Mayo Elbow Performance Index

 Physiopedia: Mayo Elbow Performance Index
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Search strategy 2
Purpose 2
Clinically relevant anantomy (art. Cubiti) 2
Technique 3
Evidence 4

 
Search strategy
Keywords: Mayo elbow performance index, validity, mayo elbow performance score, mayo elbow performance
Search engines: pubmed, google scholar
Purpose
The Mayo Elbow Performance score (MEPS) or MEPI (Mayo Elbow Performance Index) is an instrument used to test the limitations to use the elbow during ADL caused by the pathology . This specific test uses 4 subscales, namely pain, arc of motion of the art. humeroulnaris , stability and disorders in ADL.. MEPS can be used to measure in which conditions which treatment works best, often post-operative(example: Difference in prognosis between open and closed fractures when operated) .
Clinically relevant anantomy (art. Cubiti)
3 Joints make the art. Cubiti.
The art. humeroulnaris connects the humerus and the ulna and allows flexion and extension in the elbow. This is the most important function for the MEPI and has its own subscale. It is connected with the lig. collaterale ulnare. The lig. collaterale laterale goes from the humerus over the radius to ulna and this way connects the three bones involved.
Muscles who are related to the joints of the elbow can be deviated in 4 groups: the flexors, the extensors, the pronators and the supinators.

Flexors: M. Biceps, M. Coracobrachialis, M. Brachioradials M. Brachialis, M. Pronator Teres, flexors of the wrist
Extensors: M. Triceps, M. Anconeus, M. Supinator
Pronators: M. Pronator Teres,M. Pronator Quadratus, M. Brachioradialis
Supinators: M. Supinator, M. Brachioradialis, M. Biceps

Technique
MEPS is a 4 part test where clinical information is rated based on a 100 points scale.
• - 60 - poor
• 60-74 – fair
• 75-89 - good
• 90-100 – excellent

Part 1: Pain
The therapist asks the patient how severe the pain is and in how frequent the pain appears. 45 points are for patients who do not have pain, 30 points are given to patients who have mild pain, moderate pain results in 15 points, patients with severe pain get 0 points.
Part 2: Arc of motion
De patients starts with his elbow completely stretched. The patients tries to bend his arm. 20 points are given when the arm reaches more than 100° flexion, when the angle is between 100° en 50° the therapist gives 15 points. When the maximum is no more than 50° 5 points are given.
Part 3: Stability
When the elbow is considered stable, 10 points are noted. A mildly unstable elbow results in 5 points. An unstable elbow does not receive points (0).
Part 4: ADL
Based on 5 ADL’s who are each given 5 points an image is sketched how well the patient is able to participate in the daily life. The activities are combing your hair, performing personal hygiene, eating and putting on shirt and shoes.
Mayo elbow performance index has 2 variants. The first one is used for comparison between pre – and postoperative results with patients who had a Kudo elbow prosthesis. The prosthesis was placed as a treatment for rheumatic arthritis. An example can be found in Moorey BF. table 9 at page 145. As you can see the ADL are removed from the score sheet. The points are added up and put on a 100 points scale with norms equal to the standard test.
In the last version of the MEPI the ADL is also removed and the part strength is added. The factor pain is rated at a scale of 40 with 40 no pain and 0 for greatest pain ever, the way rating is the same as for normal test. Both stability and arc of motion are rated equal to the standard MEPI. The strength is measured on clinical rating scale and goes from 20 for normal strength over 14 for mild loss of strength and 7 for moderate loss of strength to 0 for marked loss of strength. The results are punt on a scale with a maximum of 100 points. The result can be put into 4 groups as follows:
• 91- 100: excellent
• 90 – 81: good
• 80 – 71: fair
• - 70: poor
Evidence
Turchin et al. described the MEPS a: “The Mayo elbow-performance index had a clear format. The associated costs were low because only a goniometer was necessary. Little training was needed, and the system was suitable for use in a clinic. Neither strength nor deformity was included in the content of the scale, and motion was assessed only in terms of flexion and extension. The scaling was ordinal and seemed appropriate. Function and motion were weighted less heavily than pain.”
Mayo Elbow Performance Index often appears in scientific documentation as a golden standard for questionnaires, to measure improvement after surgery, to compare treatments or conditions and as an indication for therapy. Never the less Lungo et al. concluded that further research is necessary to document validity and sensitivity of a lot of elbow tests including the MEPS and only one article was found were MEPS was really tested. This article showed that the correlation with the other tests( Broberg and Morrey, Ewald et al, The Hospital for Special Surgery and Pritchard) was high but the correlation with a visual analogue scale was only moderate.

References
Books

Morrey BF, An KN.. In: Morrey BF, editor. The elbow and its
Disorders: Functional evaluation of the elbow . 3rd ed. Philadelphia: WB Saunders; 2000. p 82

Prof. Dr. VAN ROY P., prof. Dr. CLARIJS J.P., e.a., Compendium artrologie, Brussel, Dienst uitgaven VUB, 2010

Prof. Dr. VAN ROY P., prof. Dr. CLARIJS J.P., e.a., Compendium topografische en kinesiologische ontleedkunde, Brussel, Dienst uitgaven VUB, 2010

Articles

TURCHIN D.C et al, Validity of Observer-Based Aggregate Scoring Systems as Descriptors of Elbow Pain, Function, and Disability, The Journal of Bone & Joint Surgery, nr 80, 1998, p. 154-162
(evidence level 2B)

LUNGO, U.G. et al, Rating systems for evaluation of the elbow, nr 87, 2008, p. 131-161
(evidence level 1B)

MIN W. et al, Comparative Functional Outcome of AO/OTA Type C Distal Humerus Fractures: Open Injuries Do Worse Than Closed Fractures, the journal of trauma, 15 september 2011
(Evidence level 2A)