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ABSTRACT: Der „Disability of Arm, Shoulder and Hand“-Fragebogen (DASH) hat sich mittlerweile weltweit als Self-Report-Fragebogen zur
Beurteilung des funktionalen Zustands nach Verletzungen oder Erkrankungen der oberen Extremität durchgesetzt. Nachdem er im
deutschsprachigen Raum zunächst nach den von Guillemin vorgeschlagenen Richtlinien übersetzt worden war, folgte seine Validierung.
Nachfolgend wurde diese Version als offiziell zertifizierte deutsche Version akkreditiert. Es folgten Untersuchungen zur Möglichkeit
der Darstellung diagnosespezifischer Profile, die Erhebung von Referenzwerten und Untersuchungen bezüglich statistischer Möglichkeiten
der Vergleichbarkeit von DASH-Daten. Insgesamt hat sich der DASH als effizientes und wertvolles Instrument bei der Evaluation
funktioneller Ausfälle der Befragten erwiesen.
The Disability of Arm, Shoulder and Hand Questionnaire (DASH) has been accepted worldwide as a self-report questionnaire designed
to assess the functional status of the upper extremity following injury or disease. Following its initial translation for
German-speaking countries according to the guidelines proposed by Guillemin, DASH received its validation. This version was
subsequently accredited as the officially certified German version. Research was then carried out to investigate the possibility
of developing diagnosis-specific profiles, as well as establishing reference values and examinations in order to statistically
compare DASH data. Altogether, DASH has proved to be an effective and valuable tool for the evaluation of functional loss
among respondents.
Trauma und Berufskrankheit 04/2012; 10:381-383.
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ABSTRACT: The aim of this study was to determine a) data for the disabilities of arm, shoulder and hand (DASH) score of a non-clinical group as well as to establish b) a comparison of DASH data between different groups of people.
After collection of 716 DASH questionnaires from healthy, working individuals (non-clinical sample) and 795 questionnaires from patients with injuries and conditions of the upper extremity (clinical sample), the data were assessed according to age, gender, manually or non-manually working into DASH total, DASH activity, DASH impairment, DASH music/sport and DASH work scores. In order to establish a comparability, these data were transformed using T-norms.
Median DASH data of the non-clinical sample showed a functional impairment, since they deviated from 0. Men, aged 50-65, who were working manually showed the highest DASH score. Age did not have a significant effect on the DASH score of the clinical sample. The median overall DASH score of the clinical sample was higher than the scores seen with the non-clinical sample.
Using T-norms a reference framework has been established for DASH scores, thus making it possible to interpret and compare individual scores between patients.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 02/2010; 42(1):55-64. · 0.88 Impact Factor
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ABSTRACT: Ziel dieser Studie war es, die Effektivität eines patientenorientierten Handrehabilitationsprogramms im Vergleich zu einem
Standardprogramm bezüglich der funktionellen Ergebnisse, der beruflichen Situation, der Patientenzufriedenheit und der Kosten
zu evaluieren. Das Patientenkollektiv bestand aus 2 konsekutiven Kohorten mit je 75 Patienten, die an unserem stationären
Handrehabilitationsprogramm teilnahmen. Die eine Patientengruppe erhielt das im Hause „bisher übliche“ Standardprogramm, wohingegen
die Behandlung für die Patienten der anderen Gruppe aus einem speziell auf ihre Bedürfnisse zugeschnittenen, adaptierten Programm
bestand. Die Daten wurden zu 3 Messzeitpunkten erhoben. Sowohl klinische als auch subjektive Variablen wurden erfasst. Patienten
des adaptierten Programms zeigten bei allen Variablen bessere Ergebnisse. Unter anderem kehrten mehr Patienten an ihren Arbeitsplatz
zurück und die Zeit der Arbeitsunfähigkeit war kürzer, womit eine erhebliche Kostenersparnis erreicht werden konnte. Der patientenorientierte
Ansatz war nicht nur aus ethischer Sicht, sondern auch aus Effektivitäts- und Kostengründen geeigneter.
