The role of hand therapy in facilitating participation in rock wall climbing: A case report of a woman with cerebral palsy.

STUDY DESIGN: This is a case report. BACKGROUND: A woman with hemiplegic cerebral palsy and limited right upper extremity motion, strength, and control was referred to hand therapy to enable participation in adaptive climbing. PURPOSE: The purpose of this case is to describe the role of hand therapy in identifying and addressing barriers to participation in adaptive climbing. Description of the patient's wrist flexion/extension, grip strength, and functional use over the course of eleven months is also included. METHODS: Activity analysis, iterative problem solving, activity simulation, activity modification, and targeted therapeutic exercises were used over the course of eleven sessions. RESULTS: The patient conveyed successful participation in adaptive climbing with reported improvements in overall strength, motion, ability to shift weight, ability to manage digit spasticity, spontaneous right upper extremity use, and body awareness. Active right wrist flexion, wrist extension, and grip strength improved by 33 degrees, eight degrees, and 35 lbs, respectively. CONCLUSIONS: This case highlights an unconventional treatment scenario where outpatient hand therapy was entirely focused on targeting and facilitating the patient's participation in a specific activity-adaptive climbing. Rehabilitation professionals, uniquely suited to helping individuals explore interests, determine "good fit", identify barriers, and navigate obstacles, can advance the promotion of participation in activities that are both meaningful and physically engaging.

Association of Clinical Assessments of Hand Function and Quantitative Ultrasound Metrics in First Carpometacarpal Osteoarthritis.

BACKGROUND: Thumb carpometacarpal (CMC) osteoarthritis (OA), a degenerative condition affecting hand use, is typically evaluated through radiographs and clinical examination. Although this can determine treatment, it is difficult to evaluate functional limitations. Shear wave elastography (SWE) is a quantitative ultrasound technique that characterizes tissue stiffness. QUESTIONS/PURPOSES: This pilot study aimed to establish data of the SWE findings in the thenar eminence muscles in patients with first CMC OA and correlate these findings with the clinical tests of hand function. METHODS: This cross-sectional study correlated the SWE stiffness of thenar eminence muscles to clinical tests of hand function in patients with first CMC OA and in asymptomatic control subjects, using Spearman's correlation coefficient. Mean SWE values of the thenar eminence muscles in patients were compared with those in control subjects. The study was performed in a non-profit tertiary care hospital setting. Patients and control subjects were recruited on a volunteer basis. RESULTS: SWE values in the abductor pollicis brevis and flexor pollicis brevis muscles showed moderate to very strong correlation with multiple measures of hand function. Mean SWE values of the thenar eminence muscles in first CMC OA patients were lower than those in asymptomatic control subjects. CONCLUSIONS: Correlations between mean SWE values in the thenar eminence muscles and clinical measures of hand function suggest decreased function in subjects with less stiff thenar eminence muscles.

Using Carpal Tunnel Questionnaire in clinical practice: A systematic review of its measurement properties.

INTRODUCTION: Carpal Tunnel Questionnaire (CTQ) is widely used for assessing condition-specific impairments in individuals with carpal tunnel syndrome (CTS) or for assessing outcomes after carpal tunnel surgery (carpal tunnel release [CTR]). A systematic review of its measurement properties can greatly facilitate its evidence-based use in clinical practice. The purpose of this study was to systematically locate, appraise, and synthesize the evidence concerning the reliability, responsiveness, validity, minimal detectable change (MDC), and minimal clinically important difference (MCID) for the CTQ and its scales. STUDY DESIGN: This is a systematic review of measurement properties. METHODS: Using predefined keywords, PubMed, CINAHL, PsychInfo, and ProQuest were searched to locate primary studies that assessed measurement properties of the CTQ. The methodological quality of the included studies was assessed using a standardized tool. Data concerning the measurement properties were extracted and synthesized. The pooled estimates for the indices of test-retest reliability, standard error of measurement, responsiveness, MDC, and MCID were calculated from the included studies. RESULTS: A total of 34 articles were deemed eligible and included in this review. The methodological quality of these 34 studies was generally good. Most studies suggested that the CTQ and its scales had good test-retest reliability and internal consistency. However, few studies found that the Symptom Severity Scale had more than one factor. The responsiveness of the CTQ and its scales was excellent across the studies. The pooled estimates for the MDC90 and MCID for Symptom Severity Scale/Functional Status Scale were 0.72/0.79 and 1.05/1.13, respectively. DISCUSSION: The results of this review support the use of CTQ and its scales in assessing conditions-specific impairments in individuals with CTS or after CTR. However, an effort should be made to review and modify the content of the symptom severity scale due to multiple reports challenging its unidimensional structure. CONCLUSIONS: The totality of evidence emerging from this systematic review suggests that the CTQ and its scales provide reliable and valid estimate of impairments resulting from CTS or after CTR.

