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Development and Validation of an International Outcomes Tool for Upper Extremity Burn Scar Contracture Release
Lawrence Z Cai, BS1, Trung Hau Le Thua, MD2; Mohan Krishna Dangol, MD3; Iftekhar Ibne Mannan, MBBS4; Shafquat Hussain Khundkar, MBBS4; Raghav Shrotriya, MS5; Vinita Puri, MCh5; Shankar Man Rai, MS3; James Chang, MD1
1Stanford School of Medicine, Stanford, CA, 2Hue Central Hospital, Hue, Viet Nam, 3Kirtipur Hospital, Kathmandu, Nepal, 4Popular Medical College, Dhaka, Bangladesh, 5Seth G S Medical College and King Edward Memorial Hospital, Mumbai, India
Introduction: Post-burn contractures (PBCs) cause significant disability, particularly to patients in low- and middle-income countries (LMICs). The high prevalence of PBCs in LMICs, particularly with injuries of the upper extremity, remains high, and a gap exists in our ability to longitudinally measure post-operative outcomes in these settings. We report the development and testing of a novel upper extremity outcomes tool designed specifically for resource-poor settings.
Methods: Items for the upper extremity outcomes tool were selected through previously described stages of Scale Development: Item Generation through literature review and expert interviews, Item Reduction through feasibility and cultural relevance, and Field Testing with international PBC patients. The outcome instrument was first piloted with 10 patients in Nepal who were undergoing PBC release of the upper extremity at one week pre-operatively, immediately pre-operatively, and one month post-operatively, to evaluate sensitivity to early changes in functional status and test-retest reliability.
Results: The final outcomes instrument was a twenty-item tool that evaluates Appearance, Activities of Daily Living, Somatosensation, Satisfaction, and Range of Motion outcomes of the upper extremity, with a floor of 20 and a ceiling of 100 points. Initial findings demonstrate that the scale is sensitive to early change, with patients show an average improvement of 14 points between pre-operative and one-month post-operative states. Test-retest reliability was acceptable (ICC > 0.7), as evaluated by intraclass correlation of scores at one week preoperatively and one day pre-operatively.
Conclusion: We have developed a novel survey instrument to measure functional outcomes of the upper extremity after burn contracture release. The instrument is sensitive to early change in patient functional status following PBC release of the upper extremity. It is easy to use and relevant in resource-limited settings around the world. Statistical validation is now ongoing at four hospitals in Bangladesh, India, Nepal, and Vietnam. Patients are instructed to complete translated versions of the new outcome instrument and the DASH at one day pre-operatively, one month post-operatively, and three months post-operatively to evaluate construct validity and long-term sensitivity to change.
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