Brazilian version of the Jebsen Taylor Hand Function test: An observational cross-sectional study on standardization, reliability and normative data.

STUDY DESIGN: This is an observational cross-sectional study. BACKGROUND: To assess dexterity and hand function, it is important to use validated performance-based outcome measures, such as the Jebsen Taylor Hand Function test (JTHFT). There is no previous study that has used this test in asymptomatic individuals to establish normal values for the Brazilian population, or to assess its reliability. PURPOSE: The first aim of the study was to provide a standardized illustrated manual of the Brazilian version of the JTHFT. The second aim was to evaluate JTHFT test-retest reliability in asymptomatic adults, and the third aim was to determine normative values. METHODS: This study consists of 236 individuals aged 18-60 years, of both sexes, asymptomatic for pain or injury in the upper limbs. An illustrated manual of instructions was developed in Portuguese, test-retest reliability was assessed by determining the intraclass correlation coefficient (ICC), and to evaluate the average of the correlations between the items, the Cronbach Alpha coefficient was used. The standard error of measurements of the test and retest of the JTHFT subtasks was also performed. RESULTS: The Cronbach Alpha coefficient, resulted in acceptable average values 0.75 for the dominant hand and 0.76 for the nondominant hand. JTHFT subtests reveal moderate to excellent test-retest reliability, varying from 0.53, 95% CI: 0.39-0.64; to 0.93, 95% CI: 0.91-0.95 for the dominant hand, and for the nondominant hand 0.66, 95%: 0.57-0.74; to 0.92, 95% CI: 0.90-0.94. CONCLUSION: JTHFT is reliable for a Brazilian sample in terms of test-retest measures and can be used both in research and in clinical practice. A standardized illustrated manual of application was provided.

Effects of workplace upper extremity resistance exercises on function and symptoms of workers at a tertiary hospital: a randomized controlled trial protocol.

BACKGROUND: Work-related musculoskeletal disorders (WRMDs) are often caused by inadequate use of the musculoskeletal system during work. Evidence suggests that multimodal intervention through exercises, massage, education, and ergonomic guidelines reduces pain and symptoms in the neck and upper extremities and help to prevent musculoskeletal disorders. The purpose of this study will be to assess the additive effectiveness of a specific and individualized workplace strengthening exercise program to an ergonomic guidance in reducing fatigue, pain and discomfort in the upper extremities and neck perceived by workers. METHODS: This trial was designed according to the Consolidated Standards of Reporting Trials - CONSORT guidelines. Participants will be employees of a tertiary hospital, with any complaints of pain or discomfort in the upper extremities during the past 12 months, without clinical musculoskeletal diagnosis. 166 participants will be randomized into parallels groups as control and workplace exercises. The primary outcomes will be Numerical Pain Scale, isokinetic muscle strength of abduction and isometric handgrip strength. Secondary outcomes on discomfort, fatigue, work capacity and dysfunction will be assessed by QuickDASH, Patient Specific Functional Scale, Neck Disability Index, Need for recovery, Work Ability Index self-report questionnaires and FIT-HANSA performance test. The Ergonomic Work Analysis will be done by Quick Expose Check, RULA, REBA, RARME, ROSA and HARM risk assessment ergonomic tools. We will analyze the difference between baseline and 12 weeks of intervention by T test of independent samples (95% confidence interval, p < 0.05). Clinical significance will be analyzed by the minimum clinically important difference and effect size by Cohen index. The association between the variables will be analyzed by construct validity with the hypothesis of correlations between pain and muscle strength, strength and functionality and strength and fatigue. DISCUSSION: Although studies have shown promise outcomes for workplace exercises as an available therapeutic resource used to minimize complaints of pain and discomfort related to work, the results of this study aim to bring evidence about the benefit of a specific resistance exercise as an effective modality to facilitate mechanisms of neuromuscular adaptations, with gradual and posterior hypertrophy in the later phases. TRIAL REGISTRATION: (NCT04047056, https://clinicaltrials.gov/ct2/show/NCT04047056?term=NCT04047056&draw=2&rank=1 ) on Dec 03, 2020.

