Activities of Daily Living and Pain Intensity at Baseline in Patients with Polystructural Gunshot Wounds of the Upper Limb

Nataliya Borzykh; Svitlana Barabash; Iryna Roy; Anton Kudrin; Lyudmila Kravchuk

doi:10.15391/prrht.2025-10(6).04

Authors

Nataliya Borzykh Rehabilitation Department, State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0002-3733-7905
Svitlana Barabash Rehabilitation Department, State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine https://orcid.org/0009-0000-9111-7826
Iryna Roy Rehabilitation Department, State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0002-4138-4691
Anton Kudrin Rehabilitation Department, State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0002-8156-2755
Lyudmila Kravchuk Department of Therapy and Rehabilitation, National University of Physical Education and Sports of Ukraine, Kyiv, Ukraine https://orcid.org/0009-0009-8572-2398

DOI:

https://doi.org/10.15391/prrht.2025-10(6).04

Keywords:

Gunshot injury, physical therapy, occupational therapy, mine-blast injury, military rehabilitation, upper limbs

Abstract

Purpose. This article analyzes the structure of the total sample of patients with polystructural injuries of the upper extremities depending on the severity of injuries and the type of reconstructive interventions and evaluates the results of the initial examination according to the indicators of activity of daily life and intensity of pain syndrome with the determination of the most severe clinical group.

Materials and methods. The study involved 56 patients with gunshot wounds of the upper extremities after reconstructive interventions. Patients were divided into groups according to the severity of the polystructural injury (I-IV grade). All study participants underwent an initial examination using the DASH questionnaire, the modified Frenchay scale (MFS), and the visual analogue pain scale (VAS). Mathematical statistical methods were used to analyze the structure of the total sample and identify the most severe clinical group.

Results. The initial examination of 56 patients after gunshot wounds of the upper extremities in the post-acute period revealed the prevalence of grade IV severity (55%), in terms of distribution by segments, the most common injuries were in the shoulder-elbow segment (37%). Initial condition in the group as a whole (n=56): VAS=7 points, DASH=61.5, MFS=72.5 — pronounced pain syndrome and functional deficit. The Kruskal-Wallis test did not reveal significant differences between groups I, II, combined III-IV for pain, MFS and DASH before treatment (H=1.50; 3.57; 0.80; p>0.05). However, group II (nerve plastic surgery) tends to have the worst results: the highest pain (rank 31.04), the lowest MFS function (rank 26.31), the highest DASH disability (rank 31.38). Such results may be due to neuropathic pain, paresis and sensory deficits, which limit activity more than musculoskeletal defects in grade IV in the post-acute period.

When comparing the performance of the four most difficult tasks of the modified Frenchay scale (MFS), statistically significant intergroup differences were found only in the task of “simulating cutting food” (H=6.96; p=0.031), where the worst results (the lowest mean rank 19.46) were recorded in group II (peripheral nerve plastic surgery).

Conclusions. Despite the lack of statistical significance, grade II polystructural injury was functionally the most severe according to the visual analogue scale, MFS and DASH scales, and one statistically significant task of the MFS scale. This partially contradicts the expectations that grade IV (muscle/bone defects) would have the worst prognosis, and indicates the key role of the nerve defect (grade II) as a limiting factor in functional recovery.

References

Borzykh, N. O., Barabash, S. V., Roi, I. V., & Opryshchenko, R. I. (2025). Algorithm for constructing a rehabilitation examination according to the ICF based on the severity of polystructural gunshot injury to the upper limbs. Sports Medicine, Physical Therapy and Ergotherapy, (1), 176–184. https://doi.org/10.32782/spmed.2025.1.25

Girard, E., Abba, J., Boussat, B., Trilling, B., Mancini, A., Bouzat, P., Létoublon, C., Chirica, M., & Arvieux, C. (2017). Damage control surgery for non-traumatic abdominal emergencies. World Journal of Surgery. https://doi.org/10.1007/s00268-017-4262-6

Gummesson, C., Atroshi, I., & Ekdahl, C. (2003). The Disabilities of the Arm, Shoulder and Hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskeletal Disorders, 4, Article 11. https://doi.org/10.1186/1471-2474-4-11

Heller, A., Wade, D. T., Wood, V. A., Sunderland, A., Hewer, R. L., & Ward, E. (1987). Arm function after stroke: Measurement and recovery over the first three months. Journal of Neurology, Neurosurgery & Psychiatry. https://doi.org/10.1136/jnnp.50.6.714

Hlynyana, O. O., Kopochynska, Yu. V., & Khudetskyi, I. Yu. (2020). Physical rehabilitation for organ and joint endoprosthetics: A textbook (190 pp.). Sikorsky Kyiv Polytechnic Institute. https://ela.kpi.ua/server/api/core/bitstreams/4f56c8bb-0e76-414d-8aa1-d51c9661305a/content

