How therapists specializing in hand therapy evaluate the ability of patients to participate in their daily lives: An exploratory study.

STUDY DESIGN: Exploratory, Survey Design. INTRODUCTION: A gap in current knowledge exists regarding how therapists evaluate patient difficulty participating in life situations. PURPOSE: The goal is to explore how therapists measure participation. METHODS: A survey questionnaire was developed, piloted, and tested for reliability and validity. Convenience sample of 249 participants responded, providing information about assessment tools employed, problems and goals identified, indications for patient discharge, and participants' demographics. RESULTS: Participants used tools to measure body structures/functions, and informal discussion about daily activities, daily to weekly. Participation measures were employed monthly or less. Participation was noted more often in goals than problems identified in case study vignettes. Body structures/functions and participation were considered equally when anticipating patient discharge. CONCLUSIONS: Evaluations principally employed tools and identified problems relevant to impairments in body structures/functions. Yet, when looking forward, setting goals and anticipating discharge, patients' participation needs were also attended. LEVEL OF EVIDENCE: 2c.

Declines in mobility and changes in performance in the instrumental activities of daily living among mildly disabled community-dwelling older adults.

BACKGROUND: Gait speed is as an important predictor of mortality, volume of medical care, hospitalization, onset of activities of daily living (ADL) disability, and nursing home placement. We examined associations between change in gait speed and change in observed performance in the instrumental ADL (IADL) in a sample of mild-to-moderately disabled older adults. METHODS: Participants in the Sources of Independence in the Elderly project (n = 375) were approached to complete a 4-m gait assessment and a performance test of IADL competency at three points over 2 years. IADL competency was assessed by occupational therapists, who rated participants using the Assessment of Motor and Process Skills (AMPS) and who also made a global rating of need for help or supervision. Linear mixed models were developed to assess change in motor AMPS score relative to baseline status and change in gait speed and AMPS process scores. RESULTS: Baseline gait and change in gait were significant correlates of change in the AMPS motor ability measures in models that adjusted for cognitive status and AMPS process ability. Even respondents with gait speeds of 1 m/s at baseline were at risk of declining AMPS motor ability and an occupational therapist rating of IADL disability if gait speed declined. CONCLUSIONS: Slowing in gait speed is an important risk factor for IADL disability in mild to moderately disabled older adults.

Effect of life review writing on depressive symptoms in older adults: a randomized controlled trial.

OBJECTIVE: We examined the effects of engaging in the occupation-based intervention of life review through writing on expressed depressive symptoms as measured with the Geriatric Depression Scale in older adults residing in senior residences. METHOD: The study design was a randomized controlled trial that took place in four senior residences in New York City. Forty-five participants (23 treatment, 22 wait-list control) ≥ 65 yr old participated in the 8-wk, once-weekly autobiographical writing workshop, Share Your Life Story (Sierpina, 2002). RESULTS: Depressive symptoms were significantly less prevalent for the treatment group than for the control group after the 8-wk life review program (repeated-measures analysis of variance p = .03). CONCLUSION: The results suggest that the Share Your Life Story writing workshop is an effective occupation-based intervention for occupational therapists to use with older adults who reside in senior residences.

Mild depressive symptoms, self-reported disability, and slowing across multiple functional domains.

BACKGROUND: Subthreshold depressive symptoms are common in older adults. The threshold for the clinical significance of such symptoms is unclear. Mechanisms linking depressed mood to increased risk of disability need further investigation. METHODS: Among older adults who did not meet criteria for depression, respondents reporting no anhedonia and dysphoria over the past two weeks were compared to respondents reporting occasional symptoms with respect to self-reported disability and cognitive, psychomotor, and physical performance tests. RESULTS: Of 312 community-resident participants without dementia, 35.3% (n = 110) reported one or both of the two depressive symptoms at mild severity (no more than "several days" in the past two weeks). Older adults with mild depressive symptoms reported more physician-diagnosed medical conditions (2.2 vs. 1.8, p < 0.01) and mobility problems (3.0 vs. 1.8, 0-7 scale, p < 0.001), and were slower in gait (0.80 vs. 0.73 m/sec, p < 0.01) and speed of cognitive processing (Trail B, 166.1 vs. 184.7 sec, p < 0.001). In regression models that adjusted for sociodemographic and medical status, subthreshold symptoms were not a significant correlate of slowing in gait speed or cognitive performance. However, subthreshold depressive symptoms were associated with self-reported mobility limitation in models that adjusted for observed performance. CONCLUSIONS: Mild depressive symptoms in this sample were not an independent correlate of slowed performance. However, the presence of mild depressive symptoms was associated with poorer appraisal of mobility after adjustment for objective measures of mobility.

A test case: does the availability of visual feedback impact grip strength scores when using a digital dynamometer?

