DOI: 10.5176/2251-3833_GHC12.41
Authors: Denise Schmid, Juerg Lustenberger and Beate Hanson
Abstract: The SF-36 quality-of-life questionnaire is widely used for measuring treatment effects. However, the ability of this score to assess clinical change may be reduced in patients with problems of the upper extremities due to the compilation of its physical subdimensions [1]. This pooled analysis assessed the differences in SF-36 progression during the bone healing period between patients treated for upper versus lower extremity injuries. In addition, any differences in potential ceiling effects of all eight SF-36 subdimensions were investigated.The data were pooled from nine fracture treatment, deformity correction, and joint arthrodesis studies involving a total of 1066 patients. The SF-36 data were allocated to distinct follow-up (FU) time points of 6 and 12 weeks, 6 months as well as 1 year after initial treatment. The SF-36 patterns over time were assessed using multilevel modelling. The absolute and relative differences in the ceiling effects between the groups were determined.In general, lower PCS scores were achieved for the lower extremity group compared to the upper extremity group with a significant difference occurring at 15 weeks and 6 months. The average PCS scores of the lower limb group consistently increased between 6 weeks and 1 year after treatment. The upper extremity group showed the largest increase in PCS scores between 6 to 15 weeks with the maximum mean result at 6 months. The average MCS scores were consistently above 50 points in this group at each evaluated time point, while patients of the lower limb group achieved 47.8 points at 6 weeks and improved to 51.8 points at 15 weeks. For all eight subdimensions, the lower extremity group showed inferior results at all FU examinations. The SF-36 scores for the subscales of Physical Function, Role Emotional, Bodily Pain, and Role Physical exhibited a significant difference between the groups. Considerably higher ceiling effects were found for all SF-36 scales in the upper limb group.In conclusion, patients with upper limb problems had significantly better results in terms of the physical dimensions of the SF-36 with more pronounced ceiling effects. These results lead to the hypothesis that the SF-36 is limited in its ability to detect functional status and changes during the bone healing process in this patient group. It is recommended to combine the SF-36 with specific scores to assess functional outcomes during bone healing in patients with upper extremity problems.
Keywords: quality of life; function; pain; orthopedics; traumatology; fracture treatment
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