Exercises using a touchscreen tablet application improved functional ability more than an exercise program prescribed on paper in people after surgical carpal tunnel release: a randomised trial

Question: In people who have undergone surgical carpal tunnel release, do sensorimotor-based exercises performed on the touchscreen of a tablet device improve outcomes more than a conventional home exercise program prescribed on paper? Design: Randomised, parallel-group trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: Fifty participants within 10 days of surgical carpal tunnel release. Intervention: Each participant was prescribed a 4-week home exercise program. Participants in the experimental group received the ReHand tablet application, which administered and monitored exercises via the touchscreen. The control group was prescribed a home exercise program on paper, as is usual practice in the public hospital system. Outcome measures: The primary outcome was functional ability of the hand, reported using the shortened form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were grip strength, pain intensity measured on a 10-cm visual analogue scale, and dexterity measured with the Nine-Hole Peg Test. Outcomes were measured by a blinded assessor at baseline and at the end of the 4-week intervention period. Results: At Week 4, functional ability improved significantly more in the experimental group than the control group (MD –21, 95% CI –33 to –9) on the QuickDASH score (0 to 100). Although the mean estimates of effect on the secondary outcome also all favoured the experimental group, none reached statistical significance: grip strength (MD 5.6 kg, 95% CI –0.5 to 11.7), pain (MD –1.4 cm, 95% CI –2.9 to 0.1), and dexterity (MD –1.3 seconds, 95% CI –3.7 to 1.1). Conclusion: Use of the ReHand tablet application for early rehabilitation after carpal tunnel release is more effective in the recovery of functional ability than a conventional home exercise program. It remains unclear whether there are any benefits in grip strength, pain or dexterity. Trial registration: ACTRN12618001887268

On the stability of Voronoi cells

Let T be a given subset of ℝ n , whose elements are called sites, and let s∈T. The Voronoi cell of s with respect to T consists of all points closer to s than to any other site. In many real applications, the position of some elements of T is uncertain due to either random external causes or to measurement errors. In this paper we analyze the effect on the Voronoi cell of small changes in s or in a given non-empty set P⊂T\{s}. Two types of perturbations of P are considered, one of them not increasing the cardinality of T. More in detail, the paper provides conditions for the corresponding Voronoi cell mappings to be closed, lower and upper semicontinuous. All the involved conditions are expressed in terms of the data.This work has been supported byMICINN of Spain, Grant MTM2008-06695-C03-01/03 and SECTyPUNCuyo, Argentina

The effects of a mobile app-delivered intervention in people with symptomatic hand osteoarthritis: a pragmatic randomized controlled trial

BACKGROUND: Exercise therapy, self-management and education are recommended interventions for hand osteoarthritis (OA), but new de- livery systems are needed to solve lack of adherence. AIM: To determine the effects on hand function and pain related measures of a mobile app-delivered intervention, compared with usual care, in patients with symptomatic hand OA. DESIGN: A pragmatic, multicenter, two-group parallel randomized controlled trial. SETTING: Community health centers in rural southern Spain. POPULATION: Eighty-three participants with unilateral or bilateral symptomatic hand OA were proposed to participate, and finally 74 were included and randomized. METHODS: Participants received a home multimodal treatment (exercise, education, and self-management recommendations) with the Care- Hand mobile app or usual care (written exercises) over 12 weeks. Monthly telephone calls were performed to monitor adherence. The primary outcome was hand physical function (Australian/Canadian Hand Osteoarthritis Index, AUSCAN) at 3- and 6-months. Secondary measures included hand pain intensity and morning stiffness, upper limb function, hand dexterity, and grip and pinch strength. RESULTS: The CareHand group showed significant within-group changes in hand function at 6-months (-3.0, 95% CI -5.1 to -0.9 vs. usual care: -0.9, 95% CI -3.3 to 1.5). Neither group showed improvements in hand function at 3-months (CareHand: -1.5, 95% CI -3.1 to 0.1; usual care: -0.5, 95% CI -2.7 to 1.7). For the secondary outcomes, the CareHand group showed better results on upper limb function both at 3- and 6-months, and on pain both at 1- and 3-months compared to usual care group. Linear regression models indicated that baseline scores of pain intensity, hand status, and upper limb function were associated with a greater improvement in hand pain and physical function. CONCLUSIONS: A mobile app-delivered intervention is effective for improving hand function, and better than usual care for upper limb function and pain. Further research is warranted to understand the impact of mobile health (mHealth) in people with hand OA. CLINICAL REHABILITATION IMPACT: mHealth interventions are a feasible and secure multimodal delivery approach in older adults with hand OA in rural primary care setting. Baseline pain and upper limb function might predict functional hand outcome

The multicriteria big cube small cube method

Multicriteria optimization, Bicriteria optimization, Approximation algorithms, Facility location problems, Continuous location, Global optimization, Nondifferentiable optimization, Semi-obnoxious location, 90-80, 90B85, 90C29,