An exploratory study on the predictors of lifelong participation in adults with brachial plexus birth injury.

BACKGROUND: During transitions to adulthood, participation after brachial plexus birth injury is contextualized by increasing independence and age-related milestones, illustrated by new social demands, education or career choices, and physical maturation. However, our understanding of the underlying mental or physical factors that influence participation into adulthood remains unrecognized. PURPOSE: The aim of this study was to identify how mental and physical factors relate to participation of adults with brachial plexus birth injury as measured by a battery of standardized patient-reported outcome measures. STUDY DESIGN: Prospective cross-sectional study with cases and controls. METHODS: Participants aged 19-34 years with brachial plexus birth injury were age- and sex-matched with controls. Participation was measured using the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). Covariates were measured using the QuickDASH, Short Form-12 Mental (SF-12 MCS) and Physical (SF-12 PCS) Component Scores, and Brief Pain Inventory measures. RESULTS: Twenty-six young adults with brachial plexus birth injury (25.9 +/- 4.0 years) were sex (F:M, 21:5) and age-matched to 26 control (24.8 +/- 3.1 years) participants. The brachial plexus birth injury group reported significantly greater USER-P Restrictions and lower USER-P Satisfaction compared with the control group. Among the brachial plexus birth injury participants, multiple strong correlations were found to be significant between USER-P Restrictions and all covariates. Brachial plexus birth injury status and pain interacted as a significant predictor of participation restriction, while SF-12 MCS, SF-12 PCS, and Brief Pain Inventory pain interference were significant predictors of lower USER-P Satisfaction irrespective of diagnosis. CONCLUSIONS: Adults with brachial plexus birth injury reported greater participation restrictions than control-group peers. Severity of injury positively correlated with participation restrictions and was significantly associated with decreased upper limb function and physical health, and greater pain interference. This indicates the importance of holistic rehabilitation in adults with brachial plexus birth injury, including mental health and pain management.