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

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

The contribution of health and psychological factors in patients with chronic neck pain and disability: A cross-sectional study

© 2018, Journal of Clinical and Diagnostic Research. All rights reserved. Introduction: One approach to reduce the burden of neck pain is the management of the prognostic factors that are associated with greater disability. Studies which quantify these predictors can support interventions that attempt to modify these trajectories. Aim: The aim of the present study to determine the contribution of psychological and health factors that are commonly associated with neck pain and disability levels. Materials and Methods: Patients between 18-65 years old were recruited to participate in the present study if they had neck pain for more than three months, with a minimum score 5/50 on the Neck Disability Index (NDI). Sixty patients were included in the study and they completed four patient reported outcomes including the Numeric Pain Rating Scale (NPRS), NDI, Short Form-12 (SF-12) and the Hospital Anxiety and Depression Scale (HADS). Multivariable regression analysis were performed to determine the contribution levels of anxiety, depression and health status on pain and disability levels. Results: There were 13 males and 47 females in the study with a mean age of 39.45±12.67 years. Pain levels were explained by physical and mental components of SF-12 and HADS subscales which accounted for 40% of the variance. SF-12 and the HADS subscales explained 50% of the variance in patients disability levels. Conclusion: The self-reported anxiety of HADS and the physical health status of SF-12 were the two significant contributors of pain and disability levels for patients with chronic neck pain. Future interventions should aim to modify these factors

Does Deep Cervical Flexor Muscle Training Affect Pain Pressure Thresholds of Myofascial Trigger Points in Patients with Chronic Neck Pain? A Prospective Randomized Controlled Trial

© 2016 Pavlos Bobos et al. Background. We need to understand more about how DNF performs in different contexts and whether it affects the pain threshold over myofascial trigger points (MTrPs). Purpose. The objectives were to investigate the effect of neck muscles training on disability and pain and on pain threshold over MTrPs in people with chronic neck pain. Methods. Patients with chronic neck pain were eligible for participation with a Neck Disability Index (NDI) score of over 5/50 and having at least one MTrP on either levator scapulae, upper trapezoid, or splenius capitis muscle. Patients were randomly assigned into either DNF training, superficial neck muscle exercise, or advice group. Generalized linear model (GLM) was used to detect differences in treatment groups over time. Results. Out of 67 participants, 60 (47 females, mean age: 39.45 ± 12.67) completed the study. Neck disability and neck pain were improved over time between and within groups (p\u3c0.05). However, no differences were found within and between the therapeutic groups (p\u3c0.05) in the tested muscles\u27 PPTs and in cervicothoracic angle over a 7-week period. Conclusion. All three groups improved over time. This infers that the pain pathways involved in the neck pain relief are not those involved in pain threshold

Systematic review of the measurement properties of performance-based functional tests in patients with neck disorders

© 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. Objectives The purpose of this systematic review is to identify and synthesise studies evaluating performance-based functional outcome measures designed to evaluate the functional abilities of patients with neck pain. Design Systematic review. Data sources A literature search using PubMed, Scopus, CINAHL, EMBASE, COCHRANE, Google Scholar and a citation mapping strategy was conducted until July 2019. Eligibility criteria More than half of the study\u27s patient population had neck pain or a musculoskeletal neck disorder and completed a functional-based test. Clinimetric properties of at least one performance-based functional tests were reported. Both traumatic and non-traumatic origins of neck pain were considered. Data extraction and synthesis Relevant data were then extracted from selected articles using an extraction guide. Selected articles were appraised using the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form (QACMRR). Results The search obtained 12 articles which reported on four outcome measures (functional capacity evaluations (FCE), Baltimore Therapeutic Equipment Work Simulator II (BTEWS II), Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA)) and a physiotherapy test package, to assess the functional abilities in patients with mechanical neck pain. Of the selected papers: one reports content validity, five construct validity, four reliability, one sensitivity to change and one both reliability and construct validity. QACMRR scores ranged from 68% to 95%. Conclusions This review found very good quality evidence that the FIT-HaNSA has excellent inter and intra-rater reliability and very weak to weak convergent validity. Excellent quality evidence of fair test-retest reliability, weak convergent validity and very weak known groups validity for the BTEWS II test was found. Good to excellent quality evidence exists that an FCE battery has poor to excellent reliability and very weak to strong validity. Good to excellent quality of weak to strong validity and trivial to strong effect sizes were found for a physiotherapy test package. Prospero registration number CRD42018112358

Psychometric properties of the Zephyr bioharness device: A systematic review

© 2018 The Author(s). Background: Technological development and improvements in Wearable Physiological Monitoring devices, have facilitated the wireless and continuous field-based monitoring/capturing of physiologic measures in healthy, clinical or athletic populations. These devices have many applications for prevention and rehabilitation of musculoskeletal disorders, assuming reliable and valid data is collected. The purpose of this study was to appraise the quality and synthesize findings from published studies on psychometric properties of heart rate measurements taken with the Zephyr Bioharness device. Methods: We searched the Embase, Medline, PsycInfo, PuMed and Google Scholar databases to identify articles. Articles were appraised for quality using a structured clinical measurement specific appraisal tool. Two raters evaluated the quality and conducted data extraction. We extracted data on the reliability (intra-class correlation coefficients and standard error of measurement) and validity measures (Pearson/Spearman’s correlation coefficients) along with mean differences. Agreement parameters were summarised by the average biases and 95% limits of agreement. Results: A total of ten studies were included: quality ratings ranged from 54 to 92%. The intra-class correlation coefficients reported ranged from 0.85–0.98. The construct validity coefficients compared against gold standard calibrations or other commercially used devices, ranged from 0.74–0.99 and 0.67–0.98 respectively. Zephyr Bioharness agreement error ranged from − 4.81 (under-estimation) to 3.00 (over-estimation) beats per minute, with varying 95% limits of agreement, when compared with gold standard measures. Conclusion: Good to excellent quality evidence from ten studies suggested that the Zephyr Bioharness device can provide reliable and valid measurements of heart rate across multiple contexts, and that it displayed good agreements vs. gold standard comparators – supporting criterion validity