Considerations in evaluating new treatment alternatives following peripheral nerve injuries: a prospective clinical study of methods used to investigate sensory, motor and functional recovery.
The current problem finding reliable and objective methods for evaluating results after peripheral nerve repair is a challenge when introducing new clinical techniques. The aim of this study was to obtain reference material and to evaluate the applicability of different tests used for clinical assessment after peripheral nerve injuries. Fifteen patients with a history of complete median nerve transsection and repair, and 15 healthy volunteers were included. Each subject was investigated using a battery of conventional and new tests for functional, sensory and motor recovery including questionnaires, clinical evaluations, neurophysiological and physiological findings. The results were statistically analysed and comparisons were made within the patient group and between patients and healthy volunteers using a 'per protocol' and an 'intention to treat' approach. Criteria for success were stipulated in order to be able to judge the usefulness of each method. The results showed that 19 of 34 variables, representing six of 16 methods, were not able to fulfil the criteria and were thus questionable for the evaluations of nerve repair in a clinical trial setting. However, 2pd, sensory recovery according to the non-modified British Medical Research Council, sensory neurography, manual muscle test, electromyography, questionnaires (i.e. DASH and the 4 question form) and performance tests (i.e. AMPS and Sollerman's subtests 4 and 8) did fulfil the criteria defined for being useful.
Aberg
M
M
Department of Hand & Plastic Surgery, Umeå University Hospital, Umeå, Sweden. maria.aberg@astratech.com
Ljungberg
C
C
Edin
E
E
Jenmalm
P
P
Millqvist
H
H
Nordh
E
E
Wiberg
M
M
D000200:Action Potentials / Q000502:physiology; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002648:Child; D002986:Clinical Trials as Topic; D004185:Disability Evaluation; D004576:Electromyography / Q000379:methods; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D009416:Nerve Regeneration / Q000502:physiology; D009431:Neural Conduction / Q000502:physiology; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology; D012677:Sensation / Q000502:physiology*; D012684:Sensory Thresholds; D013933:Thumb / Q000503:physiopathology; D016896:Treatment Outcome