Clinical Assessments of Hand Function in First Carpometacarpal Osteoarthritis Do Not Appear to Correlate with Radiographic Findings.

BACKGROUND: Thumb carpometacarpal (first CMC) osteoarthritis (OA), a degenerative process affecting hand use, is typically assessed by clinical examination and radiographs. This assessment determines treatment, but it may not reflect functional limitations. QUESTIONS/PURPOSES: We aimed to explore the relationship between measures of hand function and radiographs in individuals with and without first CMC OA. METHODS: We designed a cross-sectional, observational pilot study, enrolling five patients with first CMC OA (nine thumbs with modified Eaton-Littler grades ranging from 1 to 4, using retrospective radiographic data) and nine healthy controls. They underwent evaluation of hand function using four patient-reported outcome measures (PROMs)-the Patient-Specific Functional Scale (PSFS); the Patient-Rated Wrist/Hand Evaluation (PRWHE); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH)-and one performance measure, the Arthritis Hand Function Test (AHFT). Spearman's ρ with 95% subject clustered bootstrapped confidence intervals was calculated to assess for correlations between radiographic findings and measures of hand function. RESULTS: Only the DASH work score showed strong positive correlation with radiographic OA grade, with PSFS, PRWHE, M-SACRAH, and AHFT scores demonstrating low to moderate correlations. Notable differences were found between patients and control subjects in median scores of the DASH, PSFS, PRWHE, and M-SACRAH, as well as in the grip, pinch, and button scores of the AHFT. CONCLUSION: While only the DASH work score strongly correlated with radiographic grade of first CMC OA, several measures detected considerable differences in functional hand use between patients and control subjects. The findings of this pilot study suggest that hand function scores be considered in addition to radiographs when determining severity of first CMC OA. The findings can also inform the design of a larger, powered study.

A systematic review of the benefits of occupation-based intervention for patients with upper extremity musculoskeletal disorders.

STUDY DESIGN: Systematic review of intervention studies (level 3a). INTRODUCTION: Occupation-based intervention (OBI) uses daily activities as a treatment modality. Its growing use with patients diagnosed with upper extremity musculoskeletal disorders (UE MSK) has driven interest in its supporting body of evidence. PURPOSE OF THE STUDY: The purpose of this study was to locate, appraise, and summarize current evidence of the effectiveness of OBI in treating patients with UE MSK. METHODS: Searches of PubMed, CINAHL, the Cochrane Register for Controlled Trials, and PEDro databases were conducted using predetermined keywords. Studies included in this systematic review described the use of OBI in UE MSK. Two examiners independently reviewed and assessed the quality of each study using the PEDro scale. RESULTS: Results of the database searches yielded 991 studies, 13 of which were deemed eligible to include in this review (6 randomized controlled trials, 4 pretreatment/post-treatment cohort or case series studies, and 3 single case reports). Quality of the studies varied, with 4 rated poor, 2 moderate, and 4 excellent. Overall, individuals receiving OBI showed superior benefits in patient-reported, performance, and physical measures assessing the upper extremity. DISCUSSION: Findings of this review provide preliminary evidence for the use of OBI with patients with UE MSK, however, generalizability of the evidence was compromised due to heterogeneity in study subjects as well as conceptualization, dosage, and delivery of OBI. CONCLUSIONS: The existing literature reflects promising trends in the use of OBI, underscoring its utility as a treatment option for UE MSK-related impairment, limitations, and restrictions. Nonetheless, scientific evidence concerning the effectiveness of OBI needs to be improved by conducting high-quality studies that clearly conceptualize this intervention and heighten understanding of its role in hand therapy practice.

