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Measuring Outcomes and Determining Long-Term Disability after Revision Amputation for Treatment of Traumatic Finger and Thumb Amputation Injuries

Background: Disability ratings after finger amputations are based on anatomical injury according to the American Medical Association’s Guides to the Evaluation of Permanent Impairment. These ratings determine disability and compensation, without considering validated outcomes measures. The authors hypothesize that patient-reported outcomes reflect function and health-related quality of life after traumatic finger amputations, and that Guides scoring does not accurately rate postamputation disability. Methods: Patients were classified by amputation: single finger, thumb, multifinger, or multifinger plus thumb. Eighty-four patients completed functional tests, the Jebsen-Taylor Hand Function Test, and patient-reported outcomes [Brief Michigan Hand Questionnaire (MHQ), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Short Form-36 health-related quality-of-life questionnaire). Patients were given disability scores according to the Guides. Pearson correlations between outcomes metrics were calculated, and linear regression evaluated associations between amputation group, Guides score, and outcomes measures. Results: The Brief MHQ and Quick DASH questionnaires had significant correlation with functional tests, the Jebsen-Taylor test, and the physical component summary of Short Form-36. Only the Brief MHQ correlated with the mental component summary of the Short Form-36 (r = 0.29, p = 0.02). The Guides score only correlated with the Jebsen-Taylor test (r = 0.47, p < 0.001). Regression results indicate that the Brief MHQ, Quick DASH, and Guides score predict Jebsen-Taylor test score; however, amputation group and Guides score do not predict patient-reported outcomes. Conclusions: The American Medical Association Guides score represents anatomical and functional outcomes without addressing mental health and other components of disability. As a result, Guides scoring is inadequate for determining postamputation disability. In evaluating composite amputation outcomes, Brief Michigan Hand Questionnaire outperformed other metrics. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.