Physical function, quality of life, musculoskeletal pain, and prosthesis use in adults with congenital reduction defects of the upper limb: A cross-sectional study

J Hand Ther. 2026 Apr 17:S0894-1130(25)00220-0. doi: 10.1016/j.jht.2025.12.018. Online ahead of print.

ABSTRACT

BACKGROUND: Individuals with congenital reduction defects of the upper limb (CRDUL) are routinely offered prostheses to enhance function and prevent strain-related problems. Despite early interventions, long-term use is limited, and evidence of benefits in adulthood remains scarce.

PURPOSE: To compare physical function, health-related quality of life (HRQoL), life satisfaction, and musculoskeletal pain in adults with CRDUL vs population controls, and to examine differences between current and former prosthesis users to inform individualized habilitation strategies.

STUDY DESIGN: Cross-sectional study.

METHODS: Adults (≥18 years) with congenital reduction defects of the upper limb (ICD 10 Q71.0-Q71.9) and randomly selected population controls completed a questionnaire covering demographics, physical function (QuickDASH: Disabilities of the Arm, Shoulder, and Hand), health-related quality of life (EQ 5D 5L VAS), life satisfaction (SWLS: Satisfaction With Life Scale), and self-reported musculoskeletal pain (past 12 months, present/absent). Congenital reduction defects of the upper limb-specific items (limb characteristics, prosthesis/specialized grip-related questions) were excluded for controls. Analyses included t tests, Mann-Whitney U, chi-square, and logistic regression; effect sizes: (Cliff's delta (δ), Cohen's d (continuous), and Cohen's h (categorical).

RESULTS: Of 192 eligible adults with CRDUL and 1092 randomly selected controls, 108 (56%) and 341 (31%) responded, respectively. The CRDUL group was younger (median 27 vs 48 years; p < 0.001), had higher QuickDASH scores (p < 0.001, δ= 0.48), and higher prevalence of neck, shoulder, and arm pain (p < 0.001, h= 0.51-0.57), particularly among women. HRQoL and life satisfaction scores were similar between groups (EQ-5D-5L VAS: 80 (IQR 70-90) in both; SWLS: 25.7 (SD 6.6) vs 25.7 (SD 6.3)). Prosthesis use was discontinued by 54%, most often due to discomfort and impracticality. No significant differences were found between current and former users across outcome measures.

CONCLUSIONS: Adults with CRDUL report reduced physical function and more musculoskeletal pain than controls, but similar HRQoL and life satisfaction. Prosthesis use was frequently discontinued. Findings support individualized prosthetic care guided by user-defined goals rather than routine provision based on anatomical feasibility.

PMID:42000241 | DOI:10.1016/j.jht.2025.12.018