Evaluating Factors that Affect Hand Dexterity after Distal Radius Fracture

Abstract Objectives: The primary objective of this study was to determine the effect of age and gender on hand dexterity after distal radius fracture (DRF). The second aim of this study was to evaluate the recovery of hand dexterity in 1-year follow-up of DRF. The third purpose of this study was to determine the extent to which loss of range of motion (ROM) and grip strength predicts hand dexterity 6-months after injury Methods: A prospective cohort study of 242 patients with DRF examined the recovery of hand dexterity across 3 time-points (3, 6 and 12 months). Dexterity testing was performed using the small, medium and large objects subtests of the NK Dexterity testing; in both hands. The mean of two trials was computed. A generalized lineal model (GLM) multivariate analysis was performed to determine the effect of age and gender on hand dexterity. Repeated measures (GLM) was performed to test recovery over time controlling for age and gender. A second prospective study of 391 patients examined if physical impairments predict hand dexterity at 3 months and 6 months after the DRF. A stepwise multiple regression was performed. Scatter plots were analyzed and the probability level was set at α=0.05, CI 95% Results: Age was a statistically significant predictor for hand dexterity for all size of objects R2=0.227, p2=0.038, p=0.003, R2=0.044, p=0.01) but no significant effects were found on small objects (R2=0.000, p=0.860). Males had better hand dexterity scores on large and medium objects in the 3 to 6-month period. From 6-months to 12-months showed that males on medium objects were worsened while females had a slightly worst dexterity scores on that period. The manipulation of small objects indicated that females were performing much better in all three evaluation time points. Age, sex and radial-ulnar deviation arc of motion were significant predictors of large hand dexterity explaining the 23.2% of the variation in scores while, age and flexion-extension were significant predictors for the manipulation of small objects explaining the 10.9% of the variable at 3-months after fracture (n=391). At 6-months post injury, grip strength, ROM flexion-extension and age were found to be significant predictors explaining 34% of the variation in large hand dexterity. For the small objects, age, grip strength, sex and radial-ulnar deviation were significant predictors explaining 25.3% of the variation (n=319). Conclusion: This study indicates that dexterity improves rapidly in between 3 and 6 months, and slowly worsened until 1-year following DRF; and it does not recover to the state of the uninjured hand even by 1 year. This would support the need for greater attention to hand dexterity during rehabilitation. Also, this study confirms that demographics and wrist impairments determine dexterity following DRF. At the 3-month follow-up, hand dexterity is determined primarily by ROM radio-ulnar deviation and flexion-extension. At the 6-month follow-up hand dexterity is determined primarily by grip strength and flexion-extension ROM. Identifying predictors of hand dexterity following a DRF can assist clinicians understand the relationship between hand dexterity and physical impairments to improve hand functio

Joint Protection Programs for People with Hand Arthritis

The fact that Joint Protection Programs (JPP) can reduce pain and improve function is based on small, but definitive Randomized Controlled Trials (RCTs), conducted in the 1980s. However, changes over time in the nature of hand use, the rapid expansion of technology, and improvements in our understanding of health literacy mean that these programs are now outdated. Further, problems with adherence to JPP are well documented. The purpose of this thesis was 1) to conduct a scoping review to map all the available evidence around joint protection programs in published and unpublished studies 2) to evaluate the effectiveness of joint protection programs when compared to usual care/no joint protection/advice on pain reduction and improvement of hand function for individuals with hand arthritis 3) to conduct an overview of systematic reviews to establish the current state of evidence evaluating the effectiveness of joint protection for people with hand RA and OA 4) to investigate the barriers, facilitators, expectations and patient preferences regarding joint protection programs in people with hand arthritis 5) to evaluate the Content Validity Index (CVI) of Patient-Rated Wrist Evaluation (PRWE), Australian/Canadian Osteoarthritis hand Index (AUSCAN) and Thumb Disability Exam (TDX) in patients with hand arthritis and 6) to design a single center, investigator-blinded, randomized, 12-month, parallel-group, superiority study for the evaluation of the efficacy of a hand exercise and a joint protection program on pain Intensity levels in people with hand osteoarthritis. From the existing literature, we found evidence of very-low to low quality that the effects of joint protection programs compared to usual care/control on pain and hand function are too small to be clinically important at short-, intermediate- and long-term follow-ups for people with hand arthritis. We also found that awareness of the potential benefits of JP, and prior experience with JP program were very low. Common potentially modifiable patient-reported barriers to participate in future JP interventions, included: cost, work commitments distance from home to clinic and times that the JP intervention were provided. These barriers might be addressed with free and accessible forms of delivery of JP, which may lead to better uptake and participation in JP. Our findings also demonstrated very high content validity indices for the PRWHE, AUSCAN, and TDX; with strong consensus across reviewers. This augments prior statistical evidence supporting statistical measurement properties, to provide support for the content validity