The aim of this study was to evaluate the effectiveness of a patient-oriented hand rehabilitation program compared to a standard
program in terms of functional results, work situation, patient satisfaction and cost. The patient collective comprised two
consecutive cohorts, each of 75 patients, who took part in our in-patient hand rehabilitation program. One patient group received
the standard hitherto “usual” program, while the treatment for the other group consisted of a special program custom-tailored
and adapted to their needs. Data were gathered at three measurement time points. Both clinical and subjective variables were
measured. Patients following the adapted program showed better results in all variables. Among other things, more patients
returned to work and the periods of inability to work were shorter, as a result of which significant cost saving could be
achieved. The patient-oriented approach was more suitable not only from an ethical point of view, but also from an effectiveness
and cost-effectiveness point of view.
Trauma und Berufskrankheit 09/2008; 10:378-380.
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ABSTRACT: This study evaluated the effectiveness of a patient-oriented, hand rehabilitation programme compared to a standard programme regarding functional outcomes, return to work, patient satisfaction and costs. Patients were recruited in two consecutive cohorts. One cohort received the standard treatment programme (n = 75) and the other a programme based on principles of patient orientation (n = 75). Data were collected at the beginning and end of rehabilitation and 6 months after discharge. Clinical variables included range of motion, grip and pinch strength. Self-reported measures included pain, upper extremity functioning, health status, satisfaction and job situation. Analysis of variance for repeated measurements was used to calculate the main effects. The patient-oriented group showed more favourable results with respect to DASH scores (P <.05), pain (P <.001) and patient satisfaction (P <.0001). More patients returned to their former jobs and time off sick was reduced. We concluded that the patient-oriented approach was more effective and cost-saving.
Journal of Hand Surgery (European Volume) 08/2008; 33(6):771-8. · 1.17 Impact Factor
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ABSTRACT: In einer gemeinsamen Studie zwischen der BG-Unfallklinik Ludwigshafen und der VBG wird untersucht, ob durch den Einsatz patientenorientierter,
standardisierter Fragebögen die Funktionsfähigkeit, Teilhabe sowie Patientenzufriedenheit von VBG-Versicherten besser von
Rehabilitationsmanagern bewertet werden können. Langfristiges Ziel wäre, mittels dieser Qualitätssicherungsmaßnahmen zur Evaluation
von Behandlungsverläufen und -ergebnissen dem Kostenträger zur verbesserten Kosten-Nutzen-Analyse zu verhelfen. Zwischen 2004
und 2006 nahmen 48 VBG-Versicherte mit distalen Radiusfrakturen an der Studie teil. Während des Rehabilitationsverlaufs erhoben
Rehabilitationsmanager Daten zur Funktionsfähigkeit (DASH-Fragebogen) sowie Zufriedenheit mit der Dienstleistungserbringung
(ZUF-8) und den funktionellen Ergebnissen. Statistisch signifikante Verbesserungen ergaben sich zwischen den DASH-Daten zu
Beginn und zu Ende der Behandlung; die Versicherten waren mit ihrer Behandlung und den funktionellen Ergebnissen „zufrieden“
bis „sehr zufrieden“. Diese neue Vorgehensweise erwies sich als praktikabel und vorteilhaft. Die VBG wird den DASH auch in
Zukunft in der Rehabilitation einsetzen.
A joint study was carried out by the BG Trauma Centre in Ludwigshafen and the VBG to examine whether the use of patient-oriented
standardised questionnaires made it possible for rehabilitation managers to evaluate functioning, participation and patient
satisfaction more accurately. The long-term aim was to enable the accident insurance payers to perform more efficient cost-benefit
analyses by using the quality assurance measures to monitor treatments and their outcomes. Forty-eight patients insured with
VBG, all of whom had sustained fracture of the distal radius, took part in the study between 2004 and 2006. During the course
of the treatment rehabilitation managers collected data on upper extremity functioning (DASH questionnaire), satisfaction
with treatment (ZUF-8) and satisfaction with functional outcomes. Statistically significant improvements were found in the
DASH data from the beginning to the end of treatment. The clients were “satisfied” or “very satisfied” with their treatment
and with the functional outcomes. This new procedure in quality assurance has proved to be both practicable and advantageous.
The VBG will include DASH in future rehabilitation programmes.
Trauma und Berufskrankheit 01/2008; 10(1):84-89.