Huang, H., Grant, J. A., Miller, B. S., Mirza, F. M., & Gagnier, J. J. (2015). A systematic review of the psychometric properties of patient-reported outcome instruments for use in patients with rotator cuff disease. American Journal of Sports Medicine, 43(10), 2572–2582. https://doi.org/10.1177/0363546514565096

Huriev, S. O., Kukuruza, Ya. S., Yalovenko, V. A., & Volna, I. M. (2014). Analysis of the experience in the treatment of gunshot wounds to the extremities. Emergency Medicine: From Science to Practice, (2), 25–32. http://nbuv.gov.ua/UJRN/ekctrenam_2014_2_5

Klapchuk, Y. V., Burianov, O. A., Yarmoliuk, Y. O., Borodai, O. L., Bibik, T. A., & Vakulych, M. V. (2020). The current state of diagnosis and treatment of servicemen with gunshot wounds of large joints: Review of the literature. Current Aspects of Military Medicine, 27(2), 110–124. https://doi.org/10.32751/2310-4910-2020-27-33

Kruk, I. M., & Hryhus, I. M. (2022). Physical therapy for military personnel with the consequences of gunshot wounds. Rehabilitation & Recreation: Aspects of Human Development, (12), 44–51. https://doi.org/10.32782/2522-1795.2022.12.6

Laclergue, Z., Ghédira, M., Gault-Colas, C., Billy, L., Gracies, J. M., & Baude, M. (2023). Reliability of the Modified Frenchay Scale for the assessment of upper limb function in adults with hemiparesis. Archives of Physical Medicine and Rehabilitation, 104(10), 1596–1605. https://doi.org/10.1016/j.apmr.2023.04.003

Moshkivskyi, V. M., & Larionov, V. V. (2023). Anesthesiological support for reconstructive and plastic surgery in cases of polytrauma to the forearm and hand caused by gunshot wounds. Ukrainian Journal of Military Medicine, 4(1), 94–103. https://doi.org/10.46847/ujmm.2023.1(4)-094

Naumenko, L. Y., Ipatov, A. V., Zub, T. O., & Mametyev, A. O. (2018). State of disability due to upper extremity traumas in Ukraine in 2017. TRAUMA, 19(4), 9–14. https://doi.org/10.22141/1608-1706.4.19.2018.142100

Radajewska, A., Opara, J. A., Kucio, C., Błaszczyszyn, M., Mehlich, K., & Szczygiel, J. (2013). The effects of mirror therapy on arm and hand function in subacute stroke in patients. International Journal of Rehabilitation Research, 36(3), 268–274. https://doi.org/10.1097/MRR.0b013e3283606218

Sigirtmac, I. C., & Oksuz, C. (2021). Systematic review of the quality of cross-cultural adaptations of Disabilities of the Arm, Shoulder and Hand (DASH). Medicina del Lavoro, 112(4), 279–291. https://doi.org/10.23749/mdl.v112i4.11424

Strafun, S. S., Borzykh, O. V., Borzykh, N. O., Kurinnyi, I. M., Haiko, O. H., & Laksha, A. A. (2017). Tactics of surgical treatment of the wounded with polystructural gunshot injuries of the upper limbs at the level of specialized care. Litopys Travmatolohii ta Ortopedii, (1–2), 21–27. http://nbuv.gov.ua/UJRN/Lto_2017_1-2_8

Strafun, S. S., Borzykh, N. O., Haiko, O. G., Borzykh, O. V., Gayovich, V. V., & Tsymbaliuk, Y. V. (2018, July 24). Priority directions of surgical treatment of patients with damage to the peripheral nerves of the upper limb in polystructural injuries. Trauma. https://doi.org/10.22141/1608-1706.3.19.2018.136410

Strafun, S., Borzykh, N., Kurinny, I., & Borzyh, O. (2022). Clinical and organizational aspects of firearm injuries of the upper extremities. TRAUMA, 18(6), 64–68. https://doi.org/10.22141/1608-1706.6.18.2017.121180

Trutiak, I., Pivnyk, V., Prokhorenko, H., & Kalynovych, N. (2021). The role and place of damage control surgery in military medical evacuation doctrine during hostilities in modern war. Proceedings of the Shevchenko Scientific Society. Medical Sciences, 65(2). https://doi.org/10.25040/ntsh2021.02.12

Tsymbaliuk, V. I., Luzan, B. N., & Tsymbaliuk, I. V. (2015, July 7). Diagnosis and treatment of patients with traumatic peripheral nerve injuries in combat conditions. Trauma, 16(3), 13–18. https://doi.org/10.22141/1608-1706.3.16.2015.80206

Wendel, K., Ståhl, A., & Iwarsson, S. (2013). Inter-rater agreement of a modified and extended Swedish version of the Frenchay Activities Index (FAI). European Journal of Ageing, 10(3), 247–255. https://doi.org/10.1007/s10433-013-0259-7