Construct validity and internal consistency of the Home and Family Work Roles Questionnaires: a cross-sectional study with exploratory factor analysis.

INTRODUCTION: Exploratory Factor Analysis (EFA) measures the underlying relationships between questionnaire items and the factors ("constructs") measured by a questionnaire. The Home and Family Work Roles Questionnaire has not been assessed using EFA; therefore, our objective was to identify the factors measured by this questionnaire. METHODS: We recruited 314 persons to complete the questionnaire and to answer several demographic questions. We determined if the data was factorable by performing Bartlett's test of sphericity and the Kaiser-Meyer-Olkin measure of sampling adequacy. We used the Factor package in Jamovi statistical software to perform EFA. We employed an Oblimin rotation and a Principal Axis extraction method. We also calculated the internal consistency of the questionnaire as a whole as well as each individual question. RESULTS: Our sample consisted of 265 (85%) women, 45 (14%) men, and 3 (1%) non-binary or other genders. The mean age of our participants was 34.65 (SD = 11.57, range = 18-65) years. EFA suggested a three-factor model. Questions 11, 13, 14, 15, and 16 measured one factor (we interpreted this as "Caregiving Roles"), questions 1, 3, 4, 8, 9, 10, 18, and 19 measured a different factor ("Traditionally Feminine Roles"), and questions 2, 5, 6, and 12 measured the "Traditionally Masculine Roles". The questionnaire and each individual question demonstrated excellent internal consistency (Cronbach's α > 0.90). CONCLUSION: The Home and Family Work Roles Questionnaire may measure three distinct factors, which we have named Caregiving, Traditionally Feminine, and Traditionally Masculine Roles. This aligns with the theory used in developing the questionnaire. Separation of the Home and Family Work Roles Questionnaire into three sub-scales with distinct scores is recommended to measure each of the recommended constructs.

Does a familial subtype of complex regional pain syndrome exist? Results of a systematic review.

Background and Objective: Complex regional pain syndrome (CRPS) is a chronic condition characterized by severe regional pain, allodynia, hyperalgesia, and functional impairment. The aim of this systematic review is to investigate whether a familial subtype of CRPS (fCRPS) exists and to determine whether people with fCRPS have specific characteristics. Methods: Databases CINAHL, Medline, PsycINFO, and PubMed were searched with no date limitation. Quality of reporting was assessed using the Scottish Intercollegiate Guidelines Network scale and the Joanna Briggs Institute's checklists. Results: Eight studies were included. Family relationships were defined as any immediate (i.e., parents or siblings) or blood relatives. A combination of participants with known or unknown causes for CRPS was recruited. The studies in this review support the potential for the existence of fCRPS, although this included less than 25% of those affected. People with potential fCRPS showed more severe symptoms, more sites involved, a higher percentage of spontaneous onset, and earlier age at onset. An elevated sibling recurrence risk ratio of 5.6 (95% confidence interval [CI], 3.0 to 9.8) was reported for people under 50. None of the studies established a pattern of heritability. Therefore, the most likely explanation for heritability would be a multifactorial model in which cumulative and interactive Gene × Environment effects may be involved. Conclusions: This systematic review supports the potential for the existence of fCRPS; however, all identified studies used uncontrolled case reports, case series, and case-control designs that cannot provide evidence of causation. Further studies are required to reveal the heritability and genetic structure of fCRPS.

