Background: Children with unilateral congenital below-the-elbow
deficiency present a dilemma to clinicians. Parents want the child to have a
prosthesis and, because it seems that the deficiency will cause functional
problems, one is customarily prescribed for infants. Use of the prosthesis is
then encouraged throughout childhood. However, these children frequently
abandon the prosthesis. There are no evidence-based guidelines regarding
prescription of prostheses or standard methods for assessing use and
function.
Methods: A multicenter outcomes study was done to assess the quality
of life and function of 489 children with a unilateral congenital
below-the-elbow deficiency; 321 wore a prosthesis, and 168 did not. The
Unilateral Below-the-Elbow Test (UBET) was designed, validated, and
administered to these children along with several outcomes measures, including
the Pediatric Outcomes Data Collection Instrument (PODCI), the Pediatric
Quality of Life Inventory (PedsQL), and the Prosthetic Upper Extremity
Functional Index (PUFI).
Results: Use of a prosthesis was not associated with any clinically
relevant differences in PODCI or PedsQL scores. Non-wearers performed either
the same as or better than wearers on the UBET. When queried (with use of the
PUFI) about performance of various tasks, non-wearers scored themselves higher
than wearers. Children with a unilateral congenital below-the-elbow deficiency
scored the same as or higher than the general population on the PedsQL. They
scored significantly lower than the general population on the PODCI Upper
Extremity Physical Function Domain and higher on the Happiness Domain, but the
differences were small.
Conclusions: Prostheses may help with social acceptance or may be
useful as tools for specialized activities, but they do not appear to improve
function or quality of life, which are nearly normal for children with
unilateral congenital below-the-elbow deficiency regardless of whether they
wear a prosthesis. These findings call into question the standard practices of
fitting infants with prostheses and encouraging young children to wear the
prosthesis.
Level of Evidence: Therapeutic Level II. See Instructions
to Authors for a complete description of levels of evidence.