ابزارهای سنجش میزان عملکرد اندام فوقانی در انواع اختلالات اسکلتی عضلانی در حوزه توانبخشی: مرور یکپارچه

Background and Aim
The upper extremities play an essential role in people's lives because they are integral to performing activities of daily living such as self-care, various types of work, leisure, and social activities. Impairment of the upper extremity can affect other body functions such as sleep or emotional functions [1, 2, 3, 4] and can influence the individual's experience of autonomy and independence [3, 5, 6, 7]. Impairment of an upper extremity (eg, finger amputations or carpal tunnel syndrome) is not only related to peripheral upper extremity conditions but also to other health conditions, such as rheumatologic diseases (eg, rheumatoid arthritis), stroke, and tetraplegia.
Other investigators report that approximately 70%-80% of persons with stroke have upper extremity impairment [8] and that more than 75% of persons with rheumatoid arthritis [9] show impairments in body functions and limitations in activities associated with upper extremity function. In addition, restoration of upper extremity function is reported to be a major priority for people with tetraplegia [10, 11].
Considering the significant consequences that result from upper extremity impairments [3, 4, 12, 13, 14, 15], efforts during the last 2 decades have focused on developing condition-specific outcome measures to assess bodily impairments, activity limitations, and participation restrictions. With the exception of the tetraplegic population, for which few outcome measures specific to upper extremity function have been applied [16], a proliferation of outcome measures has been seen in the fields of peripheral upper extremity conditions [17, 18, 19, 20], rheumatologic diseases [17, 18] and stroke [21].
Thus it is worthwhile to study the areas of functioning, disability, and health that are addressed by different outcome measures that focus on the upper extremity. A comparative examination would allow researchers and health professionals to select the best outcome measure to address the impairments and needs of a specific population in research or practice. The International Classification of Functioning, Disability, and Health (ICF) [22] is a useful tool for performing such a comparison [23]. The ICF provides a comprehensive framework for classifying and describing functioning, disability, and health in people with various types of diseases or conditions. The ICF is composed of 4 components—Body Functions, Body Structures, Activities and Participation, and Environmental Factors—that are organized into a hierarchical structure (Figure 1). Chapters are related to each component, and each chapter is divided into different levels of categories [23, 24]. For example, the third-level ICF category “d4452 Reaching” is one element of the second-level category “d 445 Hand and Arm Use,” which in turn is an element of the chapter “d4 Mobility,” which is part of the ICF component “d Activities and Participation.”
An ICF-based comparison also enables the selection of outcome measures that best address the functioning domain in relation to an intervention, which may be at the level of Body Function or Structure, Activities and Participation, or the Environment. Thus the objective of this literature review is to provide an overview of different outcome measures used to address functioning and disability by focusing on persons with impairments in upper extremity function. Our specific aims are to (1) identify outcome measures that address functioning and disability in studies that involve persons with impairments in upper extremity function; (2) compare the content of the identified outcome measures with the ICF as a reference; and (3) report the reliability and responsiveness data of the identified outcome measures when these data are available.
Reliability means “repeatability” or “consistency.” An outcome measure can be considered reliable if it provides the same result with repeated applications. Interrater reliability is used to assess the degree to which different raters are consistent on ratings with the same outcome measure. The test-retest reliability is used to find the consistency of a measure over time. Responsiveness describes the ability of an outcome measure to detect clinically important change [25].
 
Upper limb musculoskeletal disorders (ULMSDs) are a common health problem in the general population, children and in patients referred to orthopaedic clinics.1–4 The point prevalence range of ULMSDs in different populations is reported as ranging from 1.6% to 53% at any one time, while the annual prevalence ranges from 2.3% to 41%.2,5,6 Upper limb problems affect between 24% and 30% of the working population, being second only to the spine region at 37% to 52%, as the most affected region.2,7 This results in a heavy economic and social burden on both the health care systems and society generally.2,8 Additionally, ULMSD patients have reduced activities of daily living (ADL), along with reduced participation in social, work and leisure activity, all of which may initiate a harmful cycle of pain-disability.3,9,10 The ability to reduce pain coupled with improved function and return to work, are critical considerations in the management of symptomatic patients in the clinical setting, for both the physician and rehabilitation provider.
In contrast to traditional physical, biomechanical and physiological parameters, self-report evaluation from patient-reported outcome measures (PROMs) has the ability to provide greater reliability and accuracy. 11 Moreover, physical dimensions such as range of motion (ROM), hand grip strength, and tactile sensation have only weak correlation with activity limitations in such affected populations. 7 To quantify function and limitations in these patients, reliable and valid instruments are critical. Over recent decades PROMs have gained greater attention and use, due to their capacity to provide concise evaluation of a patient’s functional ability and limitations. 12 Among the five categories of PROMs (generic, condition-specific, disease-specific, region-specific and joint-specific), 13 region-specific PROMs have several advantages. These include simple to use, 14 smaller error margins enabling a smaller sample size, 15 reduced burden for therapists, and patients,7,15–17 and more feasible and applicable in both the research and clinical settings.18,19
. These disorders can affect a variety of body parts including upper limb. Since upper limb plays an essential role in carrying out daily activities as well as in the individual's independence, it is significant to have an accurate measurement of the upper limb and a treatment plan appropriate to the patient's physical and mental status. The purpose of the current study was to evaluate the instruments used for measuring upper limb function in a variety of disorders by integrative review of the published articles between 2000-2020, using the keywords: assessment, musculoskeletal disorders, and upper limb function. 
Materials and Methods:
A systematic review encompassing 3 steps was performed. The first step was selection of studies.
 
 The second step was identification of outcome measures and extraction of information on the 
 
reliability and responsiveness of the extracted outcome measures. The third step was linkage of the 
 
information contained within the outcome measures to the corresponding categories of the ICF.
 
In step 1, the MEDLINE, CINAHL, PsycINFO, and EMBASE databases were used to select.
The present integrative review analyzed the articles reporting determination of the appropriate instruments for the upper limb function published between 2000 and 2020. Iranian databases SID and MagIran and non-Iranian databases OTseeker, Sciencedirect, and PubMed was reviewed. Content analysis was used to analyze the data.
 
Results: 
The results of the search in the cited databases led to over 50 papers in the areas of musculoskeletal disorders and upper extremity function with language restriction. from which 14 were removed due to mismatching subjects, addressing a variety of methods to improve upper extremity function, such as medication, therapeutic approaches in physiotherapy, occupational therapy, and discussing musculoskeletal disorders in other organs. Finally, a total of 36 articles were selected according to inclusion criteria.
 
Conclusion:
This systematic review provides an overview of the outcome measures used to address functioning 
 
and disability as they are related to the upper extremity. The results of this study may help clinicians 
 
and researchers select the most appropriate outcome measure for their clinical population or
 
 research question according to ICF-based content validity, and additional information on the 
 
reliability and responsiveness of the measures is provided. Our findings also can provide directions 
 
for further research.
 
This literature review provides an overview of outcome measures used to address functioning and 
 
disability in persons with impairment in upper extremity function. Moreover, it presents an 
 
overview of the content addressed in these outcome measures when the ICF is used as a reference.
 
It was possible to identify outcome measures from a comprehensive perspective rather than from 
 
just one specific patient population. We also present information on the reliability and 
 
responsiveness of the outcome
 
By aggregating the results of the selected studies, the present review article showed that there are a lot of questionnaires used for measuring upper limb function wherein DASH and ULFI are observed to be the most frequently used and the most reliable questionnaires.