Contexte et objectifs: Le syndrome de douleur régionale complexe (SDRC) est une maladie chronique qui se caractérise par de fortes douleurs régionales, une allodynie, une hyperalgésie et une déficience fonctionnelle. Le but de cette revue systématique était de vérifier s'il existe un sous-type familial de SDRC (SDRCf) et de déterminer si les personnes atteintes de SDRCf présentent des caractéristiques particulières.Méthodes: Des recherches ont été effectuées dans les bases de données CINAHL, Medline, PsychINFO et PubMed, sans limite de date. La qualité des rapports a été évaluée à l'aide de l'échelle du Scottish Intercollegiate Guidelines Network et des listes de vérification de l'Institut Joanna Briggs.Résultats: Huit études ont été incluses. Les relations familiales ont été définies comme toutes les relations immédiates (i.e. parents, frères ou soeurs), ou les parents consanguins. Une combinaison de participants pour lesquels les causes du SDRC étaient connues et inconnues ont été recrutés. Les études ayant fait partie de cette revue vont dans le sens de la possible existence d'un SDRCf, bien que cette constatation touchait moins de 25 % des personnes affectées. Les personnes souffrant d'un possible SDRCf présentaient des symptômes plus graves, un plus grand nombre de régions touchées, un pourcentage plus élevé de déclenchements spontanés et le déclenchement de la maladie à un plus jeune âge. Un rapport relatif de récurrence élevé, se situant à 5,6 (95 % IC, 3,0 à 9,8) chez les frères et soeurs, a été rapporté pour les personnes de moins de 50 ans. Aucune des études n'établissait de modèle d'héritabilité. L'explication la plus plausible pour l'héritabilité serait donc un modèle mutifactoriel dans lequel les effets cumulatifs des gènes et de l'environnement pourraient interagir.Conclusions: Les conclusions de cette revue systémaique vont dans le sens de l'existence possible du SDRCf; toutefois, toutes les études répertoriées ont eu recours à des devis non contrôlés comme des rapports de cas, des séries de cas et des études cas-témoins qui ne peuvent pas prouver le lien de causalité. D'autres études sont nécesaires pour révéler l'héritabilité et la structure génétique du SDRCf.

Exercise to improve functional outcomes in persons with osteoporosis: a systematic review and meta-analysis.

Osteoporosis affects many aspects of daily life. The aim of this systematic review was to assess the effects of exercise interventions on functional outcomes in persons with osteoporosis, in comparison with controls. METHODS: Four databases were searched and yielded 1587 citations. Two reviewers independently determined study eligibility, rated risk of bias, appraised methodological quality of studies, and resolved discordance by consensus. RESULTS: A total of 28 studies examining 2113 participants met inclusion criteria; 25 studies were suitable for meta-analyses. Four categories of exercise were identified using the ProFaNE taxonomy. After removing studies with high risk of bias and sorting them into intervention sub-types, we were able to sufficiently reduce the heterogeneity. The standardized mean difference (SMD) favored multicomponent exercise for mobility (- 0.56, 95% CI [- 0.81, - 0.32], p = 0.06, I2 = 51%); balance (0.50, 95% CI [0.27, 0.74], p = 0.28, I2 = 21%); and self-reported measures of functioning (- 0.69, 95% CI [- 1.04, - 0.34], p = 0.02, I2 = 61%). Trials were judged at low or unclear risk of selection bias, indicating inadequate reporting and at high risk of performance bias due to lack of participant blinding. The mean methodological quality rating of the studies was 63.5% indicating moderate quality. CONCLUSIONS: A multicomponent exercise program of high-speed training combined with simulated functional tasks is promising to enhance functional outcomes. Due to substantial clinical heterogeneity of the target groups and specific demands of exercise modes, it is unclear which exercise program is optimal.

Facilitators and barriers to exercise adherence in patients with osteopenia and osteoporosis: a systematic review.

The aim of this study was to categorize the facilitators and barriers of exercise and identify methods to promote exercise adherence in the osteoporosis population. Despite the fair methodological quality of included randomized controlled trials (RCTs), less than 75 % identified facilitators and barriers to exercise. Methods to promote and measure exercise adherence were poorly reported. INTRODUCTION: Several studies have shown exercise to be successful in maintaining or increasing BMD in individuals with low bone mass. Yet, adherence to exercise is poor, with 50 % of those registered in an exercise program dropping out within the first 6 months, lack of time being the number one barrier in many populations. However, in the osteoporosis population, the main facilitator and barrier to exercise is still unclear. The aim of this study is to examine the extent to which RCTs reported the facilitators and the barriers to exercise and identified methods to promote adherence to an exercise program. METHODS: PubMed, CINHAL, EMBASE, and the Cochrane Review were queried using a predefined search criterion, and the resulting citations were imported into DistillerSR. Screening was carried out by two independent reviewers, and articles were included in the analysis by consensus. The methodological quality of included studies was assessed using the PEDro scale. RESULTS: Fifty-four RCTs examining exercise interventions in patients with osteopenia or osteoporosis were included. A spectrum of facilitators and barriers to exercise for osteoporotic patients were identified; however, no one facilitator was more frequently reported than the other. The most commonly reported barriers were lack of time and transportation. In most RCTs, methods to promote and measure exercise adherence were unsatisfactory. Of the 54 papers, 72 % reported an adherence rate to an exercise program; the lowest reported rate was 51.7 %, and the highest 100 %. CONCLUSIONS: Most RCTs found were of fair quality; however, less than three quarters identified facilitators and barriers to exercise. Reporting of methods to promote and measure exercise adherence were low. Future work should be directed toward identifying major facilitators and barriers to exercise adherence within RCTs. Only then can methods be identified to leverage facilitators and overcome barriers, thus strengthening the evidence for efficacy of optimal interventional exercise programs. This review has been registered in PROSPERO under registration number CRD42016039941.

