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Correlations between Patient-reported Outcomes and Reachable Workspace in Children with Brachial Plexus Birth Injuries
R. Tyler Richardson, PhD1; Stephanie A Russo, MD, PhD2; James G Richards, PhD3; Ross S Chafetz, DPT, PhD4; Emily Nice, BS5; Dan A Zlotolow, MD6; Scott H Kozin, MD6
1Penn State University - Harrisburg, Middletown, PA; 2Akron Children's Hospital, Akron, OH; 3University of Delaware, Newark, DE; 4Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA; 5Shriners Hospitals for Children, Philadelphia, PA; 6Shriners Hospital for Children Philadelphia, Philadelphia, PA

Introduction Brachial plexus birth injuries (BPBI) lead to alterations in upper extremity (UE) movement and joint contractures. Children with BPBI report difficulty with activities of daily living and reduced quality of life. A recently developed reachable workspace tool measures the area one can reach with their arms using three-dimension motion capture technology. Proof of concept for assessing upper extremity function in children with BPBI has been demonstrated, but its relationship to patient-reported outcomes (PRO) is unknown. We hypothesized that reachable workspace would correlate with PRO measures.
Materials and Methods Twenty-two children with BPBI or their parents completed the Pediatric Outcomes Data Collection Instrument (PODCI). Thirteen also completed the Patient-Reported Outcomes Measurement Information System (PROMIS) UE and mobility scales. Affected limb reachable workspace was measured with real-time feedback to guide participants (Figure). Data is analyzed by percent of potential workspace reached, median reach distance, and maximum reach distance. These 3 variables are reviewed for the entire workspace and by region (Figure). Pearson correlations were assessed between percent workspace reached, median reach distance, maximum reach distance and PODCI UE and global scales and PROMIS UE and mobility scales.
Results There were moderate, significant correlations between median and maximum reach distance and PROMIS UE scores (Table). There were moderate, nonsignificant correlations between median and maximum reach distance and percent workspace reached and PROMIS UE. The remainder of correlations were weak and nonsignificant (Table).
Conclusions Reachable workspace measures correlated with PROMIS UE, but not PROMIS mobility or PODCI measures. However, some comparisons may be underpowered with the small sample size. The regions that exhibited the most consistent relationship with PROMIS UE were upper anterior contralateral, upper anterior ipsilateral and lower anterior contralateral. These regions require shoulder flexion/abduction, elbow extension, and/or shoulder cross-body adduction; movements frequently impaired in children with BPBI. The strength of the correlations demonstrated in this study are similar to or greater than previously published correlations between function measures and PROs. This study shows that reachable workspace identified functional deficits that are important to a patientsí perceptions of function and may be more capable of capturing patient satisfaction than other clinical measures.


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