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ABSTRACT: Since 1948, closed reduction and osteosynthesis for supracondylar humeral fractures using two K-wires from the medial and lateral side has been performed on a regular basis. Although this procedure is used routinely, many authors have described paralysis of the ulnar nerve after blindly inserting the medial K-wire. Only very few publications describe the treatment options after iatrogenic paralysis of this nerve. The patients described showed progressive paralysis of the ulnar nerve after K-wire osteosynthesis. Intraoperatively, all patients showed scarring but intact continuity. After surgical revision and neurolysis, all four patients showed complete restitution after 1 year. If patients show progressive paralysis of the ulnar nerve early operative revision after 3 months should be performed.
Der Unfallchirurg 01/2007; 109(12):1090-3. · 0.61 Impact Factor
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ABSTRACT: The use of the balloon dissector ("space maker") for the implantation of soft tissue expanders is illustrated and technical aspects and advantages are compared to the conventional method.
Over a 10-year period a group of 90 patients with evaluation records (m = 34, f = 56) was analysed retrospectively. The mean age was 23 years (range: 5 to 62 years). Overall, 164 expanders were implanted and in 73 cases (44.5%) a balloon dissector was used.
The mean intraoperative expander filling was increased up to 27% of the volume of the tissue expander after using the balloon dissector; in contrast it was 15% after conventional dissection. The mean duration of expansion was decreased by 9.8% after space maker dissection.
The use of the space maker is a scar-sparing technique. Time of operation and overall duration of expansion are reduced. Patient comfort is clearly improved. The negligible costs of a space maker are compensated by the cost reduction due to shorter operating time, fewer outpatient contacts and a low complication rate. The indications for the use of balloon dissectors are the expansion of skin (scar correction after burns, trauma, tumour), breast reconstruction and augmentation, and the prefabrication and rapid intraoperative expansion of musculocutaneous flaps.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 09/2006; 38(4):240-5. · 0.88 Impact Factor
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ABSTRACT: The system of German diagnosis-related groups (G-DRG) has undergone modifications for burn cases (Y-DRG) since 2003. The DRG catalog includes two of seven Y-DRGs without a case weight.
The BG Trauma Center in Ludwigshafen could demonstrate that the cost of burn care treatment could not be reimbursed through Y-DRGs in 2004.
By being accredited as a so-called "individual hospital-based unit" for burn care (Besondere Einrichtung), it was possible to agree to an "all-inclusive" contract. The daily rate is reimbursed with 2792 Euros/day. The reimbursement of the treatment of burn patients is thus cost covering.
In summary the budget for 2006 should be calculated by an individualized hospital rate for all Y-DRGs, especially as it was shown that the additional payments (Zusatzentgelte) for selected therapies did not cover the costs of special treatments in burn care in 2005 and 2006. The problem has been recognized and published internationally. The special and cost-intensive treatment of burn patients is difficult to calculate in a system of diagnosis-related groups due to the low number of cases.
Der Unfallchirurg 07/2006; 109(6):505-10. · 0.61 Impact Factor
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ABSTRACT: HintergrundDie Fallpauschalenverordnung hat seit 2003 einige Modifikationen der Y-DRG fr Verbrennungsbehandlung erfahren. Im Katalog 2006 bleiben 2 der 7 Y-DRG ohne Bewertung.Material und MethodenIn der BG-Unfallklinik Ludwigshafen konnte ber die vergleichende Kalkulation der Erlse der Bundespflegesatzverordnung und der Fallpauschalenverordnung fr 2004 ermittelt werden, dass eine Kostenunterdeckung fr die bewerteten Y-DRG vorliegt.Ergebnisseber die Anerkennung als Besondere Einrichtung fr den Bereich Verbrennung ist es 2004 gelungen, fr alle Y-DRG einen All-inclusive-Tagestarif von 2792EUR/Tag zu verhandeln. Hiermit konnte eine kostendeckende Vergtung der Behandlung Brandverletzter erzielt werden.SchlussfolgerungZusammenfassend ist fr das Budget 2006 die Verhandlung in Richtung eines krankenhausindividuellen Tagessatzes fr Verbrennungspatienten attraktiv, insbesondere da gezeigt werden konnte, dass die zur