Clinimetric Evaluation of Questionnaires Used to Assess Activity After Traumatic Brachial Plexus Injury in Adults: A Systematic Review

Objectives: To identify upper limb questionnaires used in the brachial plexus injury (BPI) literature to assess activities and to evaluate their clinimetric properties. Data Sources; Study Selection; Data Extraction: This systematic review was undertaken in 2 stages. In stage 1, 10 electronic databases and 1 Internet journal were searched for quantitative studies (ie, randomized controlled trials, comparative studies, case series, and case studies) that evaluated outcome after BPI, irrespective of language or date of publication, from date of database inception to September 2010. All outcome instruments used were extracted and classified using the International Classification of Functioning, Disability and Health framework. Questionnaires were identified that apportioned >50% of the total score to the assessment of upper limb activity. In stage 2, 4 electronic databases were searched for papers that evaluated the clinimetric properties of all identified activity questionnaires with respect to peripheral nerve injuries of the upper limb. Two independent reviewers assessed the clinimetric properties of identified questionnaires according to standardized criteria. Data Synthesis: Stage 1 identified 4324 papers, of which 265 met the inclusion criteria. One hundred and three outcome measures were identified, the majority of which assess body function or body structure. Twenty-nine questionnaires assessed upper limb activity. Two questionnaires, the ABILHAND and Disability of the Arm, Shoulder and Hand (DASH), attributed >50% of the overall score to activity of the upper limb. The DASH had some published evidence of clinimetric properties in individuals with peripheral nerve injuries. Neither had been clinimetrically evaluated for BPI, nor met all quality criteria. Conclusions: Day-to-day activities of the upper limb are infrequently evaluated after BPI. While attempts have been made to measure activity, there is a paucity of clinimetric evidence on activity questionnaires for individuals with BPI. We recommend that a core set of items be developed which evaluate activity, as well a body structure, body function, and participation.