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Lin et al. Plast Aesthet Res 2024;11:8 https://dx.doi.org/10.20517/2347-9264.2023.57 Page 7 of 12

The Michigan Hand Questionnaire (MHQ) was developed using psychometric principles to measure
[56]
different health state domains for patients with hand disorders . The questionnaire consists of 37 items
broken into six main categories, which include overall hand function, ADLs (e.g., holding glass, turning
door knobs, tying shoelaces), satisfaction with hand function, pain, work performance, and aesthetics. A
systematic review of the MHQ demonstrated high re-test reliability and internal consistency . The MHQ
[57]
was used in 2/26 studies [16,47] .

The Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire was a joint initiative of the American
Academy of Orthopedic Surgeons and several other organizations and measures patient-rated UE disability
and symptoms . It consists of a 30-item disability scale with questions focusing on the degree of difficulty
[58]
of performing physical tasks (e.g., gardening, changing lightbulb overhead, making bed, washing back);
severity of associated pain, weakness, and stiffness; and negative impact on social activities, self-perception,
and sleep. The DASH was used in 2/26 studies [16,47] .

SCIM evaluates disability and function that are affected by SCI, including self-care (feeding, grooming,
bathing, dressing), respiration and sphincter management, and mobility (including transfers to chair/bed).
The SCIM was developed and validated for use in people with SCI and multiple iterations have been
refined, with the latest available version being the SCIM III [59-61] . The SCIM was used in 2/26 studies [23,50] .

The Canadian occupational performance measure (COPM) was designed for use by occupational therapists
to assess outcomes in the areas of self-care, productivity, and leisure. It is based on a semi-structured
interview and measures patient-designated goals for daily function . It comes in digital or paper forms that
[62]
must be purchased prior to use. The COPM was used in 2/26 studies [15,23] .

Other reports
In 10 of the 26 studies, de novo satisfaction scales, semi-structured interview qualitative measures, and other
subjective descriptions of participants’ abilities to perform ADLs were reported [11,14,17,20,21,23,32,33,36,63] . In 13 of 26
studies, some pre- and post-operative video content of UE movement was included to enhance visualization
of the outcomes [14,15,17,18,20,23,27-29,31,32,36,47] .

DISCUSSION
Summary of the current literature and findings
In people with cervical SCI, gaining UE function is a top priority [64,65] . NT surgery expands eligibility for
surgical reconstruction and improves function and independence . In the current SCI literature, there is a
[17]
lack of consensus regarding which clinical assessments and outcome measures are most useful . In this
[22]
comprehensive literature review, we found that MMT was the most widely used post-operative outcome
measure. While many studies included functional and patient-reported outcome measures, only 19% of the
studies used standardized assessments and 38% included subjective de novo questionnaires and
observational reports.

While strength assessment with MMT is useful, it has high interrater variability and provides ordinal non-
[66]
continuous data . Additionally, an increase in strength does not necessarily translate into useful UE
[66]
function or improved performance of ADLs . Nevertheless, MMT remains the most widely used outcome
measure in this setting. Another commonly used assessment is myometry, which has been shown to be
more sensitive than MMT [67,68] . However, similar to MMT, myometry may not correlate with useful
function. Standard dynamometers for pinch and grip measurement can also require more force than some
[41]
people with cervical SCI are able to produce .