Introduction
Method
Part 1: Selection of FCE Tests
Test (ICF code) (materials) | Description of original test | Adaptations | Extra test instructions | Measurement outcomes | Number of times the test is performed | |
---|---|---|---|---|---|---|
AE-ULA participants | BE-ULA participants | |||||
Overhead lifting test (d4300) | Five lifts with a plastic receptacle from table to crown height and v.v. in standing position within 90 s. Weight increments 2 kg (females) or 4 kg (males) until maximum amount of kgs is reached If five lifts with a certain amount of kgs are not reached, a decrement of 1 kg (females) or 2 kg (males) may be tried | Fixed grasp positions | Performed one-handed. The unaffected hand grasps the front side of the receptacle | The non-affected hand and the prosthesis hand hold the handles of the receptacle | Maximum amount of kg that can be lifted five times from table to crown height, within 90 s | Once |
Repetitive Overhead lifting test (one-handed) |
Not existing
Added to test the one-handed overhead lifting capacity | N/A | 20 lifts with a weight of 1.9 kg from table to crown height and v.v. in standing position with the unaffected hand | Time (s) needed for 20 lifts from table to crown height, up and down counts as one | Once | |
Overhead working test (d4158) | Standing with hands at crown height, manipulating nuts and bolts, and wearing cuff weights of 1 kg around the forearms | No cuff around the prosthetic wrist | Performed one-handed | The prosthesis hand is used to fixate the nuts | Time (s) which the position can be held | Once |
Repetitive reaching test (d4452) | Sitting with bowls on wingspan distance, move 30 marbles horizontally at table height from right to left and v.v. as fast as possible The test is performed with one arm | The bowls with marbles are replaced for a one-button clicking system. The procedure remains the same | Touch the button on the clicking system Performed with the unaffected hand only | Touch the button on the clicking system The test is performed with the unaffected hand and the prosthesis hand | Time (s) needed to make 30 reaching movements, back and forward counting as one | Three times; AE-ULA participants and controls: all trials with non-affected/dominant hand. BE-ULA participants and controls: first and third trial with non-affected/dominant hand, second trial with prosthesis hand/ braced non-dominant hand |
Fingertip dexterity test (d4458) (Purdue pegboard, model 32020, J.A. Preston Corporation, New York, NY, USA) | Sitting in front of a Purdue pegboard, placing pins with left or right hand as fast as possible in a 30 s trial | When testing with the prosthesis: pins are picked up with the non-affected hand, transferred to the prosthesis and then placed in the pegboard | Performed with the unaffected hand only | When performed with the prosthesis hand: pins are picked up with the unaffected hand and manually placed in the prosthesis hand | Number of pins placed in 30 s | Three times; AE-ULA participants and controls: all trials with non-affected/dominant hand. BE-ULA participants and controls: first and third trial with non-affected/dominant hand, second trial with prosthesis hand/ braced non-dominant hand |
