Background
Methods
Scale development process
The patient-rated ulnar nerve evaluation (PRUNE)
Characteristic (n = 89) | Descriptors |
---|---|
Age in years | Range 20-81 |
Mean = 52.75; SD- 12.86 | |
Gender
| % |
Male | 75 |
Female | 25 |
Workers compensation status
| % |
No | 82% |
Yes | 15% |
Claim in progress | 3% |
Type of work
| % |
Heavy repetitive | 37 |
Heavy intermittent | 18 |
Light repetitive | 18 |
Light intermittent | 28 |
Work status
| % |
Normal duties | 21 |
Light duties at same work place | 15 |
Off work due to arm | 18 |
Handedness
| % |
Left | 7 |
Right | 93 |
Surgical side
| % |
Left | 58 |
Right | 43 |
Electrodiagnostic findings
| 37.47 m/s |
AE-MNCV | 50.65 m/s |
BE-MNCV | 13.17 m/s |
DNCV (m/s) | 3.79 mV |
AE-CMAP | 17.29% |
BE-CMAP | 4.98 mV |
CMAP ADQ amplitude | 5.74 μV |
SNAP digit V | 21.42 ms |
SNCV digit V (ms) | 75% |
Surface EMG confirmed | 89% |
Needle EMG confirmed | |
McGowan stage [1]
| % |
0 | 0 |
I | 13 |
II | 46.4 |
III | 40.6 |
Treatment
Comparison study measures
The SF-36
The bishop scale
Patient recruitment
Analyses
Scale distributions and floor/ceiling
Content validity
Reliability
Structural validity
Construct validity
Constructed hypotheses for known-group validity
Responsiveness
Results
Content validity
Item | Rationale for exclusion/modification |
---|---|
Deleted items | |
Pain during activity | Contamination of pain and function concepts within item |
Combing hair | Not appropriate to all respondents; higher level of missingness |
Using arms rise from a chair | Highly correlated to tying shoes; less responsive |
Pulling a heavy object | Correlated to lifting a heavy object; lifting a 10 kg weight |
Lifting a 10 kg weight | As above; not all respondents understand 10 kg |
Putting on a coat | Respondent feedback suggested less relevant; poor item performance overall |
Doing up buttons | Cognitive interviews and task analysis suggests this item does not reflect sensory impairment of the ulnar nerve— the concept of fine motor control was covered by finger use question |
Modified items | |
At night (while sleeping) | Shift workers were not sure if at night meant during sleep or their night activity which was work. Added ( while sleeping to clarify) |
Hold an object | Item performance variable; however strong bio mechanical support and patient endorsement that some type of holding object with arm bent was difficult. Qualitative interviews indicated that respondents used a variety of reading devices and positions; and were not always clear that it meant a continuous activity. Item modified to specify one hour interval and allow multiple options for the object that was held clarifying that the elbow is bent |
Eating | Added specification of different eating utensils for cultural transferability |
Control of the small finger | Different respondents use either small, little or fifth finger to indicate the fifth digit. Motor dysfunction related to the ulnar comprise could include either deformity, lack of motor control— lay terms were used for these phenomena. |
Finger use | Finger use was a common difficulty reported by patients. It was most remarkably noted for keyboarding or musical instrument use but not all respondents perform these tasks therefore the question was modified to: Repeated finger movement (like when typing, playing instruments or moving small objects ) |
