Invited Review: Outcome measures used in peripheral nerve surgery for symptomatic neuroma in upper extremity amputations: A scoping review-Article

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The scoping review by Yang et al. highlights the variability and lack of standardization in outcome measures used to evaluate peripheral nerve surgery for symptomatic neuromas in patients who have undergone upper extremity amputations (UEA). The review sifted through 1137 articles and eventually analyzed 35 studies. Key findings reveal significant heterogeneity in the assessment of pain, health-related quality of life (HRQOL), neurotrophic measures, psychological, and sensorimotor functions. <br /><br />Pain intensity was predominantly measured using tools like the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS), each with varied reporting periods and instructions, often posing reliability issues. HRQOL measures were primarily assessed through instruments such as PROMIS and DASH, though these lacked consideration for the unique needs of UEA populations. Notably, only one measure specifically designed for the amputee population was found.<br /><br />Neurotrophic assessments commonly utilized Tinel’s sign and electrodiagnostic tests, while psychological outcomes were usually gauged by patient satisfaction or acceptance of surgical results. Sensorimotor functions often involved tactile discrimination and grip strength measured via various dynamometers. The review also found that well-validated measures like VAS and NRS required more consistent application and documentation to minimize biases.<br /><br />Yang et al. recommend developing a core outcome set tailored to the UEA population, emphasizing the need for consensus among experts through multi-center collaborations. This would ensure more reliable and valid comparisons of treatment outcomes, facilitating better clinical and therapeutic decision-making. The study advocates for leveraging patient-reported outcomes and adapting to advancements in measurement instruments like Computerized Adaptive Testing (CAT) to reduce response burden while maintaining robust data quality.<br /><br />Overall, the review underscores the need for standardized and comprehensive outcome measures to better evaluate and translate research findings into clinical practice for managing symptomatic neuromas in UEA patients.

Keywords

peripheral nerve surgery

symptomatic neuromas

upper extremity amputations

outcome measures

pain assessment

HRQOL

neurotrophic measures

sensorimotor functions

standardization

core outcome set