Verfgung stehenden Zusatzentgelte nicht kostendeckend sind und fr die berwiegende Mehrzahl an kostenintensiven Einzelleistungen der Verbrennungsmedizin keine Zusatzentgelte im Katalog 2005 und 2006 vorliegen. Internationale Vergleiche zeigen, dass die Problematik kein deutsches Phnomen der Fallpauschalen darstellt. Die besondere und kostenintensive Behandlung von Schwerbrandverletzten bei geringen Fallzahlen ist kalkulatorisch schwierig in ein Fallpauschalensystem einzuordnen. Individuelle Tarife sollten deshalb angestrebt werden.BackgroundThe system of German diagnosis-related groups (G-DRG) has undergone modifications for burn cases (Y-DRG) since 2003. The DRG catalog includes two of seven Y-DRGs without a case weight.MethodsThe BG Trauma Center in Ludwigshafen could demonstrate that the cost of burn care treatment could not be reimbursed through Y-DRGs in 2004.ResultsBy being accredited as a so-called individual hospital-based unit for burn care (Besondere Einrichtung), it was possible to agree to an all-inclusive contract. The daily rate is reimbursed with 2792 Euros/day. The reimbursement of the treatment of burn patients is thus cost covering.ConclusionIn summary the budget for 2006 should be calculated by an individualized hospital rate for all Y-DRGs, especially as it was shown that the additional payments (Zusatzentgelte) for selected therapies did not cover the costs of special treatments in burn care in 2005 and 2006. The problem has been recognized and published internationally. The special and cost-intensive treatment of burn patients is difficult to calculate in a system of diagnosis-related groups due to the low number of cases.
Der Unfallchirurg 05/2006; 109(6):505-510. · 0.61 Impact Factor
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ABSTRACT: Jhrlich werden deutschlandweit ber 6000 Kinder mit einer Verbrennung stationr in Krankenhusern behandelt. Durch eine Verbesserung der Therapie wurde die Mortalitt schwerstbrandverletzter Kinder in den vergangenen Jahren stark reduziert. Der Erfolg der Behandlung hngt nicht zuletzt auch von der richtigen Primrversorgung unmittelbar am Unfallort ab. Durch die geringe Inzidenz schwerer Brandverletzungen stellt die thermische Verletzung im Kindesalter eine besondere Herausforderung fr den Notarzt dar. Die hufigsten Fehlerquellen bei der Erstversorgung dieser Kinder sind Unterkhlung durch zu lange Wundkhlung und fehlerhafte Wundversorgung, fehlende Analgosedierung und fehlerhafte Infusionsregime durch Fehleinschtzung der betroffenen Krperoberflche. Der Arbeitskreis Das schwerbrandverletzte Kind hat Therapieempfehlungen fr die notrztliche prklinische Versorgung von brandverletzten Kindern erarbeitet, die vorgestellt werden.Every year, more than 6.000 children with burn injuries are treated in German hospitals. With improved therapy mortality of children with severe burns was greatly reduced in recent years. The success of in-hospital treatment depends on correct primary on-scene treatment. Due to the low incidence of severe burn injuries, thermal trauma in children poses a special challenge to the emergency physician. The most frequent mistakes in the treatment of these children are hypothermia caused by prolonged cooling and incorrect wound treatment, lack of analgesia and sedation, and incorrect infusion regimens caused by false estimation of involved body surface. Guidelines for the prehospital treatment by emergency physicians developed by a task force on treatment of children with severe burns are presented.
Notfall 02/2006; 9(2):227-238. · 0.54 Impact Factor
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ABSTRACT: A case of complex microsurgical reconstruction of the dorsum of the foot, including tendon transfer following tumor resection, in a 15-week-old male infant is presented. After birth, a 5.5 x 4 cm large tumor was observed on the dorsum of the right foot. Biopsy showed a congenital malignant fibro sarcoma. After initial chemotherapy a radical excision of the tumor at the age of 14 weeks was followed. To cover the defect a musculocutaneous latissimus dorsi flap was taken, the cutaneous part being large enough to cover the defect. Extensor tendons were reconstructed with free tendon transplants. Amputation is usually indicated in these cases. To the best of our knowledge, microsurgical reconstruction in infants at this age with congenital malignant tumors has not yet been reported. The case shows that Plastic surgery can play an important role in pediatric oncology and should routinely be integrated into the multi-modal treatment concepts.