Efficacy of transcutaneous electrical nerve stimulation for rotator cuff tendinopathy: a systematic review.

OBJECTIVE: To perform a systematic review on the efficacy of transcutaneous electrical nerve stimulation (TENS) for the treatment of rotator cuff tendinopathy in adults. METHODS: A literature search was conducted in four databases (CINAHL, Embase, PubMed and PeDRO) for randomised controlled trials published from date of inception until April 2015, comparing the efficacy of TENS for the treatment of rotator cuff tendinopathy with placebo or any other intervention. Risk of bias was evaluated using the Cochrane risk of bias tool. Results were summarised qualitatively. RESULTS: Six studies were included in this review. The mean methodological score was 49% (standard deviation 16%), indicating an overall high risk of bias. One placebo-controlled trial reported that a single TENS session provided immediate pain reduction for patients with rotator cuff tendinopathy, but did not follow the participants in the short, medium or long term. Two trials that compared ultrasound therapy with TENS reported discrepancy and contradictory results in terms of pain reduction and shoulder range of motion. Corticosteroid injections were found to be superior to TENS for pain reduction in the short term, but the differences were not clinically important. Other studies included in this review concluded that TENS was not superior to heat or pulsed radiofrequency. CONCLUSION: Due to the limited number of studies and the overall high risk of bias of the studies included in this review, no conclusions can be drawn on the efficacy of TENS for the treatment of rotator cuff tendinopathy. More methodologically sound studies are needed to document the efficacy of TENS. Until then, clinicians should prefer other evidence-based rehabilitation interventions proven to be efficacious to treat patients with rotator cuff tendinopathy.

Translation and validation of the PREE (Patient Rated Elbow Evaluation) to a French version.

BACKGROUND: Only a few outcome measures specific to elbow pathology and the assessment of their impacts on function are valid and reliable when used in French speaking populations. The English version of the Patient Rated Elbow Evaluation (PREE) was determined to be an optimal candidate for translation. HYPOTHESIS: A French version of the PREE (PREE-Fr) will be generated and compared to its original version in terms of reliability and responsiveness. MATERIALS AND METHODS: The PREE was translated following the guidelines of the American Academy of Orthopedic Surgeons. Patients with a variety of elbow pathologies completed the French version of the PREE (PREE-Fr), the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Mayo Elbow Performance Score (MEPS) on three different occasions. The test-retest reliability of the PREE-Fr was calculated using questionnaires that were filled out with a one-week interval between them. The responsiveness was assessed using questionnaires filled out six months after treatment. RESULTS: A French version of the PREE was generated. Data gathered from 54 patients yielded an intra-class correlation coefficient for reliability of 0.89 (CI95%: 0.79-0.94) for the PREE-Fr. For construct validity, using the Pearson correlation coefficient, we obtained excellent correlation between the PREE-Fr and QuickDASH at day one, one week and six months (0.89-0.96) while that between the PREE and MEPS was good to excellent (0.70-0.95). Responsiveness of the PREE-Fr was assessed and yielded a standardized response mean of 1.03, meaning that a large change was recorded between day one and six months. DISCUSSION: The PREE-Fr should be considered in French speaking populations for patients with elbow pathology, whether it is for research or evaluation purposes as it is valid, reliable and responsive to change.

Rasch analysis of the Edmonton Symptom Assessment System and research implications.