Pain items | ICF | Meaning in ICF language |
---|---|---|
Code(s)
| ||
When it is at its worst | b28014 - Pain in upper limb | Sensation of unpleasant feeling indicating potential or actual damage to some body structure felt in either one or both upper limbs, including hands. |
At rest | b28014 - Pain in upper limb | |
In the morning; # | b28014 - Pain in upper limb | Note: The descriptors of after work or while sleeping refer to a time point NOT an activity so they are not coded in ICF |
After work/activity# | b28014 - Pain in upper limb | |
At night# | b28014 - Pain in upper limb | |
How often do you have pain# | b28014 - Pain in upper limb | |
Other symptom items:
| ||
Numbness in my little finger | b265 - Touch function | Sensory functions of sensing surfaces and their texture or quality. Inclusions: functions of touching, feeling of touch; impairments such as numbness, anaesthesia, tingling, paraesthesia and hyperaesthesia |
“Pins and needles” in my little finger | b265 or b280 - Sensation related to the skin | Sensations related to the skin such as itching, burning sensation and tingling. Inclusions: impairments such as pins and needles sensation and crawling sensation |
Cramping or unable to control my little finger | b760 - Control of voluntary movement functions | Functions associated with control over and coordination of voluntary movements. Inclusions: functions of control of simple voluntary movements and of complex voluntary movements, coordination of voluntary movements… |
Weakness in my hand (pinch/grip) | b7300 - Muscle power functions | Functions related to the force generated by the contraction of a muscle or muscle groups. Inclusions: functions associated with the power of specific muscles and muscle groups, muscles of one limb, one side of the body, the lower half of the body, all limbs, the trunk and the body as a whole; impairments such as weakness of small muscles in feet and hands… |
Specific activities items
| ||
Eat (use fork, knife, or chopsticks) | d550 - Eating | Carrying out the coordinated tasks and actions of eating food that has been served, bringing it to the mouth and consuming it in culturally acceptable ways, cutting or breaking food into pieces, opening bottles and cans, using eating implements, having meals, feasting or dining. |
Lift a heavy object | d4300 - Lifting | Raising up an object in order to move it from a lower to a higher level, such as when lifting a glass from the table. |
Hold an object with my elbow bent (a telephone, tool, book, phone or electronic device) | d4401- Grasping | Using one or both hands to seize and hold something, such as when grasping a tool or a door knob |
Repeated reaching | d4452 - Reaching | Using the hands and arms to extend outwards and touch and grasp something, such as when reaching across a table or desk for a book |
Tasks with repetitive finger use –like typing, playing musical instruments or handling small objects | d440 - Fine hand use | Performing the coordinated actions of handling objects, picking up, manipulating and releasing them using one’s hand, fingers and thumb, such as required to lift coins off a table or turn a dial or knob. Inclusions: picking up, grasping, manipulating and releasing Exclusion: lifting and carrying objects (d430) |
