Outcome and clinical changes in patients 3, 6, 12 months after a severe or major hand injury - can sense of coherence be an indicator for rehabilitation focus?

Background: Our objective was to explore outcome and clinical changes in hand function, satisfaction in daily occupations, sleep disturbances, health and quality of life in consecutive patients after a severe or major hand injury. Our objective was also to investigate possible differences between groups according to severity of injury, presence of peripheral nerve injury and the patients' sense of coherence. Methods: A postal questionnaire, including demographic data, disabilities of the arm, shoulder and hand (DASH), QoL (SF-36), EuroQol (EQ-5D VAS), hand function (VAS), satisfaction in daily occupation (SDO), was sent out 3, 6 and 12 months after injury to 45 consecutive patients with a severe or major hand injury. Sense of coherence (SOC) was evaluated at 6 months. For the descriptive study, non-parametric tests were used since almost all results were measured with ordinal scales, the study sample was small, and most variables not normally distributed. Results: Almost all self-assessed aspects of hand function, satisfaction in daily occupations, health (DASH), and physical QoL (SF-36) improved statistically for the whole group over time. Large clinical improvement was seen for physical QoL and health, while a low or no improvement was observed for mental QoL, and cold sensitivity. Few differences were found between participants with a severe or major of hand injury or with or without a major nerve injury. No significant differences in demographic data were observed between participants with high or low SOC, but participants with low SOC showed significantly lower satisfaction in daily occupations, higher DASH scores, lower mental QoL, more sleep disturbances, and bodily pain. Correlation was found between SOC, and QoL, health and satisfaction in daily occupations. Conclusions: SOC had a significant influence on patients with a severe or major traumatic hand injury. Patients with lower SOC would probably benefit from extra support and help to master their daily life, indicating that sense of coherence is an indicator for future rehabilitation focus

Linguistic validation and cultural adaptation of an English version of the Evaluation of Daily Activity Questionnaire in rheumatoid arthritis

Background: To linguistically validate and culturally adapt the Evaluation of Daily Activity Questionnaire (EDAQ) for use in rheumatoid arthritis (RA) from Swedish to British English. The EDAQ is a patient reported outcome measure of daily activity ability. It includes 11 activity domains (Eating and Drinking; Personal Care; Dressing; Bathing; Cooking; Moving Indoors; House Cleaning; Laundry; Moving and Transfers; Communication; Moving Outdoors) and was developed for use in rheumatoid arthritis (RA). Methods: The EDAQ was translated from Swedish to English using standard methods. Activity diaries, cognitive debriefing interviews and focus groups were completed with people with RA to: generate new culturally applicable items; identify important items in the Swedish version to retain in the English version; and develop the English EDAQ based on their views of content and layout. Content validity was established by linking the EDAQ to the International Classification of Functioning RA Core Set. Results: The English EDAQ translation was harmonised with the Swedish version to ensure equivalence of meaning. Sixty-one people with RA participated. 156 activities were identified from 31 activity diaries and included in a draft English EDAQ. Following interviews (n=20) and four focus groups, 138 activities were retained and three additional domains added (Gardening/Household Maintenance; Caring; and Leisure/ Social Activities). Most ICF RA Core Set activities are in the EDAQ. Conclusions: The English EDAQ is a detailed self-report measure of ability in RA. with good content validity

Hand-arm vibration syndrome; Consequences for hand function and quality of life

Workers exposed to hand-held vibrating machines may risk developing a hand-arm vibration syndrome (HAVS), a condition which can cause chronic impairment and disability. The aims of this thesis were 1) to obtain deeper insight and further knowledge of HAVS and the consequences for hand function, and aspects of quality of life (QoL); 2) to investigate the usefulness of clinical assessments in diagnosing HAVS; 3) to evaluate a treatment method for patients with severe cold intolerance. The thesis is based on five papers and a total of 131 vibration exposed workers. A number of questions on hand symptoms, standardised tests of hand function and questionnaires were included. Results: 1) The most common hand symptoms were cold intolerance, numbness and pain. Sensory functions were more disturbed than motor functions in clinical assessments. Working outdoors in cold weather, using vibrating machines, opening lids and packages, writing, lifting and carrying objects appeared more difficult than other activities. Workers with HAVS described lower QoL here expressed as less subjective well-being, more symptoms of ill-health and ADL difficulties than workers without symptoms. 2) Cold intolerance and pain showed a high agreement with the Stockholm Workshop Scales (SWS), the gold standard in diagnosing HAVS. Three out of ten objective tests of hand function, assessing perception of vibration, perception of touch/pressure, and dexterity showed a moderate agreement with SWS. Thus, corresponding defined objective tests of hand function (Tactilometry, Semmes-Weinstein monofilaments, and Purdue pegboard test) combined with questions on cold intolerance and pain, together with the SWS can be helpful for diagnosing HAVS. 3) Behavioural treatment of cold intolerance was not effective in workers with HAVS although digital skin temperature increased after treatment. The results indicated that the subjective assessment of cold intolerance did not correlate with the objective assessment of digital skin temperature. The findings highlight the lack of knowledge of the nature and pathophysiology of cold intolerance. Conclusion: 1) HAVS can result in impaired hand function and lower QoL 2) Specific tests of hand function and questions of hand symptoms can be useful for detecting a vibration injury. 3) Since no treatment of HAVS has proved effective, prophylactic measures should be further highlighted

Hand function tests and questions on hand symptoms as related to the stockholm workshop scales for diagnosis of hand-arm vibration syndrome.