Validade de construto do Functional Impairment Test-Hand and Neck/Shoulder and Arm (FIT-HANSA) para trabalhadores com queixas no membro superior de um hospital terciário / Construct validity of the Functional Impairment Test-Hand and Neck/Shoulder and Arm (FIT-HANSA) for workers with upper limb complaints of a tertiary hospital

O Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) é um instrumento que avalia a resistência à fadiga e o desempenho do membro superior por meio de funções motoras grossas comumente utilizadas no dia a dia. Objetivo: Analisar a validade de construto do FIT-HaNSA em trabalhadores com sintomas no membro superior, por meio da correlação entre a resistência à fadiga do segmento com os escores de força muscular do ombro, cotovelo e mão, com a capacidade para o trabalho (ICT) e com a disfunção do membro superior (QUICK DASH-Br). Métodos: Trinta e nove trabalhadores de um hospital terciário com idade média de 42,9 anos (DP13,29) foram recrutados. Os instrumentos de medida Isocinético Biodex System 4 Pro™, dinamômetro de preensão palmar JAMAR®, QuickDASH-Br e ICT foram aplicados e correlacionados com o FIT-HaNSA. O Coeficiente de Correlação de Pearson (r) foi utilizado para quantificar a associação entre os instrumentos. Resultados: O FIT-HaNSA apresentou de fraca a moderada correlação entre a força muscular do ombro, cotovelo e mão (r= 0,18 ­ 0,58), porém significativas para ombro e mão. A associação entre o FIT-HaNSA com o QuickDASH-Br e ICT se mostraram fracas (r= -0,38 e 0,21). Conclusão: Nosso estudo forneceu evidências preliminares com relação às relações esperadas e validade do FIT-HaNSA como instrumento de medida para a avaliação da fadiga e desconforto em trabalhadores com queixas no membro superior

The Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) is an instrument that assesses fatigue resistance and upper limb performance through thick motor functions commonly used in everyday life. Objective: To analyze the construct validity of the FIT-HaNSA in workers with symptoms in the upper limb, through the correlation between the fatigue resistance of the segment with the muscle strength scores of the shoulder, elbow and hand, with the ability to work (ICT) and with upper limb dysfunction (QUICK DASH-Br). Methods: Thirty-nine workers from a tertiary hospital with an average age of 42.9 years (SD13.29) were recruited. The Biodex System 4 Pro ™ isokinetic measurement instruments, JAMAR® handgrip dynamometer, QuickDASH-Br and ICT were applied and correlated with FIT-HaNSA. Pearson's correlation coefficient (r) was used to quantify the association between the instruments. Results: FIT-HaNSA showed a weak to moderate correlation between the muscular strength of the shoulder, elbow and hand (r= 0.18 - 0.58), but significant for the shoulder and hand. The association between FIT-HaNSA with QuickDASH-Br and ICT was weak (r= -0.38 and 0.21). Conclusion: Our study provided preliminary evidence regarding the expected relationships and validity of FIT-HaNSA as a measurement tool for the assessment of fatigue and discomfort in workers with complaints in the upper limb

Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties.

BACKGROUND: Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair. METHODS: This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence. RESULTS: Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity. CONCLUSIONS: Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective.

Influência da órtese estática de punho na atividade muscular e amplitude de movimento de ombro e cotovelo durante uma tarefa funcional: estudo biomecânico / Influencia de la ortesis estática de puño en la actividad muscular y la amplitud de movimiento de hombro y codo durante una tarea funcional: el estudio biomecánico / Influence of static wrist orthosis on muscle activity and shoulder and elbow range of motion during a functional task: a biomechanical study

