Outcome Measures in Adult Upper Extremity Peripheral Nerve Injuries
Fares Lebbos, Noor Elfaki, Alec J. Chen, Arman T. Zadeh, Shafic Abdulkarim, Thomas Wanna, Sami H. Tuffaha, Ala ElhelaliBackground:
Outcome assessment after upper-extremity peripheral nerve injury (PNI) remains inconsistently reported across studies. This limits comparison between interventions and confounds the interpretation of recovery. This umbrella review aimed to identify the clinical and patient-reported outcome measures (COMs and PROMs) in adults following upper-extremity PNI.
Methods:
PubMed, Embase, Cochrane Library, Web of Science, and Scopus were searched from inception to July 3, 2024, for systematic reviews, meta-analyses, and scoping reviews of COMs and PROMs in adults with upper-extremity PNIs. Outcome domain, instrument use, and reported psychometric properties were extracted. Methodological quality was assessed using AMSTAR 2. Findings were synthesized narratively.
Results:
A total of 41 reviews were included, encompassing 68 COMs and 41 PROMs. Motor outcomes were reported in 28/39 reviews. The MRC/BMRC scales were the most frequently used motor measure (26/28 reviews, 93%), followed by pinch strength (14/28, 50%) and grip strength (13/28, 46%). Static 2-point discrimination (22/27, 81%) and Semmes-Weinstein monofilament testing (16/27, 59%) were the most common sensory measures. Sensorimotor outcomes were reported in 12 reviews, with shape/texture identification the most frequent measure (8/12, 67%). PROMs were reported in 21/41 reviews, with the Disabilities of the Arm, Shoulder and Hand questionnaire most frequently reported. Only 5 reviews reported psychometric data. MRC scale for motor strength had moderate interrater reliability (κ=0.65 to 0.90), and s2PD demonstrated poor responsiveness (effect size=0.0 to 0.1).
Conclusions:
This umbrella review found heterogeneity in outcome measurement after adult upper-extremity peripheral nerve injury. Standardization of clinically relevant outcomes may improve comparability across studies and strengthen future evidence synthesis.