Purpose
Soft tissue surgery for upper extremity contractures can improve hygiene, pain, and
appearance in adults with central nervous system lesions. The goal of such interventions
is highly individual; thus, goal attainment scaling (GAS; a method of scoring the
extent to which patient’s individual goals are achieved [5 levels] in the course of
intervention and using T score values) is pertinent to evaluate outcome. The objective
of this study was to assess the effect of soft tissue surgery for upper extremity
muscle contractures in patients with central nervous system lesions using GAS.
Methods
Retrospective data from 70 interventions were included (63 patients; 23 women). The
mean age was 51.3 ± 16.2 years (range, 24.2–87.0 years). The primary goal was to improve
hygiene (n = 58), pain (n = 10), or appearance (n = 2). The etiologies were stroke
(n = 35), traumatic brain injury (n = 16), cerebral anoxia (n = 4), neurodegenerative
disease (n = 6), and cerebral palsy (n = 2). The GAS score was calculated before surgery
and 3 months after surgery.
Results
The T score (which took into account the weight of each goal) was 52.3 at 3 months
(38.5 before surgery), corresponding to a “better than expected” outcome. The mean
of the differences of the GAS score for each goal before and after surgery increased
by 1.27 for hygiene, 1.06 for pain, and 1.00 for appearance.
Conclusions
Soft tissue surgery can safely and effectively improve hygiene, pain, and appearance
in adults with cerebral damage. The preoperative evaluation should be multidisciplinary.
The GAS is a useful tool to assess the effectiveness of orthopedic surgery for these
patients.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: September 19, 2017
Accepted:
August 1,
2017
Received:
June 10,
2016
Footnotes
The authors received financial support from Allergan SA (Courbevoie, France), Merz Pharma (Paris La Défense, France), and Ipsen Pharma (Boulogne Billancourt, France).
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