The severity of hand-arm vibration syndrome (HAVS) is usually graded according to the Stockholm workshop scales. Although the Stockholm workshop scales are regarded the gold standard for assessing the severity of HAVS, they are based primarily on subjective symptoms. The aim of the present study was to explore the agreement between Stockholm workshop scales and the outcome from ten well-defined clinical tests commonly used in hand rehabilitation for assessment of hand function. One hundred and eleven vibration-exposed workers participated in the study. Ten objective tests of hand function and four questions on subjective hand symptoms were included. The results indicated that, out of these tests, perception of vibration, perception of touch/pressure and dexterity showed a moderate agreement with Stockholm workshop scales. Among specific questions on hand symptoms, cold intolerance and pain showed a high agreement with Stockholm workshop scales. It is concluded that defined objective tests combined with directed questions on specific hand symptoms, together with the Stockholm workshop scales, may be helpful for diagnosing HAVS

Health-related quality of life 5 years after carpal tunnel release among patients with diabetes: a prospective study with matched controls.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy encountered in diabetes. The short-term improvement after carpal tunnel release has previously been demonstrated not to differ between patients with and without diabetes, despite a marked impairment in health-related quality of life (HRQL) among the former. In this study, we compare HRQL 5 years after carpal tunnel release between these two groups of patients

Activity limitations before and after surgical carpal tunnel release among patients with and without diabetes.

OBJECTIVES: To evaluate activity limitations before and after carpal tunnel release among patients with and without diabetes, to explore differences between genders and the influence of grip strength on activity limitations. DESIGN: Prospective case-control study. PATIENTS: Thirty-three patients with diabetes and carpal tunnel syndrome (CTS) were age and gender matched with 30 patients without diabetes having idiopathic CTS. METHODS: Activity limitations were assessed pre-operatively, 3 and 12 months after surgery, with the self-administered Evaluation of Daily Activities Questionnaire (EDAQ) containing 102 activity items in 11 dimensions and 3 additional male-activity-oriented dimensions including 22 items. RESULTS: For all dimensions the mean score was higher for patients with diabetes compared with patients without diabetes. This indicates a more pronounced activity limitation for patients with diabetes. However, no statistical differences between the two groups could be demonstrated. In general, females have significantly higher activity limitation scores than males. CONCLUSION: CTS creates a broad variety of activity limitations for affected patients. After carpal tunnel release a significant alleviation of these limitations occurs within the first 3 months. Activity limitations seem not to be related to diabetes, but were more pronounced in women than in men, probably due to reduced grip strength

Health-related quality of life in diabetic patients with carpal tunnel syndrome

P>Aims To determine health-related quality of life (HRQL) in diabetic and non-diabetic patients with carpal tunnel syndrome (CTS) before and after surgical treatment. Methods In a prospective study, 35 consecutive diabetic patients with CTS were age and gender matched with 31 non-diabetic patients with idiopathic CTS. At baseline (preoperatively), 6, 12 and 52 weeks after surgical carpal tunnel release, patients completed the generic Short-Form 36 (SF-36) and the disease-specific Boston Carpal Tunnel Questionnaire (BCTQ). Results The SF-36 physical component scores at baseline were significantly reduced for diabetic (39 +/- 7.4) compared with non-diabetic patients (48 +/- 9.0) (P < 0.05). Mixed model analysis demonstrated no differences in post-surgical improvement over time between diabetic and non-diabetic patients. The largest clinical effect was found for bodily pain (effect size 0.8). However, population norms were not reached for the diabetic patients. At baseline, no difference was found in mental component score, which deteriorated over time for diabetic patients. At baseline, BCTQ demonstrated that diabetic patients experienced more pronounced 'numbness in the hand' than non-diabetic patients. Large clinical improvements were found in both symptom severity (effect size 1.98-2.14) and functional status score (effect size 0.89-0.94) for both diabetic and non-diabetic patients, with no difference between the two patient groups. Conclusions HRQL is impaired in diabetic patients with CTS compared with non-diabetic patients with CTS and population norms. However, diabetic patients experience similar symptomatic and functional benefits from carpal tunnel release as do non-diabetic patients

Coping strategies in daily occupations 3 months after a severe or major hand injury.

Coping strategies used in performing daily occupations 3 months after a severe or major hand injury were explored. A semi-structured interview was performed with 13 participants with hand injuries based on Hand Injury Severity Scoring System and analysed using content analysis. Six groups of strategies were identified: 'Changing performance of daily occupations', 'Actively processing trauma experience', 'Changing occupational patterns', 'Receiving assistance', 'Using emotional strategies' and 'Keeping up a social network'. The problem- and emotional-solving strategies identified in this study can be used to support other patients early in rehabilitation. Patients with few coping strategies should be recognized. Information and practical handouts to patients, therapists and relatives should stimulate and help patients with hand problems enabling in meaningful occupations and preventing unnecessary stress. Furthermore, social support should be encouraged and family should be actively involved in rehabilitation. To insure trustworthiness, member checks were used on four randomly selected participants, but could possibly be used with all participants. Further research is needed in a longitudinal study to explore which coping strategies or adaptation patients use to perform daily occupations at a later stage. Copyright (c) 2010 John Wiley & Sons, Ltd