BACKGROUND: Reliable and valid assessment of the disease burden across all forms of cancer is critical to the evaluation of treatment effectiveness and patient progress. The Edmonton Symptom Assessment System (esas) is used for routine evaluation of people attending for cancer care. In the present study, we used Rasch analysis to explore the measurement properties of the esas and to determine the effect of using Rasch-proposed interval-level esas scoring compared with traditional scoring when evaluating the effects of an exercise program for cancer survivors. METHODS: Polytomous Rasch analysis (Andrich's rating-scale model) was applied to data from 26,645 esas questionnaires completed at the Juravinski Cancer Centre. The fit of the esas to the polytomous Rasch model was investigated, including evaluations of differential item functioning for sex, age, and disease group. The research implication was investigated by comparing the results of an observational research study previously analysed using a traditional approach with the results obtained by Rasch-proposed interval-level esas scoring. RESULTS: The Rasch reliability index was 0.73, falling short of the desired 0.80-0.90 level. However, the esas was found to fit the Rasch model, including the criteria for uni-dimensional data. The analysis suggests that the current esas scoring system of 0-10 could be collapsed to a 6-point scale. Use of the Rasch-proposed interval-level scoring yielded results that were different from those calculated using summarized ordinal-level esas scores. Differential item functioning was not found for sex, age, or diagnosis groups. CONCLUSIONS: The esas is a moderately reliable uni-dimensional measure of cancer disease burden and can provide interval-level scaling with Rasch-based scoring. Further, our study indicates that, compared with the traditional scoring metric, Rasch-based scoring could result in substantive changes to conclusions.

A systematic review of the quality of psychometric evidence supporting the use of an obesity-specific quality of life measure for use with persons who have class III obesity.

With global obesity rates at 42%, there is a need for high-quality outcome measures that capture important aspects of quality of life for persons with obesity. The aim of this paper was to systematically review and critique the psychometric properties and utility of the impact of weight on quality of life-lite (IWQOL-Lite) for use with persons who have class III obesity. Databases were searched for articles that addressed obesity-specific quality of life. A critical appraisal of the psychometric properties of the IWQOL-Lite and connection to a quality of life conceptual framework was completed. Raters used a standardized data extraction and quality appraisal form to guide evidence extraction. Two articles that reviewed obesity-specific quality of life measures were found; none were based on a systematic review. Six articles on the IWQOL-Lite met the criteria for critical appraisal using guidelines. The mean quality score for these articles was 59.2%. Concepts measured were consistent with the biopsychosocial concept of health defined by the World Health Organization. There is limited but consistent evidence that the IWQOL-Lite is a reliable, valid and responsive outcome measure that can be used to assess disease-specific quality of life in persons with class III obesity.

Osteotomy of the head of the radius for partial articular malunion.

Between 1995 and 2006, five intra-articular osteotomies of the head of the radius were performed in patients with symptomatic healed displaced articular fractures. Pre-operatively, all patients complained of persistent painful clicking on movement. Only patients with mild or no degenerative changes of the radial head and capitellum were considered for osteotomy. The operations were performed at a mean of 8.2 months (4 to 13) after injury and the patients were reviewed at a mean of 5.5 years (15 months to 12 years) after the osteotomy. The average Mayo Elbow Performance Index Score improved significantly from 74 before to 88 after operation, with four patients rated as good or excellent (p < 0.05). The subjective patient satisfaction score was 8.4 on a ten-point scale. All osteotomies healed and there were no complications. In this small series intra-articular osteotomy of the head of the radius was a safe and effective treatment for symptomatic intra-articular malunion without advanced degenerative changes.

The patient-rated wrist evaluation (PRWE): cross-cultural adaptation into German and evaluation of its psychometric properties.

