Psychometric evaluation of the Disabilities of the Arm, Shoulder and Hand (DASH) with Dupuytren's contracture: validity evidence using Rasch modeling

Background Dupuytren’s contracture is a progressive, fibroproliferative disorder that causes fixed finger contractures and can lead to disability. With the advances of new therapeutic interventions, the necessity to assess the functional repercussions of this condition using valid, reliable and sensitive outcome measures is of growing interest. The Disabilities of the Arm, Shoulder and Hand (DASH) is one frequently used patient-reported outcome measure but its reliability and validity have never been demonstrated specifically for a population affected with Dupuytren’s contracture. The objective of this study was to evaluate the psychometric properties of the DASH, with focus on validity evidence using the Rasch measurement model. Methods Secondary analysis was performed on data collected as part of a randomised clinical trial. One hundred fifty-three participants diagnosed with Dupuytren’s contracture completed the DASH at four time points (pre-op, 3, 6 and 12 months post-op). Baseline data were analysed using traditional analysis and to test whether they adhered to the expectations of the Rasch model. Post-intervention data were subsequently included and analyzed to determine the effect of the intervention on the items. Results DASH scores demonstrated large ceiling effects at all time points. Initial fit to the Rasch model revealed that the DASH did not adhere to the expectations of the Rasch partial credit model (χ2 = 119.92; p < 0.05). Multiple items displayed inadequate response categories and two items displayed differential item functioning by gender. Items were transformed and one item deleted leading to an adequate fit. Remaining items fit the Rasch model but still do not target well the population under study. Conclusions The original version of the 30-item DASH did not display adequate validity evidence for use in a population with Dupuytren’s contracture. Further development is required to improve the DASH for this population

THE EFFECTS OF ANKLE BRACING ON SPORTS-SPECIFIC CAPABILITIES

INTRODUCTION Ankle braces are widely used in athletes. In some professional sports leagues it is mandatory to wear ankle braces in order to get insurance. Even prophylactic bracing is often used in normal sports. The efficiency of ankle joint orthoses was already demonstrated in several studies, and different types of external stabilization devices were compared. Especially the. aspects of mechanical stabilization were discussed in these studies as well as retrospective observations of the prophylactic benefit regarding the prevention of sprains by using orthoses. Neurophysiological or psychological aspects are hardly taken into consideration in the literature when evaluating different types of orthoses. In the presented study the proprioception with regard to the ankle joint and especially its influence by orthoses and the effect of ankle braces on sports- specific capabilities will be discussed. First of all the question is, whether the orthoses have an impact on the proprioception of the ankle joint at all. If there is an influence, then it is of particular importance for a comprehensive judgement to document the degree of influence by each type of orthoses for the injured and not injured ankle joint. By evaluating the results of this study a possible reduction of the proprioception caused by ankle sprains will be investigated as well. This phenomenon of a posttraumatic proprioceptive deficit was already described and controversially discussed in the literature. MATERIALS AND METHODS The influence of four stabilizing devices (aircast brace, . ligafix air-brace, malleoloc-brace, taping) on sportsspecific capabilities and propioceptivity of stable and unstable ankle joints were assessed. Therefore both ankle joints of 18 uninjured volunteers and 23 injured volunteers with an old ankle sprain were tested with two different set-ups (modified Japan-test, 5 point single leg jump test). We used a modular coordination-testsystem with 5 contact plates and a computer monitor that gives in randomised sequence the signal which circles of the 5 plates to jump on. RESULTS The time for both tests as well as reaction time and contact time for each moving direction was measured and calculated by a software program. Regarding the modified Japan-test and the 5 point single leg jump test the injured group achieved showed significant better results (p< 0.01) & (

Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a crosssectional analysis of the PALMS cohort

Objectives: The PALMS study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care. Methods: Prospective, multi-centre cohort study initiated in 2013. We collected baseline data on patientreported symptom severity (CTS-6), psychological status (HADS), hand function (Michigan Hand Questionnaire) comorbidities, EQ5D-3L and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model. Results: 753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). NHS and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity. Conclusions: Patient-reported symptom severity in carpal tunnel syndrome is significantly and positively associated with anxiety, depression, health-related quality of life and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast there is little or no evidence of any relationship with objectively derived CTS severity. Future research is needed to understand the impact of approaches and treatments that address psychosocial stressors as well as biomedical factors on relief of symptoms from carpal tunnel syndrome.CJH was funded by the National Institute for Health Research (NIHR) through a NIHR Senior Research Fellowship. ECFW is funded by the NIHR Cambridge Biomedical Research Centre

Does sensory relearning improve tactile function after carpal tunnel decompression? A pragmatic, assessor-blinded, randomized clinical trial

Despite surgery for carpal tunnel syndrome (CTS) being effective in 80-90% of cases, chronic numbness and hand disability can occur. The aim of this study was to investigate whether sensory relearning improves tactile discrimination and hand function after decompression. In a multi-centre, pragmatic, randomized, controlled trial, 104 patients were randomized to sensory relearning (n=52) or control (n=52) group. 93 patients completed 12 week follow-up. Primary outcome was the Shape-Texture Identification (STI) test at 6 weeks. Secondary outcomes were touch threshold, touch localisation, dexterity and self-reported hand function. No significant group differences were seen for the primary outcome (STI) at 6 weeks or 12 weeks. Similarly, no significant group differences were observed on secondary outcomes, with the exception of self-reported hand function. A secondary Complier-Averaged-CausalEffects (CACE) analysis showed no statistically significant treatment effect on the primary outcome. Sensory relearning for tactile sensory and functional deficits after carpal tunnel decompression is not effective

T1 Mapping Basic Techniques and Clinical Applications

AbstractIn cardiac magnetic resonance (CMR) imaging, the T1 relaxation time for the 1H magnetization in myocardial tissue may represent a valuable biomarker for a variety of pathological conditions. This possibility has driven the growing interest in quantifying T1, rather than just relying on its effect on image contrast. The techniques have advanced to where pixel-level myocardial T1 mapping has become a routine component of CMR examinations. Combined with the use of contrast agents, T1 mapping has led an expansive investigation of interstitial remodeling in ischemic and nonischemic heart disease. The purpose of this review was to introduce the reader to the physical principles of T1 mapping, the imaging techniques developed for T1 mapping, the pathophysiological markers accessible by T1 mapping, and its clinical uses