The effect of weekly quizzes on the development of students' theoretical thinking

In this thesis, we evaluate the effectiveness of a basic tool for the teaching of linear algebra at university level: the administration of weekly quizzes. These tests, each made of two short, conceptual questions, are believed to have the potential of developing students' theoretical thinking. At the start of our research we believed that this kind of thinking is necessary for the understanding of linear algebra and that it represents, in general, an important educational aim in university teaching. To see if, indeed, the quizzes can contribute to the development of students' theoretical thinking, we have analyzed students' solutions to the weekly quizzes administered in a Linear Algebra II course at Concordia University in Montreal, over a one-semester time span. We have used, for this purpose, a model of thinking that characterizes theoretical thinking by certain properties, which contrast practical and theoretical thinking. Our study shows that the administration of weekly quizzes could not account for the development, in general, of theoretical thinking, with all the characteristics that it encompasses. We have found that the group's engagement with certain features of thinking is directly influenced by the mathematical content of the questions in the quizzes, and thus it is impossible to evaluate their development in time. However, the quizzes do have the potential of developing other features of theoretical thinking, that we have called, more generally "habits of the mind", because they are less conditioned by content specificities

Teaching fractions through a Measurement Approach to prospective elementary teachers: A design experiment in a Math Methods course

In this study we give an account of a teaching experiment on fractions to prospective elementary teachers, which took place in winter 2014 in a Teaching Mathematics course in an Elementary Education undergraduate program at a North-American university. The experiment was an adaptation for teacher education of the “Measurement Approach” to teaching fractions developed by the psychologist V.V. Davydov for the elementary mathematics curriculum (Davydov & Tsvetkovich, 1991). The research had the characteristics of a design experiment, with a phase of reflection on the sources of meaning of fractions appropriate for the elementary school, as well as preliminary trials with one year before (winter 2013) preceding the implementation of the experiment in a “mature form.” We had two overarching goals in the design conception: fostering future teachers’ quantitative reasoning and cultivating a positioning relative to the course institution that is more conducive to accepting the approach – that of university students acquiring theoretical knowledge. In the description and the retrospective analysis of the teaching intervention we follow the realization of these goals at three levels: the overall organization of the material and tasks in the course by the instructor, the classroom interactions between the instructor and the students in lectures, and individual reasoning without mediation by the instructor. We found that the Measurement Approach encouraged a culture of systemic justification in the classroom with some students adopting flexibly and creatively the proposed models of reasoning within a given theory. However, the risk of students’ imitating only certain aspects of these models – such as words, sentence structures, or procedures – ran high, with many students using the theory only as “decoration”, without adequate understanding. Furthermore, although spontaneous engagement with quantitative reasoning for establishing validity of statements about fractions or for explaining realistic problems was rare, it was present in several students, in encouraging forms. Very few students adopted such reasoning, but those who did, exhibited sophisticated and varied strategies for solving problems, which demonstrated robust understanding of the fraction of quantity theory

Psychometric properties of the global rating of change scales in patients with neck disorders: A systematic review with meta-analysis and meta-regression

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective The purpose of this systematic review was to critically appraise and synthesise the psychometric properties of Global Rating of Change (GROC) scales for assessment of patients with neck pain. Design Systematic review. Data sources A search was performed in four databases (MEDLINE, EMBASE, CINAHL, SCOPUS) until February 2019. Data extraction and synthesis Eligible articles were appraised using Consensus-based Standards for the selection of health Measurement Instruments checklist and the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form. Results The search obtained 16 eligible studies and included in total 1533 patients with neck pain. Test-retest reliability of global perceived effect (GPE) was very high (intraclass correlation coefficient=0.80 to 0.92) for patients with whiplash. Pooled data of Pearson\u27s r indicated that GROC scores were moderately correlated with neck disability change scores (0.53, 95% CI: 0.47 to 0.59). Pooled data of Spearman\u27s correlations indicated that GROC scores were moderately correlated with neck disability change scores (0.56, 95% CI: 0.41 to 0.68). Conclusions This study found excellent quality evidence of very good-to-excellent test-retest reliability of GPE for patients with whiplash-associated disorders. Evidence from very good-to-excellent quality studies found that GROC scores are moderately correlated to an external criterion patient-reported outcome measure evaluated pre-post treatment in patients with neck pain. No studies were found that addressed the optimal form of GROC scales for patients with neck disorders or compared the GROC to other options for single-item global assessment. PROSPERO registration number CRD42018117874

