Comparison of Tests of Sensory Outcome After Nerve Injury in Children
Emily S. Ho, BSc OT Reg (Ont), MEd1; Kristen M Davidge, MD, MSc, FRCS(C)1; Gregory H. Borschel, MD, FAAP, FACS2; Howard M. Clarke, MD, PhD, FRCS(C)3
1The Hospital for Sick Children, Toronto, ON, Canada, 2Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada, 3Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada
Introduction: Standardized and systematic evaluation of sensory innervation and functional sensibility are imperative to evaluate and optimize surgical and rehabilitation management. The Weinstein Evaluation of Sensory Threshold (WEST) and Shape Texture Identification-test (STI-test) are objective measures of such sensory function. The Ten Test is a measure of perceived sensibility. These measures that have established reliability in adults post nerve injury. The reliability of the WEST and Ten Test in children with a peripheral nerve injury has not been established. The STI-test has not been validated in children. The purpose of this study is to evaluate the test retest reliability of the WEST, STI-test and Ten Test in children post nerve injury.
Materials & Methods: A cross sectional reliability study of children aged 5 to 17 years with an upper extremity peripheral nerve injury was conducted. The WEST, STI-test and Ten Test were used to evaluate the sensory outcome of the injured nerve at the respective sensory distribution in the hand. A minimum of three sites were tested for median and ulnar nerve injuries. Radial and digital nerve injuries were evaluated at a single site. Testing was repeated at a minimum of 60 minutes after the initial evaluation. Intraclass Correlation Coefficients (ICC) were used to compare the outcome of the WEST and Ten Test at the two evaluation time points. Kappa statistics were used to evaluate the STI-test.
Results: Seven children 11.8 ± 2.6 years (mean ± SD) and 8 affected nerves (3 median, 3 ulnar, 1 radial, 1 digital nerve) who sustained both open (2 laceration and repair) and closed nerve injuries (6 secondary to elbow or forearm fracture) have been included in this study to date. Preliminary results indicate that the agreement in test retest scores of the WEST was ICC = 0.63 - 0.87 and the Ten Test was ICC = 0.67- 0.83. The WEST and Ten Test scores were mildly correlated (Spearman r = 0.3 to 0.4). Agreement in STI-test test retest scores ranged from Kappa = 0.04 - 1.0.
Conclusions: Preliminary results indicates that the WEST and Ten Test scores have good test retest reliability in children post nerve injury. With additional patient recruitment, this study will help establish a reliable and valid protocol for evaluating sensory outcome in children with upper extremity nerve injuries.
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