Turn a key/doorknob/handle | d4453 - Turning or twisting the hands or arms | Using fingers, hands and arms to rotate, turn or bend an object, such as is required to use tools or utensils |
Usual activities items
| ||
Personal care activities (like washing, dressing) | D5 - Chapter 5 Self-Care | Caring for oneself, washing and drying oneself, caring for one’s body and body parts, dressing, eating and drinking, and looking after one’s health |
Household (cleaning, maintenance) | D630-649 - Household tasks | Range of tasks within domestic life that pertain to household but no specific group definition |
Work (your job or everyday work) | D8 - Chapter 8 Major Life Areas | Carrying out the tasks and actions required to engage in education, work and employment and to conduct economic transactions. |
Recreational activities | D920 - Recreation and leisure | Engaging in any form of play, recreational or leisure activity, such as informal or organized play and sports, programmes of physical fitness, relaxation, amusement or diversion, going to art galleries, museums, cinemas or theatres; engaging in crafts or hobbies, reading for enjoyment, playing musical instruments; sightseeing, tourism and travelling for pleasure |
Item behavior/distributions
Reliability
Subscale | Mean score test | Test SD | Mean score retest | Re-test SD | ICC | 95% CI | Standard error of measurement (SEM) | SEM% | Minimum detectable change (MDC) | MDC% |
---|---|---|---|---|---|---|---|---|---|---|
Pain/60 | 25.1 | 17.3 | 25.0 | 18.0 | 0.98 | 0.91-0.99 | 2.5 | 4 | 5.8 | 10 |
Sensori-motor symptoms/40 | 12.6 | 7.9 | 14.0 | 9.8 | 0.91 | 0.70-0.98 | 2.7 | 7 | 6.2 | 15 |
Specific activities/40 | 35.7 | 31.9 | 36.0 | 30.5 | 0.99 | 0.97- 0.999 | 3.1 | 8 | 7.3 | 18 |
Usual activities/40 | 10.8 | 13.2 | 13.4 | 13.0 | 0.87 | 0.57-96 | 4.7 | 11 | 11.0 | 27 |
Total Score/100 | 34.4 | 21.5 | 36.0 | 23.1 | 0.98 | 0.95-0.997 | 3.1 | 3 | 7.2 | 7 |
Construct validity
Clinically meaningful subgrouping | Subscale | Scores | |||
---|---|---|---|---|---|
Work status
|
Not working because of ulnar neuropathy (n = 9)
|
Working or able to work at previous job (n = 34)
| |||
Mean | SD | Mean | SD | ||
Total score | 53.8 | 14.6 | 16.5 | 16.2 | |
Pain | 34.1 | 16.1 | 11.2 | 12.5 | |
Symptoms | 27.8 | 12.0 | 11.6 | 10.7 | |
Specific activities | 48.4 | 12.7 | 13.0 | 16.9 | |
Usual activities | 19.9 | 7.0 | 5.4 | 8.7 | |
Ability to do activities
|
Limited (n = 25)
|
Not limited (n-27)
| |||
Mean | SD | Mean | SD | ||
Total score | 37.8 | 18.0 | 10.8 | 12.0 | |
Pain | 23.0 | 16.7 | 8.8 | 8.9 | |
Symptoms | 20.6 | 11.6 | 8.1 | 9.1 | |
Specific activities | 34.5 | 22.7 | 4.9 | 13.3 | |
Usual activities | 15.0 | 8.3 | 1.7 | 2.5 | |
Sensibility
|
Abnormal (> 5 mm) (n-14)
|
Normal (n = 28)
| |||
Mean | SD | Mean | SD | ||
Total score | 26.8 | 24.2 | 21.9 | 21.4 | |
Pain | 16.3 | 17.9 | 18.4 | 15.3 | |
Symptoms | 22.0 | 12.5 | 10.9 | 11.8 | |
Specific activities | 25.5 | 27.0 | 15.4 | 19.3 | |
Usual activities | 10.1 | 10.6 | 7.1 | 9.3 |
Clinically meaningful subgroups | Subscale | Scores | |||||||
---|---|---|---|---|---|---|---|---|---|
Overall change following surgery
|
Worse (n = 6)
|
Unchanged (n = 9)
|
Better (n = 45)
| ||||||
Mean | SD | Mean | SD | Mean | SD | ||||
Total score | 46.7 | 19.3 | 43.9 | 22.2 | 14.1 | 17.1 | |||
