Effective assessments to identify overuse injuries in unaffected limbs of persons with unilateral upper limb amputations.

STUDY DESIGN: Cross-sectional study. INTRODUCTION: Overuse injuries (OI) present major health problems and oftentimes, permanent disability. Persons with unilateral upper limb diagnoses, such as amputation, are at-risk for developing OI in their unaffected limbs. Measures to identify high-risk populations are needed. PURPOSE OF THE STUDY: Scores on 6 OI-assessments were compared for persons with unilateral upper limb amputations (UULA) and healthy participants. Cutoff values were proposed. METHODS: Sixty-two persons with UULA and 62 healthy controls completed this study. Scores for hand volume (HV), visual analogue scale (VAS), multi-site Semmes Weinstein Monofilament for median and ulnar nerves (SWM-M/SWM-U), torque range of motion for wrist/finger extension and flexion (TROM-E/TROM-F), intrinsic tightness (IT), and differential flexor tendon gliding (DFTG) were collected before and after 15 minutes of repetitive and resistive exercise. When analyzing collected data, descriptive statistics, and ANOVA were used to identify differences between groups. Receiver operating characteristic curves (ROC), area under the curve (AUC), sensitivity, and specificity were calculated to determine acceptable cutoff scores. Cutoff values with significant AUC ≥ 0.60 and sensitivity ≥ 0.80 were accepted. RESULTS: Statistically significant differences were found between HV by gender in both pre-exercise and post-exercise conditions. Gain scores for whole sample HV, female HV, and TROM-E were statistically different although differences were small and not meaningful. Significant AUC and acceptable pre-exercise cutoff values included 375 ml. for female HV (sensitivity 89%, specificity 87%), 505 ml. for male HV (sensitivity 81%, specificity 70%), 82 degrees for TROM-E (sensitivity 92%, specificity 71%), and 73 degrees of TROM-F (sensitivity 90%, specificity 89%). CONCLUSIONS: Potential at-risk OI-related populations, especially unaffected limbs of UULA persons, are best identified by pre-exercise cutoff values using HV by gender, TROM, and single-site SWM 2.83.

Effective interventions for cumulative trauma disorders of the upper extremity in computer users: practice models based on systematic review.

OBJECTIVE: A systematic review of over 4600 abstracts was performed to address the effectiveness of the current cumulative trauma disorder (CTD) interventions focused on the upper extremities of computer users. PARTICIPANTS: The researchers were the study participants. They included one Professor of Occupational Therapy and five Masters of Occupational Therapy Students from a Midwestern University. The Professor of Occupational Therapy has been practicing for 29 years. METHODS: The researchers employed stringent inclusion criteria for this review based on similar systematic review papers. Criteria for high quality qualitative research were incorporated to include studies other than randomized-controlled trials. This approach considered knowledge gained from specific interventions that were studied in greater detail with fewer clients. RESULTS: The results of this study identified 25 articles that met the inclusion criteria. Further review ranked the selected articles into high, medium, or low quality based on criteria adapted from other studies. The highest levels of evidence were found for education and training in ergonomics, forearm supports, ergonomic keyboards, ergonomic mice, and exercise/rest breaks. CONCLUSIONS: Two models of practice were created from this review to assist occupational therapists or other professionals with intervention strategies for computer users with CTDs.

Integrating occupational therapy services in a kindergarten curriculum: a look at the outcomes.

PURPOSE: We measured fine motor and emergent literacy outcomes in kindergarteners enrolled in two integrated kindergarten classrooms. The students received fully integrated occupational therapy services. Most occupational therapy services focused on planning and teacher consultation versus direct intervention. METHOD: A one-group pretest-posttest descriptive design was used to measure occupational therapy and emergent literacy outcomes in a convenience sample of 37 kindergarten-age children with and without disabilities. Four fine motor and two emergent literacy assessments were administered at the beginning and end of the school year. Data on the amount and type of occupational therapy services were documented over 7 months. RESULTS: Children without disabilities made statistically significant changes in all areas. Children with disabilities made significant changes in two of the fine motor and three of the emergent literacy assessments. CONCLUSION: Findings demonstrated that for this sample of children, significant improvements in fine motor and emergent literacy function were made.

The effectiveness of a comprehensive work hardening program as measured by lifting capacity, pain scales, and depression scores.

