Document Detail

Functional outcomes after upper extremity surgery for cerebral palsy: comparison of high and low manual ability classification system levels.
MedLine Citation:
PMID:  20141898     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The heterogeneity of cerebral palsy makes interpretation and prediction of outcome after upper extremity surgery difficult. We hypothesized that the outcome of upper extremity surgery for cerebral palsy is related to the Manual Ability Classification System (MACS) level. METHODS: We reviewed 27 patients with a mean age of 22 years, who underwent upper extremity surgery for spastic cerebral palsy at a mean follow-up of 29 months. Patients were classified into 5 MACS levels using a standardized questionnaire completed by their primary caregivers. Preoperatively and at most recent follow-up visits, patients were assessed using the House scale and patient-reported functional outcomes on a 5-point scale. We compared the outcomes of patients with high (I-II, independence in daily activities) and low (III-V, dependence in daily activities) MACS levels. RESULTS: The overall mean House scale improved from 2.9 to 4.6 postoperatively (p<.001), dressing ability from 3.7 to 4.2 (p=.005), hygiene from 4.2 to 4.9 (p=.005), and appearance from 2.4 to 4.2 (p<.001). A total of 13 patients had a high MACS level (7 had I and 6 had II) and 14 had a low MACS level (8 had III, 6 had IV, and none had V). The high-MACS group had a greater improvement according to the House scale (p=.009) and the low-MACS group had a larger improvement in hygiene status (p=.043). There were no differences in the amount of improvement in dressing ability (p=.169) and appearance (p=.765). Overall satisfaction with surgery was higher for the high-MACS group (p=.038). CONCLUSIONS: The high-MACS group had a greater improvement in rating according to the House scale and higher satisfaction than the low-MACS group after upper extremity surgery for cerebral palsy in our small number of patients. This study suggests that the MACS level can be used to predict upper extremity surgery outcomes for cerebral palsy. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
Hyun Sik Gong; Chin Youb Chung; Moon Seok Park; Hyung-Ik Shin; Moon Sang Chung; Goo Hyun Baek
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of hand surgery     Volume:  35     ISSN:  1531-6564     ISO Abbreviation:  J Hand Surg Am     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-09     Completed Date:  2010-05-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7609631     Medline TA:  J Hand Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  277-283.e1-3     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Department of Orthopaedics and Rehabilitation, Seoul National University Bundang Hospital, Seongnam, Korea.
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MeSH Terms
Activities of Daily Living*
Cerebral Palsy / classification*,  surgery*
Cohort Studies
Disability Evaluation*
Follow-Up Studies
Hand Strength
Middle Aged
Motor Skills / physiology
Muscle Spasticity / diagnosis,  rehabilitation
Range of Motion, Articular / physiology
Retrospective Studies
Severity of Illness Index
Statistics, Nonparametric
Treatment Outcome
Upper Extremity / physiopathology,  surgery*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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