Teaching fractions through a Measurement Approach to prospective elementary teachers: A design experiment in a Math Methods course

In this study we give an account of a teaching experiment on fractions to prospective elementary teachers, which took place in winter 2014 in a Teaching Mathematics course in an Elementary Education undergraduate program at a North-American university. The experiment was an adaptation for teacher education of the “Measurement Approach” to teaching fractions developed by the psychologist V.V. Davydov for the elementary mathematics curriculum (Davydov & Tsvetkovich, 1991). The research had the characteristics of a design experiment, with a phase of reflection on the sources of meaning of fractions appropriate for the elementary school, as well as preliminary trials with one year before (winter 2013) preceding the implementation of the experiment in a “mature form.” We had two overarching goals in the design conception: fostering future teachers’ quantitative reasoning and cultivating a positioning relative to the course institution that is more conducive to accepting the approach – that of university students acquiring theoretical knowledge. In the description and the retrospective analysis of the teaching intervention we follow the realization of these goals at three levels: the overall organization of the material and tasks in the course by the instructor, the classroom interactions between the instructor and the students in lectures, and individual reasoning without mediation by the instructor. We found that the Measurement Approach encouraged a culture of systemic justification in the classroom with some students adopting flexibly and creatively the proposed models of reasoning within a given theory. However, the risk of students’ imitating only certain aspects of these models – such as words, sentence structures, or procedures – ran high, with many students using the theory only as “decoration”, without adequate understanding. Furthermore, although spontaneous engagement with quantitative reasoning for establishing validity of statements about fractions or for explaining realistic problems was rare, it was present in several students, in encouraging forms. Very few students adopted such reasoning, but those who did, exhibited sophisticated and varied strategies for solving problems, which demonstrated robust understanding of the fraction of quantity theory

The development of the modern integration theory from Cauchy to Lebesgue : a historical and epistemological study with didactical implications

In this thesis, we describe the historical development of the modern integration theory by presenting the key ideas and insights that led to its shaping, from the first rigorous definition of the definite integral given by Cauchy in 1823, to Lebesgue's theory as it first appeared in his doctoral thesis of 1902. In the final part we also present recent approaches in integration theory. We show that various problems motivated the enrichment of the notion of integral, while one in particular constituted the most important trigger of this development from the beginnings well into the 20th century: the search for a better understanding of Fourier series. For our study, we principally look at original sources, and we provide detailed proofs for important results, often by elaborating on the authors' sketchy or heuristic arguments, malting thus the original results accessible to the modern reader. We then use this historical and epistemological analysis to raise some issues related to the teaching of integration at various levels at university, i.e., in calculus, analysis and measure theory courses. For this, we look at some typical textbooks and, inspired by the historical analysis, we give some suggestions for teaching. Our findings show that there might be some conceptual gaps between subsequent levels that are not necessarily insuperable, but require careful didactical analysis

Studying the storage and processing quality of the carrot taproots (Daucus carota) of various hybrids

This paper presents the results acquired from the study of eight carrot hybrids which are suitable for growing in the climatic zone of woodland steppes, while considering a set of economical and/or biological, biochemical, and organoleptic properties. The carrot hybrids that were studied have a wide range of variation in their economic value indicators, which makes it possible to grow them for storage and processing in various soils and climate conditions without irrigation. The most productive carrot hybrids are White Sabine F1 and Yellowstone F1 with a commercial yield of 55.8–58.7 t hа–1 and an average taproot weight of 118.7–136.2 g. The levels of preservation of the taproot of the hybrids White Sabine F1 and Purple Haze F1 after seven months of storage in conditions that involved the use of a stationary pit storage facility was at 81.4% and 80.2% respectively. The use of the taproots of the hybrids Yellowstone F1 and Viking F1 for drying ensures a yield of a high-quality, biologically-valuable finished product with a yield of 11.4–11.7%. Dry hybrid Evolyutsiya F1 and Mars F1 carrots contain more than 40 mg (100 g)–1 of β-carotene