OBJECTIVE: To cross-culturally adapt the Patient-Rated Wrist Evaluation form (PRWE) into German (PRWE-G) and to evaluate its reliability and validity. METHODS: A cross-cultural adaptation of the PRWE was carried out, according to established guidelines. 103 patients, who had undergone resection interposition arthroplasty (RIAP) for carpometacarpal osteoarthritis approximately 6.2 years earlier, completed a questionnaire booklet containing the PRWE-G, the Short Form 36 (SF-36), the Disabilities of Arm, Shoulder, and Hand (DASH); they also underwent clinical assessment with the Hand Function Index (HFI, Keitel) and Custom Score including grip and pinch strength tests. The results were used to assess the criterion and construct validity of the PRWE-G. To measure the re-test reliability, 51 patients completed a second PRWE-G within 2 weeks. RESULTS: The test-retest reliability of the PRWE-G was acceptable for the pain and function sub-scales and for the global score, with intraclass correlation coefficients of 0.78-0.87. The PRWE-G showed a high internal consistency (Cronbach's alphas of 0.92-0.97 for the scales and the total score). The typical error of measurement for the global score was 8.1 points, giving a minimal detectable change (MDC95%) of approximately 22.5 points. The PRWE-G scores correlated well with those of the DASH (r=0.82, p<0.001) but less well with those of the physical component summary of the SF-36 (r=0.53, p<0.001) and not at all with the mental component summary scores of the SF-36 (r=0.04, p>0.05). The PRWE-G scores correlated moderately with certain clinical findings of the HFI, Custom Score, and grip/pinch strength tests (r=0.30-0.59, p<0.001). CONCLUSION: The PRWE-G represents a valid and reliable instrument to evaluate self-rated outcome in German-speaking patients with hand and wrist pathology.

Validity of self-report measures of pain and disability for persons who have undergone arthroplasty for osteoarthritis of the carpometacarpal joint of the hand.

OBJECTIVE: To establish the validity of three self-report scales used to measure function following arthroplasty for osteoarthritis (OA) of the carpometacarpal joint. METHOD: Persons with OA of the carpometacarpal joint (n=122) were assessed on one occasion 9-117 months following tendon interposition arthroplasty. They completed three self-report measures of hand/upper limb disability: the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist Hand Evaluation (PRWHE), and the Disabilities of Arm, Shoulder and Hand (DASH). They also completed the Short Form 36 (SF-36) and performed tests of strength, range of motion (ROM), and dexterity. Factor analysis and correlations were used to determine the association among the scales and subscales considered to measure similar constructs (e.g., pain and physical disability). Correlations between the scales and measures of impairment were also conducted to examine construct validity of the disability measures. t-Tests evaluated the hypotheses that subjects with isolated hand OA would have lower scores than those with additional joint involvement. RESULTS: All three scales or their subscales loaded on one factor. Convergent validity of the disability measures was demonstrated by high correlations between similar subscales (r>0.75), and divergent validity by a lack of correlation between the measures and self-report hand appearance. As expected, correlations between disability and strength, dexterity, or a global measure of ROM were higher than with ROM of individual joints. The AUSCAN and the DASH were better able to discriminate those with localized hand OA from those with involvement of other joints. CONCLUSIONS: The AUSCAN, PRWHE, and DASH are valid assessments of pain and/or disability of hand OA, and provide information distinct from impairment measures.

Outcomes in carpal tunnel syndrome: symptom severity, conservative management and progression to surgery.

PURPOSE: This study investigated the relationship between severity of symptoms and success of nonoperative and operative treatment in patients with carpal tunnel syndrome (CTS). METHODS: An observational cohort study regarding the management of CTS was conducted. Thirty patients referred to a tertiary hand centre with a diagnosis of CTS were prospectively followed. Twenty-five of the patients (47 affected hands) were available for long-term follow up to determine management outcomes. Self-report symptoms and physical impairments were assessed and documented at baseline, 6 weeks, and 12 weeks using the CTS Severity Score (SSS), the Disability-Shoulder, Arm and Hand Score (DASH), and the Levine Functional Score. Longer-term follow-up was conducted to identify status on outcome measures and whether patients proceeded to surgery. RESULTS: Those who proceeded to surgery (n = 27/47 hands) had higher initial CTS SSS and DASH scores and also maintained higher scores compared to those who improved with conservative management (p < 0.05). Improvements occurred in the SSS (P < 0.0001), Functional Score (P < 0.001), and DASH score (P < 0.05) following surgery in the patients resistant to conservative management. Recovery of grip and dexterity was less satisfactory. DISCUSSION: This study suggests that the SSS is useful in the triage of patients on surgical wait-lists as patients with high initial scores or failure to change in short-term follow-up are likely to proceed to surgical release. Despite prolonged symptoms and previous treatment, patients with lower SSS scores had moderate success with a second trial of conservative management.

