“The upper limb is used to perform so many types of tasks. Patients need training to make the most of an upper-limb prosthesis,” she pointed out. “Physical and occupational therapists train people to use adaptive equipment and prosthetic devices, — teaching them strategies to accomplish functional tasks and guiding them in therapeutic exercises and activities. We need measures to let us know if our patients are improving the way that we expect them to. When they get a new device, what are the benefits? Are they able do more with it?”
Based on 18 everyday tasks, the AM-ULA provides standardized methods and criteria for clinicians to grade patients’ performance, speed and skill using any kind of prosthetic arm. Those tasks necessary for adults to be independent include activities such as putting on and removing a shirt, serving soda from a can, combing hair, tying shoes and using a spoon.
The metric was tested with 49 veterans at VA facilities in Tampa and New York and the Army’s Fort Sam Houston in Texas.
Resnick noted that the new tool provides more information than a self-report.
“We look at the amount of body compensation used to perform a task — how much bending or use of other more proximal joints is involved in an activity,” she explained. “That’s important, because we know that upper-limb amputees often develop problems in their neck and back.”
Two independent raters were used to refine the metric and ensure its reliability. Originally the measure included 24 tasks, but six were dropped because the independent raters came to ratings that were too different to reconcile.
When the tool is used, a patient whose scores vary more than 3.7 points between sessions is likely to have truly changed, because that change exceeds random error of measurement, according to study authors.
“Outcome measures are needed in all areas of healthcare, but particularly so in the area of prosthetic rehabilitation,” Resnik said, noting that benefit often must be proven to get insurance benefits. “High-tech prosthetic devices have great promise to help people regain function, but the costs for myoelectric and microprocessor prosthetic devices are substantially higher than those for simpler, body-powered devices.”
- Resnik L, Adams L, Borgia M, Delikat J, Disla R, Ebner C, Walters LS.
Development and Evaluation of the Activities Measure for Upper Limb Amputees.
Arch Phys Med Rehabil. 2012 Oct 17. doi:pii: S0003-9993(12)01019-2.
10.1016/j.apmr.2012.10.004. [Epub ahead of print] PubMed PMID: 23085376.
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