RESUMO As órteses são recursos terapêuticos indicados para proteger, corrigir deformidades ou auxiliar em certas funções; porém, seu uso pode acarretar compensações proximais no ombro. O objetivo deste estudo é avaliar a influência da órtese estática dorsal do punho, em 30° de extensão na biomecânica do ombro e cotovelo, em 25 voluntários assintomáticos durante uma tarefa funcional. Os dados da amplitude de movimento e ativação muscular foram adquiridos de forma sincronizada e simultânea durante parte do teste funcional Elui, que simula alimentação, dividida em alcance, deslocamento e liberação, de uma jarra, nas condições sem e com órtese. Para possibilitar a comparação entre os diferentes sujeitos e músculos, os dados foram analisados pela integral do sinal EMG de cada músculo e, para análise cinemática, foram construídos sistemas de coordenadas de marcadores pré-definidos. Os sinais captados foram filtrados e processados por um software personalizado, e utilizou-se o teste t para amostras pareadas - software SPSS, p<0,05. Notou-se um aumento significativo da ativação dos músculos deltoide anterior e peitoral maior na fase de alcance, e trapézio superior, deltoide anterior e posterior na fase de liberação com a órtese. A cinemática mostrou aumento significativo na amplitude de movimento na abdução do ombro, flexão do cotovelo e pronação do antebraço na fase de deslocamento, e dos movimentos extensão do ombro e flexão do cotovelo na fase de liberação. Nossos achados sugerem que o uso da órtese estática do punho durante a execução de uma tarefa pode acarretar compensações, com predomínio da ativação dos músculos mais proximais do membro superior.

RESUMEN Las ortesis son recursos terapéuticos indicados para proteger, corregir deformidades o auxiliar en ciertas funciones; sin embargo, su uso puede acarrear compensaciones proximales en el hombro. El objetivo de este estudio, entonces, es evaluar la influencia de la ortesis estática dorsal del puño, en 30° de extensión en la biomecánica del hombro y codo, en 25 voluntarios asintomáticos durante una tarea funcional. Los datos de la amplitud de movimiento y de la activación muscular han sido adquiridos de manera sincronizada y simultánea durante parte de la prueba funcional Elui, que simula la alimentación, dividida en alcance, desplazamiento y liberación, de un jarrón, en las condiciones sin y con ortesis. Para posibilitar la comparación entre los distintos individuos y músculos, los datos han sido analizados por la integral de la señal EMG de cada músculo y, para el análisis cinemático, han sido construidos sistemas de coordinadas de marcadores predefinidos. Las señales captadas han sido filtradas y procesadas por un software personalizado, y se ha utilizado la prueba t para muestras pareadas - software SPS®, p<0,05. Se ha visto un incremento significativo de la activación de los músculos deltoide anterior y pectoral más grande en la etapa de alcance, y trapecio superior, deltoide anterior y posterior en la etapa de liberación con la ortosis. La cinemática ha mostrado incremento significativo en la amplitud de movimiento en la abducción del hombro, flexión del codo y pronación del antebrazo en la etapa de desplazamiento, y de los movimientos extensión del hombro y flexión del codo en la etapa de liberación. En nuestros hallazgos se sugieren que el uso de la ortosis estática del puño durante la ejecución de una tarea puede acarrear compensaciones, con predominio de la activación de los músculos más proximales del miembro superior.

ABSTRACT Orthoses are therapeutic resources that are appropriate to protect and remedy deformities or to help in the performance of certain functions; however, its use may lead to proximal compensations in the shoulder. Thus, this study aims to evaluate the influence of dorsal static 30° extension orthoses on the shoulder and elbow biomechanics in 25 asymptomatic individuals during a functional task. The range of motion and muscle activation was collected by simultaneous and synchronized analysis during the Elui functional test related to feeding, under the conditions with and without the orthosis. In order to allow a comparison of the different subjects and muscles, the data were analyzed by EMG signal of each muscle and, for kinematic analysis, pre-defined marker coordinate systems were constructed. The captured signals were filtered and processed by custom software, and the t-test for paired samples, SPSS® software, p<0.05, was used. We found significant increase in activation of the anterior deltoid and pectoralis major muscle in the reach phase and upper trapezius, anterior and posterior deltoid in the release phase with the orthosis. The kinematic analysis showed a significant increase in the range of motion of shoulder abduction movements, elbow flexion and pronation in the displacement phase and shoulder extension and elbow flexion movements in the release phase. Our findings suggest that the use of static wrist orthosis while performing a task can lead to compensations, with predominant activation of more proximal muscles of the upper limb.

Radial nerve injury associated with humeral shaft fracture: a retrospective study.

OBJECTIVE: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital. METHODS: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out. RESULTS: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively. CONCLUSION: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study.

Radial nerve injury associated with humeral shaft fracture: a retrospective study

Objective: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital. Methods: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out. Results: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively. Conclusion: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study.