Microsurgery 02/2006; 26(6):429-31. · 1.61 Impact Factor
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ABSTRACT: Bereits 1948 wurde die geschlossene Reposition und Osteosynthese mit 2 gekreuzten Kirschner-Drhten bei der suprakondylren Humerusfraktur etabliert. Trotz der langen Entwicklungs- und Erfahrungsphase machen bis zum heutigen Tag immer wieder Autoren auf die Problematik der Ulnarislsion aufgrund des blind eingebrachten medialen Kirschner-Drahtes aufmerksam. Nur wenige Publikationen beschftigen sich allerdings mit der progredienten Ulnarisparese und Empfehlungen zum Zeitpunkt einer operativen Revision.Es werden 4Flle mit einer progredienten motorischen und sensiblen Ulnarisparese beschrieben. Intraoperativ zeigte sich in allen Fllen eine Vernarbung bei erhaltener Kontinuitt. Nach Revision und mikrochirugischer Neurolyse fand sich bei allen 4Patienten zum Untersuchungszeitpunkt nach 1Jahr eine vollstndige Wiederherstellung. Bei progredienter Ulnarisparese ist daher eine frhzeitige operative Revision nach 3Monaten zu empfehlen.Since 1948, closed reduction and osteosynthesis for supracondylar humeral fractures using two K-wires from the medial and lateral side has been performed on a regular basis. Although this procedure is used routinely, many authors have described paralysis of the ulnar nerve after blindly inserting the medial K-wire. Only very few publications describe the treatment options after iatrogenic paralysis of this nerve.The patients described showed progressive paralysis of the ulnar nerve after K-wire osteosynthesis. Intraoperatively, all patients showed scarring but intact continuity. After surgical revision and neurolysis, all four patients showed complete restitution after 1year. If patients show progressive paralysis of the ulnar nerve early operative revision after 3months should be performed.
Der Unfallchirurg 01/2006; 109(12):1090-1093. · 0.61 Impact Factor
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ABSTRACT: Scoring systems currently used to evaluate functional disabilities in upper extremity conditions frequently combine so-called "objective" parameters such as grip strength and range of motion with "subjective" parameters such as pain. Since its introduction, the Disabilities of Arm, Shoulder and Hand Questionnaire has proven useful in the pre- and postoperative evaluation of functional limitations of the upper extremity. This study examines the relationship between DASH scores, the so-called "objective" parameters of grip strength and range of motion and those of "mixed scores" such as Krimmer and Cooney Scores. Based on the data of six diagnostic groups, Spearman's correlation coefficients were calculated. There was no correlation between DASH scores and range of motion, however, some of the diagnostic groups showed a moderate correlation between DASH scores and grip strength. Both the Krimmer and Cooney scores showed a significant correlation with the DASH scores, indicating that these "mixed-scores" can be replaced by the DASH. Since it has been shown that grip strength and range of motion do not capture patients' functional limitations adequately, their continued use in the evaluation of upper extremity conditions should be the topic of further discussion.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie 05/2005; 37(2):126-30. · 0.88 Impact Factor
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ABSTRACT: The Disability of Arm, Shoulder and Hand (DASH) questionnaire is a standardized measure which captures the patients' own perspective of their upper extremity health status. Based on the scores of the DASH modules: symptoms, function and sport, this follow-up study of 590 hand-injured subjects from 11 diagnostic groups evaluated impairments and disabilities perceived 2 to 5 years postoperatively. Secondly, we explored the relationships between the diagnostic groups at the individual DASH item level. Exploratory testing of statistical significance showed that the DASH modules differentiated well among the groups (ANOVA P-value 0.001) and further differences existed at the item level, so that functional activity problem profiles could be developed for each diagnostic group. Our findings confirm that the DASH is a useful instrument for outcome evaluation. Moreover, in view of the continuing challenge to provide comprehensive care which meets patients' needs in the shortest space of time, we consider that DASH has potential in the development of patient-centred treatment programmes which are tailored to the individual patients' requirements and have relevance to their daily activities.