Pain | 28.6 | 22.6 | 20.1 | 17.0 | 9.9 | 12.9 | |||
Symptoms | 27.1 | 13.3 | 27.1 | 11.0 | 8.9 | 9.9 | |||
Specific activities | 40.8 | 28.8 | 35.6 | 24.8 | 10.9 | 18.8 | |||
Usual activities | 16.8 | 4.3 | 12.6 | 11.0 | 5.4 | 9.4 | |||
Hand strength
|
Both grip and pinch < 80% of opposite hand (n = 8)
|
Either grip or pinch < 80% of opposite hand (n = 7)
|
Grip and pinch both > 80% of opposite hand (n = 25)
| ||||||
Mean | SD | Mean | SD | Mean | SD | ||||
Total score | 33.1 | 18.6 | 22.1 | 17.9 | 14.8 | 16.7 | |||
Pain | 20.8 | 16.4 | 16.0 | 12.9 | 13.4 | 9.4 | |||
Symptoms | 19.0 | 14.1 | 13.5 | 9.4 | 9.8 | 9.5 | |||
Specific activities | 24.8 | 39.7 | 20.7 | 16.0 | 11.2 | 18.2 | |||
Usual activities | 13.2 | 11.1 | 9.0 | 9.0 | 5.3 | 7.6 | |||
Residual symptoms
|
Severe
|
Moderates
|
Mild occasional
|
Asymptomatic
| |||||
Mean | SD | Mean | SD | Mean | SD | Mean | SD | ||
Total score | 61.1 | 29.0 | 40.4 | 17.7 | 17.3 | 14.5 | 6.6 | 16.0 | |
Pain | 39.6 | 24.7 | 26.9 | 15.3 | 10.7 | 10.7 | 4.8 | 10.7 | |
Symptoms | 33.8 | 9.3 | 23.3 | 10.8 | 11.7 | 9.5 | 4.3 | 11.4 | |
Specific activities | 54.4 | 3.4 | 34.0 | 25.0 | 11.7 | 16.0 | 5.0 | 2.6 | |
Usual activities | 19.0 | 9.9 | 18.2 | 9.4 | 4.6 | 6.8 | 1.1 | 2.7 |
PRUNE score (2-year) | |||||
---|---|---|---|---|---|
SF- 36 subscale | Pain | SM symptoms | Specific activities | Usual activity | Total score |
76 | 76 | 75 | 75 | 76 | |
SF36 - 2-Physical Functioning Subscale | −0.5**
| −0.46**
| −0.39**
|
−0.36
**
|
−0.52
**
|
SF36 - 2 -Role -Physical Subscale | −0.35**
| −0.41**
| −0.16 | 0.08 | −0.25 |
SF36 - 2-Bodily Pain Subscale |
−0.59
**
|
−0.68
**
|
−0.53
**
|
−0.35
**
|
−0.64
**
|
SF36- 2 -General Health Subscale | −0.33*
| −0.34**
| −0.19 | −0.25 | −0.33*
|
SF36 - 2-Vitality Subscale | −0.48**
| −0.37**
| −0.21 | −0.12 | −0.36**
|
SF36 - 2 -Social Functioning Subscale |
−0.60
**
| −0.45**
| −0.31*
| −0.09 | −0.45**
|
SF36 - 2 -Role- Emotional Subscale | −0.39**
| −0.41**
| −0.30*
| −0.16 | −0.38**
|
SF36 - 2 -Mental Health Subscale | −0.34**
| −0.19 | −0.20 | −0.07 | −0.25 |
SF36 - 2 -Physical Component Summary |
−0.58
**
|
−0.68
**
|
−0.42
**
|
−0.32
*
|
−0.59
**
|
SF36 - 2 -Mental Component Summary | −0.37**
| −0.23 | −0.19 | −0.004 | −0.25 |
Factor validity
Items on baseline longer version of PRUNE (before final item reduction) | Subscale | Explanation of final decisions on items deleted from the final scale during production processes | |||
---|---|---|---|---|---|
Pain | Usual activity /role | Specific activity | Sensory/motor symptoms | ||
Variance Explained by factor (%) | 24 | 15 | 26 | 10 | Although some items cross loaded as below; the largest amount of variance was by specific activity items; followed by pain, usual activity and sensory/motor symptoms |
Pain - At its worst
|
0.86
| 0.12 | 0.26 | 0.12 | |
Pain - At Rest
|
0.76
| 0.21 | 0.36 | 0.02 | |
Pain - Morning
|
0.74
| 0.28 | 0.33 | 0.26 | |
Pain - During activity
|
0.70
| 0.29 |
0.51
| 0.26 | Pain during activity was dropped from the reduced measure |
Pain - After activity
|
0.85
| 0.15 | 0.24 | 0.19 | |
Pain - At night
|
0.83
| 0.20 | 0.25 | 0.02 | |
Pain - Frequency
|
0.89
| 0.19 | 0.11 | 0.16 | |
SM - Numbness
| 0.37 |
0.74
| −0.02 | 0.24 | Hand weakness cross loads but left as a component of sensory/motor symptoms scale given importance. Motor Control item clarified based on respondent feedback |