The prevalence of wrist ganglia in an asymptomatic population: magnetic resonance evaluation.

Magnetic resonance imaging (MRI) was performed on the wrists of 103 asymptomatic volunteers. The images were evaluated independently by two musculoskeletal radiologists and one orthopaedic surgeon. Wrist ganglia were identified in 53 out of the 103 wrists. The average long and short axes measurements were 8 mm (range 3-22) and 3 mm (range 2-10), respectively. Seventy per cent of the ganglia originated from the palmar capsule in the region of the interval between the radioscaphocapitate ligament and the long radiolunate ligament. Fourteen per cent of the ganglia were dorsal and originated from the dorsal, distal fibres of the scapholunate ligament. Two ganglia had surrounding soft tissue oedema and one had an associated intraosseous component. Unlike previous surgical and pathological series, our study showed that palmar wrist ganglia are more common than dorsal wrist ganglia. The vast majority of these asymptomatic ganglia occur without associated ligamentous disruption, soft tissue oedema or intraosseous communication.

The detection of loose bodies in the elbow: the value of MRI and CT arthrography.

Our aim was to determine the clinical value of MRI and CT arthrography in predicting the presence of loose bodies in the elbow. A series of 26 patients with mechanical symptoms in the elbow had plain radiography, MRI and CT arthrography, followed by routine arthroscopy of the elbow. The location and number of loose bodies determined by MRI and CT arthrography were recorded. Pre-operative plain radiography, MRI and CT arthrography were compared with arthroscopy. Both MRI and CT arthrography had excellent sensitivity (92% to 100%) but low to moderate specificity (15% to 77%) in identifying posteriorly-based loose bodies. Neither MRI nor CT arthrography was consistently sensitive (46% to 91%) or specific (13% to 73%) in predicting the presence or absence of loose bodies anteriorly. The overall sensitivity for the detection of loose bodies in either compartment was 88% to 100% and the specificity 20% to 70%. Pre-operative radiography had a similar sensitivity and specificity of 84% and 71%, respectively. Our results suggest that neither CT arthrography nor MRI is reliable or accurate enough to be any more effective than plain radiography alone in patients presenting with mechanical symptoms in the elbow.

Dimensionality and clinical importance of pain and disability in hand osteoarthritis: Development of the Australian/Canadian (AUSCAN) Osteoarthritis Hand Index.

OBJECTIVE: To develop a reliable, valid, and responsive self-administered questionnaire to probe pain, stiffness and physical disability in patients with osteoarthritis (OA) of the hand. DESIGN: In order to assess the dimensionality of the symptomatology of hand OA, a self-administered questionnaire was developed to probe various aspects of pain (10 items), stiffness (two items), and physical function (83 items). The question inventory was generated from eight existing health status measures and an interactive process involving four rheumatologists, two physiotherapists, and an orthopaedic surgeon. RESULTS: Face-to-face interviews were conducted with 50 OA hand patients; 39 females and 11 males with mean age 62.8 years and mean disease duration 9.4 years. Items retained were those which fulfilled specified selection criteria: prevalence > or =60% and mean importance score approximating or exceeding 2.0 Item exclusion criteria included low prevalence, gender-based, ambiguous, duplicates or similarities, alternatives, composite items, and items that were too restrictive. This process resulted in five pain, one stiffness and nine function items which have been proposed for incorporation in the AUSCAN Index. CONCLUSIONS: Using a traditional development strategy, we have constructed a self-administered multi-dimensional outcome measure for assessing hand OA. The next stage includes reliability, validity and responsiveness testing of the 15-item questionnaire.

Clinimetric properties of the AUSCAN Osteoarthritis Hand Index: an evaluation of reliability, validity and responsiveness.

