Comparison of Pediatric Outcomes Data Collection Instrument Scores and Range of Motion Before and After Shoulder Tendon Transfers for Children with Brachial Plexus Birth Palsy

Author(s): Dedini RD, Bagley AM, Molitor F, James MA

Source: J Pediatr Orthop 28: 259-264, 2008.

Summary:

Children with residual brachial plexus birth palsy often lack abduction and external rotation of the shoulder.  The primary treatment involves tendon transfers to improve these deficits.  Outcome studies have reported improvement in goniometric measurements and the Mallet classification.  Measurement of change in activity and participation may be more valuable than just range of motion.  An instrument to assess this improvement would be beneficial to rate outcome. The Pediatric Outcomes Data Collection Instrument (PODCI) is a validated health questionnaire that addresses activity and participation components of function across 5 domains.  A sixth measure called Global Function is the average of the scores for the first 4 domains.  The aim of this study was to determine whether PODCI scores improved after tendon transfers, and whether these improvements correlate with improvement in shoulder active range of motion.

Twenty-three children, with an average age of 6.3 years were enrolled in this study.  The tendon transfer was performed using standard techniques, and all patients underwent a similar postoperative therapy protocol.  PODCI scores were determined prior to surgery and one year after surgery.  Similarly, range of motion measurements were recorded both before and after surgery. 

Range of active shoulder abduction improved 35 degrees to 115 degrees.  Range of external rotation improved 41 degrees to a mean 14 degrees.  The PODCI scores for transfers in basic mobility, upper extremity function, sports function, and global function all improved.  The improvement in transfers and basic mobility was not clinically significant.  There were no changes in the PODCI scores for Pain/Comfort, and Happiness Domains. 

For children with brachial plexus birth palsy (BPBP), improvement of range of motion would logically affect PODCI outcome measures.  However, there are a variety of domains which may not be affected.  Previous studies have shown the PODCI is able to measure clear differences between normal controls and children with BPBP, who were candidates for tendon transfer. 

This study is an important step toward relating goniometric range of motion and outcome measures to the World Health Organization International Classification of Functioning, Disability, and Health Model.  There may be some limitations of PODCI such as a ceiling affect, which would limit the likelihood of finding significant correlation.  However, as surgeons, we may be required to not only improve outcome and range of motion, but to truly report that we have enhanced function of our patients.