SM - Pins And needles
| 0.27 |
0.76
| 0.18 | −0.04 | |
SM - Control finger
| 0.14 |
0.78
| 0.23 | 0.13 | |
SM - Weakness in hand
|
0.46
|
0.47
| 0.06 |
0.46
| |
SA - Combing hair | 0.32 | 0.25 | 0.78 | 0.29 | Hair combing deleted: not applicable to a number of respondents |
SA - Eating | 0.15 | 0.40 |
0.67
| 0.30 | |
SA - Lift heavy object | 0.34 | 0.18 |
0.72
| 0.31 | |
SA - Finger task |
0.49
| 0.04 |
0.66
| 0.37 | |
SA - Pull
|
0.43
| 0.12 |
0.39
| 0.52
| Pulling deleted due to cross loading and correlation with heavy lifting |
SA - Throw a small object
| 0.32 | 0.10 |
0.81
| 0.24 | Throwing deleted due to higher rate of missingness |
SA - Use a telephone | 0.39 | 0.00 |
0.73
| 0.26 | |
SA - Doing up buttons
| 0.12 | 0.25 |
0.59
| 0.21 | Doing buttons and washing deleted based on cross correlations and interviews |
SA - Wash opposite armpit
| 0.30 | 0.11 |
0.73
| 0.26 | |
SA - Reaching | 0.35 | 0.01 |
0.82
| 0.15 | |
SA - Turning a doorknob | 0.19 | 0.08 |
0.69
| 0.45 | |
UA - Personal care
| −0.02 | 0.06 |
0.40
|
0.60
| |
UA - Household
| 0.11 | 0.14 |
0.41
|
0.68
| |
UA - Work
| 0.14 | 0.08 | 0.27 |
0.85
| |
UA - Recreational activities
| 0.22 | 0.12 | 0.37 |
0.77
|
Items on Final PRUNE | 3 months after surgery | 24 months after surgery | ||||||
---|---|---|---|---|---|---|---|---|
Pain | Usual activity/role |
Specific activity
|
SM symptoms
| Pain | Usual activity/role | Specific activity |
SM symptoms
| |
Variance explained by factor (%) |
22
|
16
|
20
|
21
|
30
|
19
|
18
|
18
|
Pain- worst
|
0.82
| 0.09 | 0.34 | 0.17 |
0.84
| 0.25 | 0.26 | 0.27 |
Pain-at rest
|
0.86
| 0.38 | 0.14 | 0.23 |
0.83
| −0.12 | 0.32 | 0.38 |
Pain -in morning
|
0.77
| 0.38 | 0.27 | 0.14 |
0.86
| 0.09 | 0.25 | 0.32 |
Pain -after activity
|
0.63
| 0.28 | 0.26 | 0.16 |
0.74
| 0.13 | 0.29 | 0.27 |
Pain- at night
|
0.89
| 0.17 | 0.10 | 0.23 |
0.80
| 0.04 | 0.34 | 0.33 |
Pain- Frequency
|
0.68
| 0.14 | 0.24 | 0.36 |
0.71
| 0.21 | 0.21 | 0.34 |
SM-Numbness
| 0.06 | 0.26 | 0.19 |
0.86
| 0.36 | 0.19 | 0.15 |
0.87
|
SM- Pins and needles
| 0.24 | 0.25 | 0.10 |
0.82
| 0.39 | 0.25 | 0.20 |
0.80
|
SM-Control
| 0.36 | −0.00 | 0.17 |
0.77
| 0.33 | 0.04 | 0.23 |
0.68
|
SM-Weakness in hand
| 0.06 | 0.15 |
0.44
|
0.69
| 0.34 | 0.37 | 0.48 |
0.59
|
SA-Eating with fork or spoon
| 0.30 | 0.26 |
0.60
|
0.10
| −0.02 | 0.88 |
0.66
| 0.196 |
SA- Lift a heavy object
| 0.23 | 0.22 |
0.78
|
0.14
| 0.38 | 0.44 |
0.58
| 0.25 |
SA-Hold an object
| 0.30 | 0.47 |
0.58
|
0.26
| 0.37 | 0.123 |
0.88
| 0.14 |
SA- Finger Task
| 0.32 | 0.02 |
0.78
|
0.24
| 0.36 | 0.38 |
0.60
| 0.37 |
SA-Reaching
| 0.23 | 0.22 |
0.78
|
0.14
| 0.45 | 0.36 |
0.59
| 0.31 |
SA-Turning a doorknob
| 0.10 | 0.30 |
0.70
|
0.35
| 0.20 | 0.30 |
0.68
| 0.25 |
UA-Personal care
| 0.09 |
0.84
| 0.05 | 0.34 | −0.02 |
0.89
| 0.27 | 0.06 |
UA-Household
| 0.32 |
0.76
| 0.25 | 0.35 | 0.28 |
0.52
| 0.45 | 0.11 |
UA-Work
| 0.35 |
0.78
| 0.34 | 0.00 | 0.32 |
0.68
| 0.26 | 0.06 |
UA-Recreational activities
| 0.36 |
0.78
| 0.36 | 0.19 |
0.44
|
0.58
| 0.48 | 0.21 |
Responsiveness
Subscale | Mean change | SD | Standardized response mean |
---|---|---|---|
Pain | 18.8 | 19.4 | 0.96 |
Sensory/motor symptoms | 11.8 | 11.3 | 1.0 |
Specific activities | 17.0 | 16.2 | 1.04 |
Usual activities | 12.9 | 12.0 | 0.92 |
Total score | 34.3 | 19.5 | 1.55 |