The Journal of Hand Surgery British & European Volume 03/2005; 30(1):23-8. · 0.04 Impact Factor
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ABSTRACT: In den vergangenen Jahren konnte die Mortalitt schwerstbrandverletzter Kinder durch eine Verbesserung des intensivmedizinischen Managements erheblich reduziert werden. Gleichzeitig wurde durch die Optimierung der lokalen Wundbehandlung und der chirurgischen Transplantationstechnik das kosmetische und funktionelle Outcome deutlich verbessert. Der Erfolg der Behandlung brandverletzter Kinder hngt aber nicht zuletzt auch von der richtigen Primrversorgung ab. Diesbezglich werteten wir 80 brandverletzte Intensivpatienten unserer Klinik der vergangenen vier Jahre aus. Die hufigsten Fehlerquellen bei der Erstversorgung von brandverletzten Kindern liegen in der Unterkhlung durch fehlerhafte Wundversorgung und zu lange Wundkhlung, fehlende Analgosedierung bis hin zu fehlerhaftem Infusionsregime durch Fehleinschtzung der verbrannten Krperoberflche. Glcklicherweise enden diese Fehlbehandlungen nur selten letal und knnen durch eine enge Zusammenarbeit zwischen dem Intensiv-Pdiater und Kinderchirurgen korrigiert werden. Dennoch veranlassen gerade Einzelflle von Missmanagement ein berdenken der bisherigen Vorgehensweise, um eine Qualittsverbesserung bei der Erstversorgung von kindlichen Verbrennungen zu erreichen. Daher hat der Arbeitskreis Das schwerbrandverletzte Kind die Therapieempfehlungen fr die notrztliche Primrversorgung von Brandverletzten mit speziellen Empfehlungen fr die Versorgung von Kindern ergnzt.In recent years, advances in trauma care have led to a marked reduction in mortality in burn injuries particularly in children. This increase in survival can be attributed to a better understanding of metabolism and advances in care management. At the same time, cosmetic and functional outcomes have also been improved due to progress in local wound therapy and aggressive surgical treatment for early wound closure. However, the quality and success of treatment in pediatric burns is also dependent on the pre-hospital emergency management at the scene and during transport. In order to determine the quality of pre-hospital emergency care, the clinical notes and transfer documentation of 80 patients who were admitted to the intensive care unit between 1998 and 2001 were reviewed. Our results showed that the most frequent complications among children with burn injuries were due to hypothermia due to excessively long wound cooling, lack of analgosedation and incorrect resuscitation because of false estimations of burned body surface area. Fortunately, mortality is seldom a result of these incorrect procedures and mistakes can be adjusted by good co-operation between the pediatric physician and pediatric surgeon. Nonetheless, even single cases of mismanagement highlight the need to reassess standard practices. With the aim of improving the quality of pre-hospital emergency management, the research group Der Arbeitskreis das schwerbrandverletzte Kind has completed the guidelines for emergency management of burns with special recommendations for the medical care of children.
Intensivmedizin + Notfallmedizin 01/2005; 42(1):60-65.
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ABSTRACT: Diabetes mellitus and its sequelae such as the "diabetic foot" are increasing in incidence and pose a challenging medical and financial problem. Interdisciplinary teams have been formed to prevent and treat these problems, consisting of diabetic nurses and physicians, nutritionists, podiatrists, specialist shoemakers, general, orthopaedic and vascular surgeons. However, hardly mentioned in the literature are the surgical options offered by plastic and reconstructive surgeons. The aim of this study was to analyse the outcome of plastic surgical treatment for soft tissue defect coverage of the diabetic foot ulcer and to define the role of plastic and reconstructive surgery within an interdisciplinary treatment concept.
In a retrospective cohort study the charts of 38 diabetic patients (female n = 14/male n = 24) with an average age of 68.6 years and with 45 defects on the foot or ankle were analysed regarding the patient profile, defect etiology and size, operative procedures, complications and outcome results.
Defect coverage was performed using 20 split skin grafts, 19 local flaps and 6 free flaps as well as 27 amputations. At the time of discharge 25 of 45 defects were closed (56 %), 15 patients had an amputation and in 3 cases a small defect remained. The success rate of defect coverage decreased with increasing comorbidity. Whereas 71 % of the defects were covered in ASA stage 2 patients, only 50 % of the defects could be covered in ASA stage 3 patients and only 33 % in ASA stage 4 patients.
