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Relationship between Inner and Outer Reachable Workspace and Patient-reported Outcomes
Liliya Kachaluba, HS
1; Lauren N Lottier, MS
1; R. Tyler Richardson, PhD
2; Emily Nice, BS
3; Ross S Chafetz, DPT, PhD
3; Scott H Kozin, MD
3; Stephanie A Russo, MD, PhD
11Akron Children's Hospital, Akron, OH; 2Penn State University - Harrisburg, Middletown, PA; 3Shriners Hospitals for Children, Philadelphia, PA
INTRODUCTION
Brachial plexus birth injuries (BPBI) cause upper extremity (UE) mobility impairments. Children with BPBI report difficulty performing everyday tasks and lower quality of life than typically developing peers. Reachable workspace assesses the area that an individual can reach with their arms. Historically, reachable workspace only measures outer, far-from-body workspace. Evaluation of inner, close-to-body, reachable workspace has been recently developed. The relationship between inner reachable workspace and patient-reported outcomes (PROs) is unknown. Inner workspace for activities such as dressing may be more important to patients than outer workspace for reaching tasks. Therefore, we hypothesized that inner workspace would demonstrate stronger correlations to PROs than outer workspace.
MATERIALS & METHODS
Twenty children with BPBI or their parents completed the Pediatric Outcomes Data Collection Instrument (PODCI) and the Patient-Reported Outcomes Measurement Information System (PROMIS) UE and mobility scales. Affected limb inner and outer reachable workspace were measured with three-dimensional motion capture using real-time feedback to guide the participants. Percent workspace reached was calculated for inner and outer spaces (Figure). Pearson correlations were assessed between PODCI global and UE scores and PROMIS UE and mobility scales and inner and outer reachable workspace. Sub-regions were assessed for the workspace (inner or outer) that better correlated with PROs.
RESULTS
There were significant, moderate correlations between total inner workspace and PODCI global and UE scores (Table). There were nonsignificant moderate correlations between total outer workspace and PODCI global and UE scores. The inner thorax and abdomen regions demonstrated significant moderate to strong correlations with PODCI scores (Table).
DISCUSSION
Inner reachable workspace demonstrated a stronger relationship to PODCI scores than outer workspace. Specifically, the inner thoracic and abdominal regions had the most compelling correlations. This suggests that tasks such as dressing, bathing, and close-to-body manipulation of objects are of greater importance to patient/parent perception of function than tasks that occur in outer workspace regions, such as reach. PROMIS scores did not demonstrate significant correlations with workspace in this cohort, although the sample size was small. Nevertheless, these findings inform clinicians regarding patient/parent priorities related to UE mobility that can help direct management for children with BPBI.
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