Handgrip strength (d4400/s73022) (Hydraulic hand dynamometer, JAMAR, Sammons Preston Inc. Bollingbrook, IL, USA) | Sitting with the shoulder adducted and neutrally rotated, elbow flexed at approx. 90°, and the forearm and wrist in neutral position, pinching a hydraulic handgrip dynamometer (in position two of the five available positions [32]) for approx. 3 s | No adaptations | Performed with the unaffected hand only | Pinched kg | Three times with non-affected/dominant hand |
Part 2: Measurements
Participants
Test Procedure
(Statistical) Analyses
Results
Part 1: Adaptation of FCE Tests
Part 2: Measurement Results
Participant groups | Test statistic (df) |
p
| ||||
---|---|---|---|---|---|---|
AE-ULA | AE-C | BE-ULA | BE-C | |||
Male/female ratio (n) | 10/0 | 10/0 | 7/3 | 7/3 | ||
Age (years) [median (IQR)] | 49.0 (39.2; 52.9) | 54.3 (34.4; 58.3) | 48.5 (39.2; 51.0) | 45.9 (34.0; 55.4) | 1.3 (3) | 0.724 |
Height (cm) [median (IQR)] | 179.0 (173.8; 188.6) | 183.5 (175.9; 186.3) | 181.8 (170.6; 184.8) | 183.0 (169.1; 189.9) | 0.6 (3) | 0.894 |
Weight (kg) [median (IQR)] | 82.2 (76.5; 91.7) | 86.6 (80.5; 94.3) | 87.1 (82.6; 98.3) | 86.7 (80.3; 95.9) | 1.5 (3) | 0.678 |
Occupation (n) | ||||||
Not employed | 4 | 0 | 3 | 2 | ||
Sedentary or light | 5 | 6 | 7 | 7 | ||
Medium | 0 | 4 | 0 | 1 | ||
Heavy or very heavy | 1 | 0 | 0 | 0 | ||
Cause of ULA (n) | ||||||
Congenital | 0 | N/A | 7 | N/A | ||
Trauma | 10 | 3 | ||||
Type of prosthesis (n) | ||||||
Cosmetic |
a
| N/A | 1 | N/A | ||
Body-powered | 2 | |||||
Myoelectric | 7b
| |||||
Prosthesis use (n) | ||||||
Sometimes |
a
| N/A | 1 | N/A | ||
Always | 9 | |||||
Prosthesis fitting of socket (n) | ||||||
Reasonable |
a
| N/A | 1 | N/A | ||
Good | 9 | |||||
Dominant hand (n)c
| ||||||
Left | 5 | 2 | 4 | 2 | ||
Right | 5 | 7 | 6 | 8 | ||
Ambidextrous | – | 1 | – | 0 |
FCE-OH Test Results: Differences Between Individuals with ULA and Controls
AE-ULA | AE-C | BE-ULA | BE-C | Test statistic (df) |
p* | Post hoc comparisone
| Effect size | Missing valuesf
| |
---|---|---|---|---|---|---|---|---|---|
Test results | |||||||||
Overhead lifting testa
| 8.0 (5.5; 10.0) | 20.0 (20.0; 24.0) | 11.0 (7.3; 16.0) | 20.0 (15.0; 24.5) | 24.8 (3) | <0.001 | AE-ULA and AE-C: <0.001 | −0.97 | 0/60 |
Overhead lifting testb
| 8.0 (5.5; 10.0) | 8.0 (8.0; 9.0) | 11.0 (7.3; 16.0) | 19.0 (10.8; 22.5) | 10.3 (3) | 0.016 | 0/60 | ||
Repetitive overhead lifting test—one-handed | 41.0 (37.8; 47.8) | 40.5 (34.0; 46.3) | 38.5 (36.0; 41.3) | 36.5 (33.3; 42.3) | 3.5 (3) | 0.320 | 0/40 | ||
Overhead working testc
| 203.5 (133.0; 263.0) | 313.5 (238.0; 603.0) | 250.5 (182.8; 339.8) | 256.0 (182.8; 353.8) | 8.5 (3) | 0.037 | AE-ULA and AE-C: 0.023 | 0.65 | 0/40 |
Overhead working testd
| 158.0 (118.0; 244.0) | 325.0 (300.0; 521.0) | 230.0 (169.5; 360.5) | 243.0 (168.5; 381.5) | 9.0 (3) | 0.030 | AE-ULA and AE-C: 0.018 | 0.79 | 4/40 (8) |
Repetitive reaching test—with dominant hand | 58.7 (53.6; 59.8) | 58.3 (48.7; 65.2) | 54.5 (51.9; 58.5) | 55.3 (51.8; 63.6) | 1.2 (3) | 0.744 | 0/40 | ||
Repetitive reaching test—with prosthesis/brace | N/A | N/A | 67.5 (56.8; 77.3) | 65.0 (59.3; 78.3) | 55.0 | 0.739 | 0.08 | 0/40 | |
Fingertip dexterity test—with dominant hand | 12.7 (11.3; 14.4) | 14.3 (13.0; 14.8) | 15.5 (13.9; 17.4) | 14.0 (12.9; 18.1) | 6.4 (3) | 0.096 | 0/40 | ||
Fingertip dexterity test—with prosthesis/brace | N/A | N/A | 6.5 (5.0; 8.0) | 4.1 (1.3; 6.8) | 17.5 | 0.130 | −0.38 | 2/20 (4) | |