Despite a high complication rate, plastic surgical techniques in many cases prevented an amputation in this negatively preselected patient group. These results provide justification for plastic and reconstructive surgery being in any case part of an interdisciplinary treatment approach of the diabetic ulcer.
DMW - Deutsche Medizinische Wochenschrift 04/2004; 129(13):676-80. · 0.53 Impact Factor
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ABSTRACT: Functional disabilities of the upper extremities have a considerable social and economic impact so that interest was aroused in developing a valid and reliable instrument suitable for international use. The Disabilities of the Arm, Shoulder, and Hand questionnaire is a self-report measure recording functional limitations in the upper extremity. A German version is now available in German-speaking countries. Previous studies have been concerned with the evaluation of DASH scores. Based on the data of four diagnostic groups, this study explores DASH's ability to identify diagnosis-specific limitations at the item level. The data were pooled and examined with regard to significant differences within the groups. Diagnosis-specific limitations could be identified within all groups, indicating that DASH is capable of expressing diagnostic entities as well as summed scores. Consideration of the individual profiles opens the possibility of using DASH as a prognostic tool to anticipate functional problems arising during rehabilitation following surgical interventions.
Der Unfallchirurg 11/2003; 106(10):834-8. · 0.61 Impact Factor
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ABSTRACT: Zusammenfassung Funktionelle Beeintrchtigungen an der oberen Extremitt bergen eine erhebliche soziokonomische Bedeutung, sodass die Notwendigkeit bestand international validierte und treffsichere Tests zu entwickeln. Der „disability of shoulder, arms and hand questionnaire“ (DASH) stellt ein inzwischen auch im deutschen Sprachraum entwickeltes „Self-report-Messinstrument“ dar, das Einschrnkungen an der oberen Extremitt erfasst. Der bisherige Einsatz umfasste lediglich die Evaluation des Gesamtwerts, um so Verbesserungen oder Verschlechterungen abbilden zu knnen. Anhand von 4 Diagnosegruppen wurde berprft, inwieweit der DASH bei der Einzelfragenauswertung diagnosespezifische Ausfallsmuster darstellen kann. Es wurden Aufflligkeiten im Sinne einer Abweichung vom Gesamtdatenpool untersucht. Bei den 4 dargestellten Diagnosen traten charakteristische Ausfallmuster auf. So konnte gezeigt werden, dass der DASH in der Lage ist diagnostische Entitten abzubilden. Durch den Nachweis dieser Profile ist evtl. die Mglichkeit gegeben darzustellen, bei welchen Diagnosen, welchen Ttigkeiten und in welchem Ausma Probleme nach Operationen und in der Rehabilitation zu erwarten sind.
Der Unfallchirurg 09/2003; 106(10):834-838. · 0.61 Impact Factor
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ABSTRACT: This retrospective study evaluates a dynamic active motion protocol for extensor tendon repairs in zones V to VII. Fifty-eight patients with 87 extensor tendon injuries were examined. Using Geldmacher's and Kleinert and Verdan's evaluation systems, the results were graded as "excellent" and "good" in more than 94%, and as "satisfactory" in the remainder. The need for secondary tenolysis was low (6%), and no other surgical complication occurred.
The Journal of Hand Surgery British & European Volume 07/2003; 28(3):224-7. · 0.04 Impact Factor
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ABSTRACT: This retrospective study examines the use and advantages/disadvantages of glycerol preserved human allograft skin in our burn care facility between February 1997 and December 1999. Three hundred and twenty patients were included into the study, 85 of whom were treated with human cadaver skin. The usage of allograft slightly increased the number of operative procedures per percent of the total body surface area burn. There were no adverse effects noted from the use of allograft. The group of patients with allograft use had a significantly larger burn size, ABSI score and length of ICU stay. Demographically the groups were comparable. The considerably easier handling and storage of glycerol preserved allograft skin make it preferable to cryopreserved allograft skin in all indications where it is used as a temporary wound closure. We recommend the usage of cryopreserved skin in cases where the integration of a dermal component as a permanent part of wound closure is desired.
Burns 11/2002; 28 Suppl 1:S10-12. · 1.96 Impact Factor
