Functional outcome and quality-of-life assessment instruments in TOS

Abstract

Quality of life (QOL) research provides a framework to judge outcomes, health status, and treatment effectiveness from the patient's point of view. It is important for surgical outcomes, particularly as medicine shifts emphasis from mortality to perceived health status and patient preference. QOL research can be useful in thoracic outlet syndrome (TOS), given the disease's weak objective findings. There is no tool specific for TOS, however generic or dimension-specific measures can apply. The Disability of the Arm, Shoulder and Hand survey (DASH), a dimension-specific measure, is used to evaluate symptoms and function of patients with upper extremity disability. General measures such as the Short Form 36 (SF-36) or SF-12 can also be used. TOS patients were administered the DASH and SF-12. At baseline, patients with TOS reported similar quality of life scores as patients with congestive heart failure, and DASH scores similar to patients with chronic rotator cuff injury. DASH scores post-operatively improved 0.85 points (P < .001) for neurogenic patients and 0.81 points (P < .001) for venous per month. The physical and mental component scores of the SF-12 also improved significantly over time (0.24 and 0.15 points per month respectively for neurogenic patients, and 0.40 and 0.55 points for venous patients). Therefore, in appropriately selected patients with TOS, surgical intervention can improve their quality of life.