OBJECTIVE: The purpose of this pilot study was to examine the effectiveness of a four-week work rehabilitation program. METHOD: Investigators conducted a retrospective chart review of 312 clients participating in the Work Evaluation and Rehabilitation Clinic (WERC) Program from 1994-2000. Only 196 charts were sufficiently complete to be included in the study. Of these 196 prospective clients, 166 began the WERC program and 141 completed the program and were included in the database. Data were gathered from the initial history and evaluations conducted upon admission to the program and from the final evaluation conducted at the time of discharge. Demographic information was recorded. Data from the following assessments were collected: pre- and post-scores for subjective measures of pain using the Oswestry Back Pain Scale and a self-report of pain, the Beck Depression Inventory, the Waddell Sign, and pre- and post-scores of several physical performance tasks. RESULTS: Statistically significant post-test improvements were shown in all six outcome measures used in this study. A decrease in pain correlated with the Floor to Waist Lift test and with the Carrying An Object 20 Feet test. The percentage increase in Waddell's Sign correlated with a decrease in the Carrying An Object 20 Feet test. The Floor to Waist Lift test correlated with the Carrying an Object 20 Feet test. The Oswestry Test correlated with the Beck Depression Scale. There was no significant relationship found between diagnosis of back injury and Waddell's Sign, between either the Waddell's Sign and the Oswestry, or the Waddell's Sign and depression. A regression analysis revealed diagnosis, level of education, gender, and pre-injury work load as significant predictors of improvements made during the work program. CONCLUSION: The program was shown to be effective as measured by the post-test improvements in all 6 performance tests. Although more research is warranted into the effectiveness of treatment for clients with chronic pain, it appears that there is a relationship between pain and physical performance and pain and depression in clients completing a work hardening program.

Evaluation of an occupational rehabilitation program.

OBJECTIVE: The purpose of this study was to report the findings of a program evaluation for an occupational rehabilitation program in the Midwest. METHOD: An ex-post facto chart review was performed on 50 charts using demographic data, results from tests of performance and pain measures, and data from patient satisfaction questionnaires to find evidence of excellence in the program, and to identify areas for improvement. RESULTS: Over 97% of the participants actually completed the program and 76% returned to work within 3 months after program completion. Ninety-two percent indicated overall satisfaction with the program, and all aspects of the program were rated with a mean score of 4.25 or above on a 1 to 5 Likert scale. Evaluation of perceived pain scales of the participants indicate no discernable relationship between intensity of pain and successful return to work. CONCLUSION: The program showed a high completion rate, a high return to work rate, and high levels of patient satisfaction. Suggestions for improvement include an increase in use of real and simulated work activities, better documentation of pain measures, better programs to address psychosocial issues, lengthening the program, and increased communication with case managers and professionals outside of the work program.

Effectiveness of computer ergonomics interventions for an engineering company: a program evaluation.

OBJECTIVE: Ergonomic principles at the computer workstation may reduce the occurrence of work related injuries commonly associated with intensive computer use. A program implemented in 2001 by an occupational therapist and a physical therapist utilized these preventative measures with education about ergonomics, individualized evaluations of computer workstations, and recommendations for ergonomic and environmental changes. METHOD: This study examined program outcomes and perceived effectiveness based on review of documents, interviews, and surveys of the employees and the plant manager. RESULTS: The program was deemed successful as shown by 59% of all therapist recommendations and 74% of ergonomic recommendations being implemented by the company, with an 85% satisfaction rate for the ergonomic interventions and an overall employee satisfaction rate of 70%. Eighty-one percent of the physical problems reported by employees were resolved to their satisfaction one year later. CONCLUSION: Successful implementation of ergonomics programs depend upon effective communication and education of the consumers, and the support, cooperation and collaboration of management and employees.

Adoption of assistive technology for computer access among college students with disabilities.

PURPOSE: Fourteen college students with disabilities identified factors that influenced them to adopt or reject Assistive Technology (AT) for the personal computer in order to assess the effectiveness of a college course on adapted computer use. METHOD: Forty-eight items were developed for a Q sort to represent both positive and negative statements in each of the three areas of Scherer's' model (milieu, person and technology). The model was modified to include specific statements about the training experience. A series of three interviews were administered to the students during the year following completion of the class. RESULTS: Factor analysis of the Q sorts indicated that the participants had a unanimously positive experience. Three factors ('a positive experience', 'I'm OK, you're not OK', and 'support') emerged from the Q sort analysis. The training programme, the technology provided, and the characteristics of the individuals in the class all seemed to contribute to the success of the experience. Seventy-five percent of the students who took the class adopted at least some of the AT a year later. CONCLUSIONS: This study supports the need for specific training programmes and course work for college students with disabilities who are interested in improving computer access skills.