Perfil epidemiológico dos pacientes com queimadura em membros superiores atendidos em uma Unidade de Queimados terciária / Epidemiological profile of patients with burning in upper limbs treated at a tertiary Burns Unit

Objetivo: Determinar o perfil epidemiológico dos pacientes acometidos por queimaduras nos membros superiores, atendidos no setor de Fisioterapia de um hospital de referência regional do Sistema Único de Saúde (SUS) no atendimento terciário de saúde. Método: Realizada análise dos dados, durante o período de um ano, do setor de Fisioterapia da Unidade de Queimados do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Foram analisados: idade, sexo, procedência, acometimento de membros superiores, agente causal, utilização de substâncias químicas e local do acidente. Resultados: Foram avaliados 94 casos, destes, 76 apresentavam acometimento de pelo menos um dos membros superiores (80,8%). A idade média foi de 35,3 anos, sendo a faixa etária de 18 a 30 anos e o sexo masculino (68,4%) os mais acometidos. A principal causa de queimadura foi a associação de fogo com algum tipo de líquido inflamável, como álcool e gasolina. 39,5% dos pacientes eram provenientes de Ribeirão Preto/SP, sendo 67,1% dos casos acidentes domiciliares, e 5 casos de tentativa de autoextermínio, destes, três deles referentes a pacientes usuários de drogas ilícitas. Em 40,7% dos casos, os pacientes eram usuários de pelo menos uma substância química, como álcool, tabaco ou drogas. Conclusão: Na amostra analisada, o perfil dos pacientes com queimaduras em membros superiores foi composto principalmente por homens adultos jovens, envolvidos em acidentes domésticos, com líquido inflamável e em grande parte associados ao uso de substâncias químicas.

Objective: To determine the epidemiological profile of the patients affected by upper limbs burns, treated in the Physicaltherapy division of a regional referral hospital of the unified health system (SUS) in tertiary health care. Methods: A survey was conducted of data on patients affected by burns in upper limbs, during the period of one year, in Physiotherapy division of the Burn Unit of the Ribeirao Preto Medical School, University of Sao Paulo. The variables analyzed were: age, sex, origin, involvement of upper limbs, causative agent, use of chemicals and the accident site. Results: In the studied period 94 cases were evaluated in total, of these, 76 presented involvement of at least one of the upper limbs (80.8%). The average age of these patients was 35.3 years, being the most affected males (68.4%). The main cause of burns was the association of fire with some sort of flammable liquid, such as alcohol and gasoline. The age group most affected was between 18-30 years. 39.5% of the patients were from Ribeirao Preto, with 67.1% of household accidents, and 5 cases of attempted auto-extermination, being 3 of them illicit drug users patients. In 40.7% of cases, the patient was user of at least one chemical substance, such as alcohol, tobacco or drugs. Conclusion: The profile of patients with burns in upper limbs, in this specific sample, was composed mainly of young adult men, involved in domestic accidents, with flammable liquid and largely associated with the use of chemicals.

Confiabilidade de um teste funcional de desempenho do membro superior: Teste Elui / Reliability of the ELUI Upper Extremity Functionality Test

