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Page 6 of 12 Lin et al. Plast Aesthet Res 2024;11:8 https://dx.doi.org/10.20517/2347-9264.2023.57

videography) were reported under the other category.

Strength/movement outcomes
Manual muscle testing (MMT) was the most widely used assessment measure; 24/26 studies used MMT as
their primary outcome to measure gains in strength following NT surgery [11,13-18,20,26-37] . Results were graded
using the Medical Research Council (MRC) scale (range of 0-5). The MRC scale is the most widely
[38]
accepted and was designed for the examination of the peripheral nervous system [39,40] . Strength is graded
as follows: (1) 0/5 - no movement; (2) 1/5 - flicker of movement (3) 2/5 - movement with gravity eliminated;
[39]
(4) 3/5 - antigravity movement; (5) 4/5 - strong movement; and (6) 5/5 - normal power . Myometry is a
more quantitative and objective measure of strength. It is commonly used to assess pinch and grip strength
in pounds or kilograms. If measurable, myometry can provide continuous data, which may show changes
not detectable with standard MMT [41,42] . In our review, 6/26 studies included myometric
measurements [15,23,28,29,33,43] .

Functional outcomes
Several studies describe the use of tests that measure UE and hand movement and/or functional
limitations [44-46] . Some were originally developed to be disease-specific, while others were developed to
measure changes after certain therapeutic interventions.

The Sollerman Hand Function Test (SHFT) was developed to measure the common hand grips used by
people with cervical SCI when performing ADLs and was measured in 2/26 studies [16,47] . ARAT was
[44]
[48]
originally used to assess UE function in people recovering from stroke and brain injury . It grades
coordination, dexterity, and function based on the performance of a specific series of tasks. This was used in
[23]
1/26 studies . The Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) Test is
a valid and reliable test that was designed to measure functional outcomes in complete and incomplete
[45]
[49]
cervical SCI . The GRASSP has been shown to be predictive of overall UE and self-care function and
[50]
was used in 1/26 studies . GRT was originally developed to assess outcomes after neuroprosthesis
implantation in people with SCI . Further studies have demonstrated that GRT can reliably detect hand
[46]
function changes before and after TT surgery as well . The GRT was used in 1/26 studies .
[23]
[51]
Patient-reported outcomes
In this review, we categorized patient-reported outcome (PRO) questionnaires into three groups - general,
system-specific, and disease-specific - based on the classifications described by Alderman and Chung [24,52] .
General PROs evaluate general well-being and do not focus on a specific disease process or organ system.
System-specific PROs focus on an organ system or functional body unit and assess how it is impacted by
disease processes and improvements after surgical intervention. Lastly, disease-specific PROs are designed
for populations affected by certain pathologies. These instruments focus on evaluating the efficacies of
treatments for particular diseases.

The Short Form 36 (SF-36) survey is widely used to assess general health-related function and well-being .
[53]
It was originally designed as a generic health measure to compare health at the population level but has been
applied to specific groups such as people living with schizophrenia and stroke . This assessment was used
[54]
in 2/26 studies [16,47] . The SF-36 walk-wheel modification version was used to maintain appropriate content
validity in the physical domain section since wheelchairs (not walking/climbing) are the main mode of
locomotion for people with cervical SCI .
[55]