UNLABELLED: A cross-sectional, quantitative study of clinical measurement utility. New technological advances can challenge the efficacy of even the most widely accepted and respected tests. For example, grip strength instruments offer digital or computerized displays, precision scoring, and varied interfaces that differ from traditional Jamar™ dynamometers (Lafayette, IN). This test case explores how the opportunity to view grip strength scores during testing can influence outcomes. One hundred forty-six healthy subjects, aged 18-24 years, were tested for grip strength under visual feedback and no visual feedback conditions, using the JTech Grip Dynamometer (Salt Lake City, UT). Participants achieved a small, yet statistically significant, 1.74 lb stronger grip score with visual feedback (p<0.002). The order of grip testing conditions yielded no statistically significant differences (p=0.559). These findings suggest the need to consider how new features, unavailable with the analog Jamar™ dynamometer and unaccounted for in existing clinical guidelines could potentially influence grip scores. LEVEL OF EVIDENCE: Not applicable.

The presence and impact of stress reactions on disability among patients with arm injury.

This study explores the prevalence and types of stress reactions and their impact on self-perceived disability among arm-hand-injured patients. It tested the null hypothesis that there is no correlation between stress reactions after traumatic hand injury and arm-specific disability. In a prospective cohort of 24 patients, stress reactions were measured using the Impact of Events Scale-Revised (IES-R), and arm-specific disability was measured using the QuickDASH, an average of 7.5 months (range: 1.5-33 months) after injury. Type of injury, length of time since injury, and gender did not influence scores on the IES-R or the QuickDASH. The IES-R subscales of intrusion and hyperarousal correlated with QuickDASH scores (intrusion: r=0.57, p=0.004; hyperarousal: r=0.45, p=0.029). These findings suggest that the patient may require attention to learn how to engage in the therapy process while experiencing stress reactions.

Lifestyle-adjusted function: variation beyond BADL and IADL competencies.

PURPOSE: Using the Activity Card Sort (ACS), we derived a measure of lifestyle-adjusted function and examined the distribution of this measure and its correlates in a community sample of older adults at risk for disability transitions. DESIGN AND METHODS: Participants in the Sources of Independence in the Elderly project (n = 375) completed the ACS using a Q-sort (successive pile sort procedure), in which respondents sorted 39 nonbasic activities of daily living (non-BADL) and noninstrumental activities of daily living (non-IADL) tasks into four categories: "never performed," "used to but no longer perform," "hard to do," and "easy to do." Lifestyle-adjusted function was defined as the number reported easy/(number easy + number hard + number no longer performed). RESULTS: Respondents reported that they found it easy to perform about 60% of the activities they ever performed. However, people reporting BADL and IADL disability found it easy to perform only 32% of these activities. Lower extremity performance and depressive symptoms were significant independent correlates of lifestyle-adjusted function in models that controlled for sociodemographic and clinical status. The same 2 correlates were significant in models that excluded people with self-reported BADL or IADL disability. IMPLICATIONS: Because this measure eliminates activities never performed, it can be considered "lifestyle adjusted." Its ability to identify differences in competency among people who do not report BADL or IADL disability suggests that it may be a useful addition to functional assessment.

Unilateral and bilateral upper extremity weight-bearing effect on upper extremity impairment and functional performance after brain injury.

The purpose of the study was to investigate the effect of upper extremity (UE) weight bearing on UE impairment functional performance of persons with acquired brain injury (BI). A quasi-experimental design was used to examine a convenience sample of 99 persons with acquired BI and 22 without BI (WBI) living in a community re-entry centre. A computerized force-sensing array pressure map system was used to determine the UE pressure during unilateral and bilateral conditions. Differences between groups were examined using t-tests. Correlations were computed between UE weight bearing and hand function, and functional performance as measured by the Fugl-Meyer scale and functional independence measure (FIM) scale. The group of people with BI exerted significantly lower UE weight bearing during unilateral conditions as compared with persons WBI [left: t (119) = 2.34, p = 0.021; right: t (119) = 4.79, p = 0.043). UE weight-bearing measures correlated strongly with FIM motor scores with bilateral UE conditions yielded the highest significant correlation (bilateral left r = 0.487, p < 0.001; bilateral right r = 0.469, p < 0.01). The results indicated that UE weight-bearing pressure differs in unilateral and bilateral conditions, between persons with and WBI and between persons with stroke and traumatic brain injury. These findings may have implications for occupational therapists that use unilateral versus bilateral motor training for rehabilitation. There is a need to replicate the study design with a randomized and stratified sample of persons with BI.

Relevance of race and ethnicity for self-reported functional limitation.

It is unclear whether older adults of different race or ethnicity vary in the ways they perceive functional limitations. Variation in such self-reports may be relevant clinically, because many diagnoses (and subsequent care) depend on self-reported disability. To examine this question, self-reported hand function was compared with performance-based assessment of strength (hand dynamometer) and dexterity (Moberg Pick-Up Test) in white (n=102), African-American (n=67), and Hispanic (n=196) elderly people. Participants were Medicare beneficiaries from northern Manhattan, New York City, aged 70 and older. In adjusted analyses, self-reported hand function was associated with weaker grip strength in African-American and Hispanic participants but not in white participants. Self-reported difficulty with hand function was associated with poorer dexterity in all three groups. Similar results were observed in the subsample of participants with arthritis. These results suggest that culture or socioenvironmental differences associated with culture may influence reports of functional limitation.