A structured literature synthesis of wrist outcome measures: An evidence-based approach to determine use among common wrist diagnoses.

STUDY DESIGN: Structured literature synthesis. INTRODUCTION: Hand therapists and researchers have numerous options when selecting outcome measures for patients with wrist pathologies. An evidence-based approach to determining which measures are used most often can inform choices. PURPOSE OF THE STUDY: To describe how frequently outcome measures are used in recent randomized controlled trials of patients with wrist diagnoses. Identifying assessment design and related International Classification of Functioning, Disability and Health (ICF) domains provides additional consideration for selection. METHODS: Systematic PubMed and Cumulative Index to Nursing and Allied Health Literature searches for the time frame between January 2005 and March 2015 captured measures used in randomized controlled trials researching wrist-specific fractures, ligament injuries, nerve injuries, arthritis/arthroplasty, or stress injuries/wrist pain. RESULTS: Three most frequent measures used within each diagnostic category are detailed with assessment design described and ICF domain identified. Across diagnoses, grip/pinch strength and Disabilities of Arm, Shoulder and Hand were the most frequently used physical and patient-reported outcome measures, respectively. The Jebsen-Taylor Hand Function Test was the most frequently used performance measure. DISCUSSION AND CONCLUSIONS: Consideration of the evidence, ICF domains, wrist diagnoses, and assessment design can help hand therapists select the measure most appropriate for use. LEVEL OF EVIDENCE: 2a.

Responsiveness of three Patient Report Outcome (PRO) measures in patients with hand fractures: A preliminary cohort study.

STUDY DESIGN: Clinical measurement. INTRODUCTION: Few studies describe the responsiveness of functional outcomes measures in patients sustaining hand fractures. PURPOSE: 1--To explore the responsiveness of three function-oriented Patient Report Outcome (PRO) measures with a cohort of hand fracture patients. 2--To examine patients' PRO preference. METHODS: 60 participants with 74 hand fractures at an outpatient hospital-based hand therapy clinic consented to participate in this study. They completed the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Michigan Hand Outcomes Questionnaire (MHQ), and Patient-Rated Wrist/Hand Evaluation (PRWHE) at three trials: T1 (evaluation), T2 (one month later), and T3 (two months later). Participants also identified which PRO they felt best reflected their hand use and which was easiest to complete. Descriptive statistics, analyses of variance (ANOVA), effect size, and standardized response mean (SRM) were employed to describe participants, determine functional change between trials, and examine and compare PRO responsiveness. Questionnaire preference at T1 was reported. RESULTS: Participants demonstrated functional improvement, as measured by the DASH, PRWHE, and MHQ. T1 scores: DASH = 41.85 (SD ± 22.78), MHQ = 50.13 (SD ± 18.36), and PRWHE = 48.18 (SD ± 22.07). T2 scores: DASH = 22.11 (SD ± 18.18), MHQ = 69.89 (SD ± 15.93), and PRWHE = 22.62 (SD ± 18.15). T3 scores: DASH = 17.56 (SD ± 18.01), MHQ = 75.37 (SD ± 19.19), and PRWHE = 22.40 (SD ± 19.04). Each PRO demonstrated significant test score differences between trials (p < .001). Large responsiveness (≥.80) was noted between T1 and T2: (effect size: .98-1.23; SRM: 1.31-1.49) and T1 and T3 (effect size: 1.21-1.54; SRM 1.49-1.84). Smaller responsiveness effects were noted between T2 and T3 (effect size: .35-.64, SRM: .38-.81). No significant differences between questionnaire responsiveness were found. Patients reported PRWHE easiest to complete and MHQ best reflecting their hand use. CONCLUSIONS: DASH, MHQ, and PRWHE were each able to describe functional limitations in this cohort of patients with hand fractures. In capturing improvement over time they demonstrated comparable responsiveness in assessing change in patients with hand fractures. LEVEL OF EVIDENCE: 2c.

