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Developing a Pollicization Outcomes Measure
Dan Zlotolow, MD1; Sarah Ashworth, OTR1; Scott Kozin, MD1; Joshua Abzug, MD2;
1Shriners Hospital for Children Philadelphia, 2University of Maryland Medical Center

Introduction

Index pollicization for thumb hypoplasia/aplasia remains one the crowning achievements of modern medicine. Since its conception, the technique has been refined and expanded to include a multitude of procedures within the procedure. Among different centers and even among different surgeons, there is tremendous variability in the technique. No validated instrument yet exists to compare the outcomes of each of these modifications and variations of the technique, limiting optimization and standardization of the technique. We propose an objective and subjective outcomes instrument that builds on most of the factors cited in previous outcomes studies.

Methods

We used an objective and subjective outcomes measure instrument to evaluate 15 pollicizations in 13 patients. In addition to a pictogram, we also used visual analogue scale (VAS) subjective measures for the therapist, caretaker, and surgeon and objective range of motion and strength data. The results of this instrument were then retrospectively evaluated to look for trends within the subjective and objective portions of the instrument. A linear regression analysis was performed to see if the objective data correlated with the subjective data. We also calculated the variance between observers to see if there were any biases within these groups.

Results

Therapists were the harshest evaluators, but still averaged within 5% of the nearest observers (surgeons). Caretakers graded the patients most favorably. The standard deviation between observers was 19% for “looks like a thumb” and 21% for “works like a thumb.” Active opposition and passive CMC hyperextension were the only objective measures that had a statistically significant correlation with “looks like a thumb.” Opposition to the small finger, active thumb extension, lateral pinch strength, and die and ping-pong ball acquisition had a statistically significant correlation with “works like a thumb.” Total subjective function correlated with active opposition, die and ping-pong ball acquisition, and lateral pinch strength. Subjective evaluation pinch also correlated with bead, sticker, and die acquisition, opposition, and passive palmar abduction. Subjective evaluation of grasp correlated with ping-pong ball acquisition and opposition.

Discussion

With only 13 patients evaluated, we were able to demonstrate some correlation between the subjective impression of 3 evaluators (caretaker, therapist, and surgeon) and an objective scale that supplements an easy to use pictogram with strength measurements and object acquisition. Further work, including inter- and intra-observer variability and responsiveness, will need to be done before this instrument can be validated for use in outcome studies.


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