Average grip strength: a meta-analysis of data obtained with a Jamar dynamometer from individuals 75 years or more of age.

BACKGROUND AND PURPOSE: Although strength diminishes with age, average values for grip strength have not been available heretofore for discrete strata after 75 years. The purpose of this meta-analysis was to provide average values for the left and right hands of men and women 75-79, 80-84, 85-89, and 90-99 years. METHODS: Contributing to the analysis were 7 studies and 739 subjects with whom the Jamar dynamometer and standard procedures were employed. RESULTS: Based on the analysis, average values for the left and right hands of men and women in each age stratum were derived. CONCLUSIONS: The derived values can serve as a standard of comparison for individual patients. An individual whose grip strength is below the lower limit of the confidence intervals of each stratum can be confidently considered to have less than average grip strength.

Disparities between ambient, standard lighting and retinal acuities in community-dwelling older people: Implications for disability.

OBJECTIVES: To examine three types of visual ability-ambient acuity, standard lighting acuity, and retinal acuity-and their relationship with self-reported disability. DESIGN: Cross-sectional prevalence survey. SETTING: New York, New York. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: Ambient acuity assessed using a near reading card; standard lighting acuity and retinal acuity assessed using the Retinal Acuity Meter. Difficulty in activities of daily living was assessed according to self-report. RESULTS: Mean logMAR acuities were 0.44 (20/56) for ambient acuity, 0.33 (20/44) for standard lighting acuity, and 0.19 (20/31) for retinal acuity (all pairwise differences, P < .001). Given the distribution of disability by ambient acuity in this sample, improving ambient acuity to the level of retinal acuity could potentially reduce self-care disability 22%. CONCLUSION: Better utilization of retinal acuity through optimal ophthalmologic care and improvement in lighting would likely reduce disability in older adults.

Variation in sources of clinician-rated and self-rated instrumental activities of daily living disability.

BACKGROUND: It is unclear how well self-reports and clinician ratings of performance in the instrumental activities of daily living (IADLs; household maintenance tasks) correspond and why they may differ. METHODS: We assessed clinician-rated IADL performance using an occupational therapy protocol, the Assessment of Motor and Process Skills (AMPS). AMPS and self-rated IADL disability were compared in two groups of nondemented elderly persons without ADL limitation: a group with functional limitation only (self-reported difficulty in some area of upper or lower body function, n = 139) and a group that reported functional limitation plus IADL disability (difficulty in at least one IADL task, n = 49). Occupational therapists were blind to self-reports, and all assessments were conducted in respondent homes. RESULTS: Self-rated IADL disability was significantly associated with the AMPS motor skill score (r = -.34, p <.001), but the motor skill score was only moderately sensitive (61%) and specific (67%) in identifying self-rated disability. In adjusted logistic regression models, clinician-rated performance and self-rated IADL disability shared some physical predictors, but only clinician-rated performance was related to cognitive status. AMPS process skill scores did not relate to self-rated IADL disability or physical or cognitive status. CONCLUSIONS: In this sample of older adults without dementia or ADL disability, clinician ratings of IADL motor skill and self-rated IADL disability were correlated. Physical deficits appear to be more salient in self-ratings than is cognitive ability, because cognitive ability (in particular, verbal fluency) was associated only with clinician-rated IADL performance.

Children's computer usage: are they at risk of developing repetitive strain injury?

The purpose of this study was to determine the average time school children spend on computers and electronic games, the positions they assume, and any associated discomfort related to their use. A twenty three-point questionnaire was distributed to 476 children in first to eighth grade from three parochial schools in one of the New York City boroughs. The findings of this study suggest that children use the computer and electronic games differently than adults and that more boys than girls engage in electronic game playing. Results clearly indicated that children are experiencing discomfort from the use of computers or electronic games, and that the discomfort is largely concentrated in the neck region. Occupational therapy could be instrumental in terms of educating the children, their parents/guardians, and their teachers on proper body mechanics, applications of ergonomically suited workstations, and the use of rest/stretch breaks while engaged in computing and electronic game playing.

An exploratory look at hand strength and hand size among preschoolers.

The purpose of this study was to develop an initial understanding about grip strength, pinch strength and hand size in normally developing 3-, 4-, and 5-year-old children. This study also investigated whether there were relationships among lowing variables: hand strength, hand size, age, and gender. A Jamar dynamometer was used to measure grip strength, and a Jamar pinch gauge was used to measure lateral pinch strength. The study population consisted of 81 preschool children from culturally an economically diverse communities in New York City. Hand strength and hand size were found to increase with each age level. The 5-year-olds were strongest in grip and pinch ability and had larger hands than the 3-year-olds and 4-year-olds. There was no statistically significant difference observed between the boys and the girls or the preferred hand in terms of hand strength.