A destreza manual é uma habilidade fundamental para o desempenho das atividades cotidianas. Medidas da força muscular, amplitude de movimento e sensibilidade isoladamente podem não refletir o status funcional na avaliação físico-funcional. É importante também o uso de questionários autoaplicáveis e testes funcionais específicos que avaliem o desempenho levando em consideração o membro superior e que possam testar aspectos como a destreza, coordenação e qualidade da preensão, podendo variar em termos de padronização e propriedades psicométricas. A partir desta necessidade foi desenvolvido o Teste Funcional de Membro Superior Elui que visou oferecer um instrumento nacional de mensuração e de referência a ser utilizado na prática clínica, porém suas propriedades psicométricas ainda não são definidas. Objetivo: Analisar a confiabilidade interexaminador e teste re-teste do Teste Funcional de Membro Superior Elui. Método: 50 voluntários saudáveis, de ambos os sexos, com idade média de 32,62 anos que não apresentassem disfunção ou sintomatologia nos membros superiores foram submetidos ao teste por dois examinadores e após 30 dias por um examinador. A aplicação deste teste requer materiais simples presentes no cotidiano, divididos em 10 subitens: Simular Escrita, Virar Chave, Pegar pequenos objetos, Simular alimentação, Despejar água, Abrir Potes, Cortar com a Faca, Simular Vestuário, Pegar objetos Grandes e leves e Pegar objetos grandes e pesados. Cada voluntário avaliado deveria realizar cada item do teste com ambas as mãos ou com a mão dominante, dependendo do subitem analisado, sendo adaptada a lateralidade quando necessário. Resultados: A análise estatística foi realizada visando comparar as diferenças das medidas de cada sub-item do teste em segundos e a análise da confiabilidade interexaminadores e teste reteste pelo Coeficiente de Correlação Intraclasse (ICC) com intervalo de confiança de 95% e p < 0,05. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa local e todos os voluntários assinaram o termo de consentimento livre e esclarecido. Os resultados mostraram que com exceção da tarefa pegar pequenos objetos que teve ICC considerado não aceitável (0,65), todos os outros 9 itens apresentaram excelente confiabilidade interexaminadores entre 0,95-0,99 e Alpha de Cronbach entre 0,97-0,99. Para o teste reteste as tarefas com excelente confiabilidade foram despejar água ICC 0,98 e simular escrita ICC 0,91, boa confiabilidade para as tarefas pegar objetos grandes e pesados ICC 0,85, cortar com faca ICC 0,85 e simular alimentação ICC 0,80; confiabilidade aceitável dos itens virar chave ICC 0,74 e simular vestuário ICC 0,76; com Alpha de Cronbach de todas as tarefas entre 0,79 e 0,99. Conclusão: O Teste Elui apresentou excelente repetitividade tanto entre examinadores como em medidas repetidas ao longo do tempo pelo mesmo examinador na maioria dos subitens, sendo considerado confiável para a amostra estudada, sendo utilizada a terceira medida.

Manual dexterity is a key skill for the performance of everyday activities. Measurements of muscle strength, range of motion, and sensitivity alone may not reflect the functional status in assessing physical and functional conditions. It is also important to use self-applied assessments and specific functional tests to assess overall performance and test aspects such as dexterity, coordination and grasp quality, but these may differ in terms of standardization and psychometric properties. From this need we have developed the Elui Upper Extremity Functionality Test, with the intent to provide a national measuring instrument of the upper extremity and reference to be used in clinical practice, but its psychometric properties have not been yet defined. Objective: The aim of this study was to assess the inter-examiner reliability and test retest of the Elui Upper Extremity Functionality Test. Methods: Healthy volunteers (50) of both genders, with an average age of 32.62 years and no impairment or symptoms in the upper limbs were submitted to the test by two examiners and after 30 days by one examiner. The application of this test requires simple materials present in our everyday life, divided into 10 sub-items: Simulated writing, Turning a Key, Grasping small objects, Simulated feeding, Pouring water, Opening containers, Cutting with a knife, Simulated dressing, Grasping large and light objects, and Grasping large and heavy objects. Each volunteer evaluated should perform each item test with both hands or with the dominant hand, depending on the sub-item analyzed, and if needed, they adapted the laterality. Results: A statistical analysis was carried out to compare the differences in time measurements of each sub-item of the test in seconds. The analysis of the inter-examiner reliability and test-retest used the Interclass Correlation Coefficient (ICC) with a confidence interval of 95% and p < 0.05. The local Research Ethics Committee approved this study and all volunteers signed an informed consent form. With the exception of the Grasping small objects task, which had an unacceptable ICC (0.65), the results showed that all the other nine items had excellent inter-examiner reliability: between 0.95 and 0.99 and Cronbach's alpha between 0.97 and 0.99. For the test-retest, the tasks with excellent reliability were Pouring water ICC 0.98 and simulated writing with ICC 0.91, good reliability for the tasks Grasping large and heavy objects ICC 0.85, Cutting with a knife ICC 0.85 and Simulated feeding ICC 0.80; acceptable reliability for the items Turning a key ICC 0.74 and Simulated dressing ICC 0.76; with Cronbach's alpha of all tasks between 0.79 and 0.99. Conclusion: The Elui test showed excellent repeatability between examiners as well as with repeated measurements over time by the same examiner in most sub-items, being considered reliable for the studied sample using the third measurement.