Hand grip strength—with dominant hand | 40.3 (34.8; 47.8) | 47.7 (40.3; 51.8) | 38.3 (31.1; 51.1) | 37.5 (34.9; 42.5) | 3.1 (3) | 0.371 | 0/40 | ||
Heart rate results | |||||||||
Overhead lifting testa
| 114.6 (109.7; 116.4) | 142.0 (139.4; 162.2) | 138.8 (121.8; 144.3) | 138.6 (129.5; 156.8) | 17.2 (3) | 0.001 | AE-ULA and AE-C: <0.001 | −0.94 | 4/40 (8) |
Overhead lifting testb
| 114.6 (109.5; 116.5) | 119.3 (111.1; 139.6) | 138.8 (121.8; 150.6) | 144.1 (131.7; 156.8) | 11.3 (3) | 0.010 | 5/40 (10) | ||
Repetitive overhead lifting test—one-handed | 116.4 (109.4; 121.7) | 112.8 (106.7; 125.4) | 114.3 (108.0; 120.7) | 123.8 (113.5; 130.0) | 2.8 (3) | 0.425 | 0/40 | ||
Overhead working testc
| 106.8 (101.8; 111.6) | 115.1 (109.8; 120.5) | 106.7 (103.5; 121.8) | 114.0 (108.6; 117.4) | 4.3 (3) | 0.230 | 1/40 (2) | ||
Overhead working testd
| 106.1 (97.8; 115.8) | 117.5 (114.0; 123.2) | 105.8 (103.4; 117.5) | 115.3 (108.1; 117.4) | 5.5 (3) | 0.137 | 1/32 (2) | ||
Repetitive reaching test—with dominant hand | 125.2 (113.1; 135.7) | 129.0 (121.9; 141.8) | 121.9 (111.6; 135.0) | 129.1 (120.5; 141.3) | 3.4 (3) | 0.334 | 1/40 (2) | ||
Repetitive reaching test—with prosthesis/brace | N/A | N/A | 118.3 (114.8; 126.4) | 132.9 (118.1; 143.0) | 68.0 | 0.190 | 0.30 | 0/16 | |
Borg scale results | |||||||||
Overhead lifting testa
| 5.0 (4.0; 5.0) | 7.0 (6.5; 7.3) | 5.0 (4.0; 7.0) | 6.0 (4.0; 8.0) | 8.3 (3) | 0.040 | AE-ULA and AE-C: 0.027* | −0.64 | 1/40 (2) |
Overhead lifting testb
| 5.0 (4.0; 5.0) | 5.0 (4.0; 5.8) | 5.0 (4.0; 7.0) | 6.0 (4.5; 7.5) | 2.9 (3) | 0.406 | 1/40 (2) | ||
Repetitive overhead lifting test—one-handed | 2.0 (1.8; 2.3) | 2.0 (1.0; 2.3) | 2.0 (1.0; 3.3) | 2.0 (1.0; 3.0) | 0.5 (3) | 0.921 | 0/40 | ||
Overhead working testc
| 4.0 (3.0; 5.0) | 4.5 (3.8; 6.3) | 4.5 (2.8; 5.0) | 5.0 (3.0; 6.0) | 1.9 (3) | 0.584 | 0/40 | ||
Overhead working testd
| 4.0 (3.0; 5.0) | 5.0 (4.0; 7.0) | 4.0 (2.5; 5.0) | 5.0 (3.5; 6.0) | 3.8 (3) | 0.288 | 0/32 | ||
Repetitive reaching test—with dominant hand | 2.0 (1.0; 2.5) | 1.2 (0.0; 2.1) | 2.8 (1.8; 3.0) | 2.8 (2.0; 3.1) | 10.0 (3) | 0.019 | 0/40 | ||
Repetitive reaching test—with prosthesis/brace | N/A | N/A | 3.0 (1.8; 4.0) | 3.0 (2.0; 4.0) | 54.0 | 0.796 | 0.07 | 0/40 | |
Fingertip dexterity test—with dominant hand | 0.0 (0.0; 1.3) | 0.0 (0.0; 0.3) | 0.0 (0.0; 0.9) | 0.3 (0.0; 1.0) | 6.4 (3) | 0.096 | 0/40 | ||
Fingertip dexterity test—with prosthesis/brace | N/A | N/A | 1.0 (0.0; 3.0) | 1.0 (0.0; 1.0) | 27.0 | 0.645 | −0.14 | 0/16 |
Learning Effects for Repetitive Reaching Test and Fingertip Dexterity Test
Comparison of the Non-affected and Prosthetic Limb
Heart Rate and Perceived Exertion
Relationship Between Test Results and MSC
Individuals with MSC (n = 9) | Individuals without MSC (n = 11) | Test statistic |
p
| Effect size | |
---|---|---|---|---|---|
Overhead lifting test | 8.0 (4.0; 10.0) | 10.0 (8.0; 16.0) | 24.0 | 0.056 | 0.44 |
Repetitive overhead lifting test—one-handed | 40.0 (36.5; 45.0) | 39.0 (38.0; 42.0) | 48.5 | 0.941 | −0.02 |
Overhead working test | 219.0 (140.5; 306.0) | 230.0 (188.0; 281.0) | 49.5 | 1.000 | 0 |
Repetitive reaching test—with dominant hand | 56.5 (53.4; 59.5) | 54.5 (51.3; 59.3) | 0.8 | 0.824 | 0.06 |
Fingertip dexterity test—with dominant hand | 13.7 (12.3; 15.3) | 14.5 (11.3; 16.0) | 43.0 | 0.656 | −0.11 |
Hand grip strength—with dominant hand | 38.7 (33.7; 42.2) | 45.3 (33.0; 51.3) | 39.0 | 0.456 | −0.18 |