Use of relative motion orthoses from the perspective of hand-injured patients: A qualitative study.

BACKGROUND: Relative motion (RM) orthoses have gained popularity with therapists as their versatility lends to "protective," "exercise," and "adaptive" uses. PURPOSE OF THE STUDY: To ask for comments from patients wearing RM orthoses for protective or exercise reasons. STUDY DESIGN: Interpretive descriptive qualitative study. METHODS: Semi-structured face-to-face interviews comprised of nine open-ended questions were conducted with 20 hand injured patients who were advised to wear a protective or exercise RM orthosis for at least 4 weeks. RESULTS: Twenty patients participated in the interviews. Thirteen patients wore the protective RM orthoses had a mean age of 28 years (range,16-54) and the mean age was 34 years (range, 20-51) for 7 patients using exercise RM orthoses. Interviews generated 4 major themes: physical characteristics of the orthoses, challenges in daily living activities, emotional response to orthotic wear, and impact of social environment. DISCUSSION: Comments from both groups of patients suggested the small size of the orthosis contributed to wearing the orthosis as advised. Most found the orthosis comfortable, when not, comments were related to rubbing of the orthosis causing pain and rigidity of the orthosis resulting in finger swelling. A few were impacted by the orthosis drawing attention to their injured hand. Those wearing the exercise RM orthosis often removed it instead of using it for nonintentional exercise. CONCLUSIONS: Comments obtained from the limited structured interview of 20 patients wearing protective or exercise RM orthosis may offer therapists with some understanding from the patient's perspective. Additional study is worthwhile.

The Use of Relative Motion Flexion Orthoses for Chronic Boutonniere Deformity.

PURPOSE: This study investigated the effectiveness of a relative motion flexion orthosis (RMFO) for increasing the range of motion for boutonniere deformity. METHODS: We included 28 patients aged 13-62 years with chronic boutonniere deformity who could complete 0° proximal interphalangeal (PIP) joint extension with the pencil test and were stage 1 according to the Burton classification of boutonniere deformity. At the initial hand therapy appointment, the RMFO was made. The duration of the orthosis usage at the initial therapy session, after stopping the use of the orthosis (posttreatment), and at the follow-up period were noted. RESULTS: The mean time for orthosis usage of all patients was 11.7 weeks (6-40 weeks). The mean initial active distal interphalangeal joint flexion was 47° (0° to 90°) and improved to 66.8° (5° to 110°). The mean initial extension lag of the PIP joint was 22.5° (5° to 55°) and improved to 12° (0° to 30°). This did not change between discontinuation of the orthosis and final follow-up. CONCLUSIONS: The use of RMFO is effective in increasing active distal interphalangeal joint flexion and improving PIP extension in patients with Burton stage 1 chronic boutonniere deformity. TYPE OF STUDY/LEVEL OF EViDENCE: Therapeutic IV.

Systematic review of the quality of the cross-cultural adaptations of Disabilities of the Arm, Shoulder and Hand (DASH).

BACKGROUND: The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure is a widely used patient reported outcome measure. OBJECTIVE: The aim of this study is to evaluate the quality of translation procedures and assessment of the psychometric properties of cross-cultural adaptations of the DASH. METHODS: We reviewed the literature to identify all published studies of cultural adaptations of the DASH questionnaire. For the quality assessment, we used Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures, Quality Criteria for Psychometric Properties of Health Status Questionnaire and COSMIN Checklist for Cross-Cultural Validity. RESULTS: We included 25 articles with 26 versions of the DASH. Only the Puerto Rican version followed all six of the processes of cross-cultural adaptation. None of the versions assessed all eight measurement properties for Quality Criteria for Psychometric Properties of Health Status Questionnaire and none of them had a positive rating from agreement, internal consistency, responsiveness and interpretability. All the studies got a poor rating according to the COSMIN checklist. DISCUSSION: None of the versions got a good rating from all three checklists. We observed that supplementary tests for the adaptations are necessary, especially for assessing agreement, responsiveness and interpretability. We concluded that all versions need more research on psychometric properties.

Investigation of reliability, validity, and cutoff value of the Jebsen-Taylor Hand Function Test.

STUDY DESIGN: This is a cross-sectional study. INTRODUCTION: The Jebsen-Taylor Hand Function Test (JTHFT) evaluate the efficacy of treatment and assess a broad range of hand functions. PURPOSE OF THE STUDY: The purpose of this study was to investigate the psychometric properties of the JTHFT and to determine cutoff values. METHODS: The test-retest reliability was assessed by determining intraclass correlation coefficient (ICC), the hypothesis testing validity was assessed by using Spearman rho coefficient, and the receiver operating characteristic curve, area under the curve of the receiver operating characteristic, sensitivity, and specificity were calculated to determine the cutoff values. We administered JTHFT, Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and assessed grip strength with Jamar dynamometer. We included 162 healthy participants and 143 patients with hand injuries. RESULTS: The JTHFT subtests and total score have a good to excellent test-retest reliability (except lifting large light object for dominant hand-ICC: 0.77) for both dominant and nondominant hand (ICCs = 0.84-0.97). There was a statistically significant, weak positive correlation between the JTHFT total score and DASH-T (r = 0.39, P < .001 for the injured hand; r = 0.35, P < .001 for the uninjured hand) and also statistically significant weak negative correlation between grip strength for injured hand and JTHFT total score for injured hand (r = -0.33; P < .001). The cutoff value of the total score was found to be 37.08 s for injured hand. DISCUSSION AND CONCLUSION: JTHFT is a reliable and valid instrument. Clinicians and researchers may use this test with confidence to assess the dexterity of hand injury patients.

Do hand outcome measures reflect cultural influences?

OBJECTIVE: The aim of this study was to compare the activities listed in DASH, MHQ, QuickDASH with the activities listed in Canadian Occupational Performance Measure (COPM) in a Turkish patient population with hand injury. METHODS: COPM questionnaire was administered to 163 participants (61 male and 102 female; mean age 40.72 ± 13.70 years). The activities that were stated in COPM were categorized and checked whether they were present in DASH-T, MHQ, QuickDASH. RESULTS: The highest rated stated activities were "carrying a heavy object" (39.2%), "cleaning the house" (25.7%) and "writing" (15.9%). DASH reflects 30% whereas MHQ and QuickDASH reflect 16.32% and 10.2% of the problematic activities, respectively. CONCLUSION: None of three questionnaires have satisfactory results for reflecting the problematic activities among hand injured Turkish people. Open ended interviews should be irrevocable part of assessment process in order to describe a person-center treatment program.