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Hand Function and Appearance Following Reconstruction for Congenital Hand Differences: A Qualitative Analysis
Brian P. Kelley, MD, Lauren Franzblau, BS, Kevin C. Chung, MD MS, Noelle Carlozzi, PhD, Jennifer F. Waljee, MD, MPH, MS.
University Of Michigan, Ann Arbor, MI, USA.

PURPOSE:
Congenital hand differences induce social, psychological and functional challenges for children. However, little is known about how children perceive their outcomes after reconstructive procedures or what concerns children have.
METHODS:
A total of 33 children (ages 6-17), who were treated for congenital hand abnormalities, and their parents participated in qualitative, semi-structured interviews regarding the child’s hand function and appearance. Discussion focused on the influence of congenital hand differences on the child’s daily activities, school, and participation in sports and music. The interviews were open format to allow for the spontaneous emergence of relevant themes followed by guided questioning. The interviews were transcribed verbatim and analyzed using qualitative coding, iterative comparisons, and frequency analysis to reveal perceptions of children and parents.
RESULTS:
In this sample, 73% of children and parents reported difficulty with hand function. Children experienced difficulties with personal care (58%), school activities (30%), and household tasks (27%). Children were also bothered by their hand appearance (48%), pain (30%), and weakness (24%). Complex anomalies were associated with greater disability and limitation in sports and music.
CONCLUSION:
Children with congenital hand differences are concerned with the aesthetic appearance of their hands and limitations in their ability to perform activities. Children were often discouraged by activities that their peers accomplished easily, but with increasing age demonstrated adaptive behaviors to accommodate in their "own way," suggesting the uniqueness of their limitations. Patients may benefit from early hand therapy evaluation guided toward areas of concern to enhance functional adaptation for activities and tasks.


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