OBJECTIVE: To assess the reliability, validity and responsiveness of the Australian/Canadian (AUSCAN) Osteoarthritis Hand Index in both Likert (LK) and Visual Analogue (VA)-scaled formats. METHODS: Two separate studies were conducted; the first addressing reliability and validity issues and the second addressing index responsiveness. In a group of 50 patients with osteoarthritis (OA) of the hand, test-retest reliability was assessed at a 1-week interval and internal consistency from single administrations of the Index. Construct validity was evaluated against several other outcome measures including the Functional Index for Hand Osteoarthritis (FIHOA), separate patient and physician global assessments, Doyle Index, grip strength, pinch grip, and Health Assessment Questionnaire. A 6-week washout retreatment design was used in a group of 44 OA hand patients to assess index responsiveness and comparative responsiveness against the FIHOA. RESULTS: Reliability and construct validity coefficients confirm the reliability and construct validity of both the AUSCAN LK3.0 and AUSCAN VA3.0 Indices. The washout retreatment study establishes index responsiveness and suggests that the AUSCAN LK3.0 and AUSCAN VA3.0 Indices may be more responsive than the FIHOA. CONCLUSIONS: The patient self-completed AUSCAN LK3.0 and AUSCAN VA3.0 Indices are reliable, valid and responsive and can be recommended as primary outcome measures for future hand OA clinical trials.

Outcome of plate fixation of olecranon fractures.

OBJECTIVES: To evaluate the functional outcome of plate fixation for displaced olecranon fractures, both simple and comminuted. DESIGN: Retrospective patient, chart, and radiographic review. SETTING: Academic teaching hospital. PATIENTS: Twenty-five patients who underwent plate fixation of displaced olecranon fractures by two surgeons were independently reviewed at an average follow-up of thirty-four months (range, 15-69 months). MAIN OUTCOME MEASUREMENTS: Physical capability was assessed by measuring range of motion and isometric elbow strength. Patient-rated outcomes were evaluated using the SF-36, DASH, Mayo Elbow Performance Index (MEPI), and visual analogue scales for patient satisfaction and pain. Radiographs were evaluated preoperatively, postoperatively, and at the time of final review. RESULTS: The average patient age was fifty-four years (range, 14-81 years). The Mayo classification of fractures was fourteen Type II and eleven Type III. An adequate reduction was maintained in all elbows until union. Physical capability measures indicated nonsignificant side-to-side differences in motion or strength, except for supination motion, which was reduced in the injured arm (p = 0.003). The MEPI-rated outcome was twenty-two excellent or good. Patient satisfaction was high (9.7/10), with a low pain rating (1/10). The mean DASH score was consistent with almost normal upper extremity function. The SF-36 showed no difference in physical health as compared with the average American population. Twenty percent of patients required plate removal because of prominence of the internal fixation. The outcome was not influenced by fracture pattern. CONCLUSION: Plate fixation is an effective treatment option for displaced olecranon fractures with a good functional outcome and a low incidence of complications.

Validity of pulp-to-palm distance as a measure of finger flexion.

This study investigated the validity of pulp-to-palm distance measures as clinical indicators of finger flexion capacity. Pulp-to-palm distance and goniometry of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints were measured by a single tester in 50 patients with abnormal digital flexion using a computerized hand assessment system. The correlation between pulp-to-palm distance measurements and total finger flexion measures obtained by goniometry, was moderate (r=-0.46 and -0.51). This indicates that the measures are not interchangeable. The relationship between an upper extremity disability score (DASH) and restricted motion was stronger for the goniometric measurements (r=0.45, P<0.01) than for the pulp-to-palm distance measurements (r<0.30, P>0.01). Both types of range of motion measurements were able to discriminate between minimal and substantial upper extremity disability. Further methodological evaluation is required to support the use of pulp-to-palm distance measures as an outcome indicator.

Assessment of complications of distal radius fractures and development of a complication checklist.

The purposes of this study were to determine the overall incidence of distal radius fracture (DRF) complications, determine the incidence and types of DRF complications in a consecutive cohort of 250 patients with DRFs, describe DRF complications reported by patients compared with those reported by physicians, and formulate a DRF complication checklist to improve recording of DRF complications. We found that the overall complication rates vary widely (6% to 80%). Physician-reported complication data were collected for 236 patients, and a physician-reported complication rate of 27% was determined. A patient-reported complication rate of 21% was found for 207 patients whose patient-reported data were collected. We also noted that patients and physicians assess DRF complications differently: patients are more focused on symptoms than diagnoses. A DRF complication checklist was developed to improve prospective data collection. The checklist includes a classification for all DRF complications and allows for assessment of severity of each complication.