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.

SSc management--In person appointments and remote therapy (SMART): a framework for management of chronic hand conditions.

The changing health care climate poses unique challenges to managing a chronic and progressive disease like systemic sclerosis (SSc). At our institution, we employ a new model for SSc management that combines "in person" appointments and "remote" therapy (SMART). This program fosters an understanding of the disease process with the goal of improving skills and confidence for self-management and empowering individuals by providing a means of daily self-assessment. Technology is utilized as a means to remotely monitor and assess progress. We present our approach as a framework for long term management of chronic hand conditions. Evidence from a variety of disciplines is cited to support the design and parameters of this model.

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.

Comparison of positive pressure gloves on hand function in adults with burns.

The purpose of this study was to analyze the impact of a standard, custom-made pressure glove vs The NewYork-Presbyterian Dexterity Glove (NYPDG) with silon application on the palmer surface on functional hand use of burn survivors. A standard, custom-made pressure glove and NYPDG were given to 18 participants in a randomized order. Subjects wore each glove for 7 to 10 days during all activities of daily living (ADL). Variables such as hand function, difficulty of fine and gross motor ADL, and participant glove preference were assessed with each glove condition. Data collection of the second glove took place 7 to 10 days later incorporating a quasiexperimental, repeated measure design. A crossover design was used to analyze the data. The NYPDG demonstrated significantly better results in all of the four outcome categories measured: time to complete the Jebsen, the Jebsen Likert scale, fine motor ADL, and gross motor ADL. This study demonstrated that functional tasks took less time to complete and were more easily performed when using the NYPDG.

Comparison of positive pressure gloves on hand use in uninjured persons.

The purpose of this study was to examine functional hand use in uninjured adults when wearing a standard, custom-made pressure glove (SPG) as compared with a glove with select placement of suede, The New York-Presbyterian Dexterity Glove (NYPDG) (patent pending). Thirty-four participants received a custom SPG and NYPDG in a randomized order. Gloves were worn for one day during all activities of daily living (ADL). Hand function, difficulty of fine and gross motor ADL, and participant glove preference were assessed. The process was repeated approximately 1 week later with the remaining glove incorporating a quasi-experimental, repeated measure design. Data were analyzed using a crossover design. Results were significant in favor of the NYPDG in all of the four outcome categories: time to complete the Jebsen, the Jebsen Likert scale, fine motor ADL, and gross motor ADL. In conclusion, this study demonstrated that functional tasks were faster and easier to perform when using the NYPDG.

Effect of pressure garment work gloves on hand function in patients with hand burns: a pilot study.

This study aims to compare the effects of pressure garment work gloves (PGWGs) and standard-pressure garment gloves (SPGGs) on functional hand use in individuals with hand burns. A quasi-experimental, repeated-measure design was used. Each glove was worn for one week prior to testing. Grip strength, hand function, functional sensation, and functional task scores were assessed. Participants were asked to report which glove they preferred and why. Two individuals with three burned hands underwent this study. Grip and pinch strengths and functional sensation were decreased overall with the PGWG. However, better performance was noted with functional tasks involving gross and static fine-motor movements, and simple, dynamic fine-motor movements. These findings were found to be significant using a Cochran's test for related observations. Moreover, there was unanimous participant preference for the PGWG. In conclusion, use of PGWGs facilitated select functional performance, warranting further investigation.