Introduction to the Academy's State of the Science Conference on Upper Limb Prosthetic Outcome Measures

Laura A. Miller, PhD, CP
Shawn Swanson, OTR/L

This State of the Science Conference (SSC) was convened to examine the body of scientific knowledge related to outcome measures (OM) in upper limb prosthetics. The meeting was held in Chicago, Illinois, March 27–29, 2009, and funding for this conference was provided by the American Academy of Orthotists and Prosthetists through a grant from the US Department of Education. Experts in the field were invited to offer their insight and expertise in summarizing the evidence and identifying the key areas for future research. It was the goal of the state of the science conference to examine, debate, and answer the following six questions:

What validated instruments are available in English to measure upper limb prosthetic outcomes?
What do these instruments attempt to measure as it relates to the International Classification of Functioning, Disability and Health (ICF)/World Health Organization (WHO) classifications?
What are the relative strengths and weaknesses of current instruments?
What do various interest groups want out of an outcome measure?
What are the appropriate tools to be used for various applications (research, clinical, pediatric, and quality of life)?
In light of the literature review and the panel's discussion, what are the primary future research priorities? That is, what is missing and where do we go from here?

Upper limb prosthetic outcomes have been an area of interest for decades (see historical review of pediatric outcomes by Hubbard, in this issue). A renewed interest was drawn to the area following two OM meetings: the preconference workshop for the Myoelectric Controls (MEC) Symposium held on August 2005 and one held in Trondheim, Norway, March 2007. This led to the formation at of the Upper Limb Prosthetic Outcome Measures Group (ULPOM) after the International Society of Prosthetics and Orthotics (ISPO) meeting in Vancouver later in August 2007.¹ These meetings helped to focus and define terminology of outcomes related to upper limb prosthetics across the spectrum from Research and Development through the Clinical setting and Home Use with a basis around the ICF/WHO classification.^2–4 The reader will find that the ICF/WHO classification is the basis for much of our discussion and organization regarding upper limb OM. This classification combines the following: the medical and social disability models, the impact of the amputation, and the environment and social situations.

To address the earlier-mentioned questions number 1 and 2, a comprehensive written evidence-based review (EBR) of the literature (included in this issue) was requested of F. Virginia Wright, PT, PhD, by the Academy. During this same time, extensive work was also being done by those participating in the ULPOM group. This special issue publication combines these two bodies of work and the panel's recommendation for future research priorities. Selected participants were asked to present their experience with specific measurement tools. A general agreement among the SSC participants is that OMs are not being used widely. Therefore, various stakeholders (therapists, prosthetists, and researchers) were asked to provide certain perspectives regarding the clinical and research application of outcome measurement tools, what tools they have used (why they do and do not continue to do so) and their opinions and thoughts on why these OM are not more widely adopted or utilized. Before the meeting, the participants reviewed the evidence-based review, work done by the ULPOM group, the notes from the ISPO, MEC discussions and the various perspectives.

During the course of the meeting, existing measures were thoroughly discussed and categorized. The SSC panel evaluated the current status of the OMs deemed to be "recommended for use" and those to be "considered" for application. The recommended and considered tools were evaluated to determine what the field of application (i.e., research or patient care) would be for each and for those identified as "consider," a list was compiled of what further work would be necessary to include them as recommended. Finally, with an understanding of current barriers and needs for OMs in upper limb prosthetics, future research priorities were determined.

PARTICIPANTS

CO-CHAIRS
Laura A. Miller, PhD, CP, Assistant Professor, Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.

Shawn Swanson, OTR/L, National Director of Occupational Therapy, Advanced Arm Dynamics, Redondo Beach, CA.

INVITED PARTICIPANTS
Alberto Esquenazi, MD, Chair and Professor, Department of PM&R and Chief Medical Officer, MossRehab and Albert Einstein Director, Gait and Motion Analysis Laboratory and Regional Amputee Center MossRehab, Philadephia, PA.

Craig Heckathorne, MS, Research Engineer, Northwestern University Rehabilitation Engineering Research Program, Prosthetics Research Laboratory, Department of Orthopaedic Surgery, Northwestern University, Medical School, Chicago, IL.

Wendy Hill, BScOT, Research Occupational Therapist, University of New Brunswick, Fredericton, NB, Canada.

Sheila Hubbard, PT, OT, BScPT, Former Manager of Clinical Technology, Adjunct Clinician Investigator, Bloorview Kids Rehab, Toronto, Ontario, Canada.

Peter Kyberd, PhD, Research Chair in Rehabilitation Cybernetics, University of New Brunswick, Fredericton, NB, Canada.

Chris Lake, CPO, LPO, FAAOP, SW Clinical Director, Advanced Arm Dynamics, Upper Limb Society Chair, AAOP, Clinical Instructor, UTSW-School of Allied Health, PhD Student, University of Strathclyde, National Center for O&P.

Kathy Stubblefield, OTR/L, Neural Engineering Center for Artificial Limbs, Rehabilitation Institute of Chicago, Chicago, IL.

Jack Uellendahl, CPO, FAAOP, Clinical Prosthetics Specialist, Hanger Prosthetics and Orthotics, Phoenix, AZ.

Liselotte Norling Hermansson, PhD, Reg OT, Department of Prosthetics and Orthotics, Örebro County Council, Öebro, Sweden; Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.

F. Virginia Wright, PT, PhD, Clinician Scientist, Bloorview Research Institute, Toronto, Ontario, Canada.

GRANT REPRESENTATIVE
John W. Michael, MEd, CPO/LPO, FISPO, FAAOP, Adjunct Faculty, MSPO Program, Georgia Institute of Technology, Atlanta, GA.

CONTINUING EDUCATION DEVELOPMENT TEAM
Brian J. Hafner, PhD, Acting Assistant Professor Prosthetics- Orthotics Division, University of Washington, Seattle, WA.

Susan Ewers, MS, CPO, Teaching Associate, Prosthetics- Orthotics Division, University of Washington, Seattle, WA.

Correspondence to: Laura A. Miller, PhD, CP, Rehabilitation Institute of Chicago, 345 E Superior, Chicago, IL 60611; e-mail:

LAURA A. MILLER, PhD, CP, is affiliated with the Rehabilitation Institute of Chicago, Neural Engineering Center for Artificial Limbs, and Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois.

SHAWN SWANSON, OTR/L, is affiliated with Advanced Arm Dynamics, Redondo Beach, California.

References:

Hill W, Stavdahl O, Hermansson LN, et al. Functional outcomes in the WHO-ICF model: establishment of the Upper Limb Prosthetic Outcome Measures Group. J Prosthet Orthot 2009;21: 115–119.
Roach KE. Measurement of health outcomes: reliability, validity, and responsiveness. J Prosthet Orthot 2006;18:8 –12.
Kohler F, Cieza A, Stucki G, et al. Developing Core Sets for persons following amputation based on the International Classification of Functioning, Disability and Health as a way to specify functioning. Prosthet Orthot Int 2009;33:117–29.
World Health Organization. ICF training beginner's guide 2002. Available at: URL: www.who.int/classifications/icf/training/icfbeginnersguide.pdf