Comparison of use of plaster casting versus elastic bandage following carpal tunnel release: a randomized controlled study.

OBJECTIVE: To compare the effects of two postoperative regimens following carpal tunnel release; plaster casting and elastic bandaging. DESIGN: A randomized controlled study. PATIENTS: Patients with carpal tunnel syndrome and planned surgical carpal tunnel release were invited to participate. METHODS: A total of 94 patients were randomized to either plaster casting or elastic bandaging to be used 2 weeks postoperatively. Muscle strength, pain rated on a visual analogue scale, range of movement, sensibility, oedema, and different scores regarding symptoms and function were measured before and 2, 4, 6, 8 and 26 weeks after surgery. RESULTS: No differences were found between the 2 groups for any measurement, except for the DASH (Disability of the Arm, Shoulder and Hand) Health Score and daily function, rated 2 weeks postoperatively, in which the bandage group scored better. Both groups improved significantly over time for all measurements, sensibility was improved after 2 weeks, while strength was not fully recovered until week 26. CONCLUSION: Following carpal tunnel release no benefits were found in using plaster casting, compared with elastic bandaging. Among these patients there was more discomfort during plaster casting compared with elastic bandaging; therefore plaster casting is not recommended following this type of surgery.

Visual, musculoskeletal and balance symptoms in individuals with visual impairment.

BACKGROUND: Visual impairment is globally among the most prevalent disabilities. Research concerning the health consequences of visual deficits is challenged by confounding effects of age, because visual impairment becomes more prevalent with age. This study investigates the influence of visual deficits on visual, musculoskeletal and balance symptoms in adults with and without visual impairment, while controlling for age effects. METHODS: Thirty-nine patients with visual impairment, aged 18-72 years, were compared to 37 age-matched controls with normal vision, allocated to two age groups: < 45 and ≥ 45 years. Self-reported symptoms were measured using the Visual, Musculoskeletal and Balance Symptoms Questionnaire and compared with demographic and optometric variables. RESULTS: In total, patients with visual impairment reported more symptoms than age-matched normally sighted controls. Younger adults in the control group were almost free from symptoms, whereas younger adults with visual impairment reported levels of symptoms equal to older adults with visual impairment. Multiple logistic regression modelling identified use of eyeglasses, magnifying aids and presence of anisometropia to be the most influential risk factors for reporting visual, musculoskeletal and balance symptoms, with accentuated influence on balance symptoms. CONCLUSIONS: People with visual impairments and people with age-related normal visual deficits are both predisposed to report visual, musculoskeletal and balance symptoms relative to people without visual defects or need for eye-wear correction. Age-related variations in symptoms were observed in the control groups but not in the visual impairment groups, with younger visual impairment patients reporting as many symptoms as older visual impairment patients. These findings indicate a need for a wider interdisciplinary perspective on eye care concerning people with visual impairment and people with need for habitual daily use of eye wear correction.

Visual, Musculoskeletal, and Balance Complaints in AMD: A Follow-Up Study.

Purpose. To investigate whether patients with age-related macular degeneration (AMD) run a potentially higher risk of developing visual, musculoskeletal, and balance complaints than age-matched controls with normal vision. Methods. Visual assessments, self-rated visual function, self-rated visual, musculoskeletal, and balance complaints, and perceived general health were obtained in 37 AMD patients and 18 controls, at baseline and after an average of 3.8 years later. Results. At follow-up both groups reported decreased visual acuity (VA) and visual function, but only AMD patients reported significantly increased visual, musculoskeletal, and balance complaints. Decreased VA, need for larger font size when reading, need for larger magnification, and decreased self-rated visual function were identified as risk markers for increased complaints in AMD patients. These complaints were also identified as risk markers for decreased health. For controls, decreased VA and self-reported visual function were associated with increased visual and balance complaints. Conclusions. Visual deterioration was a risk marker for increased visual, musculoskeletal, balance, and health complaints in AMD patients. Specifically, magnifying visual aids, such as CCTV, were a risk marker for increased complaints in AMD patients. This calls for early and coordinated actions to treat and prevent visual, musculoskeletal, balance, and health complaints in AMD patients.

Reliability and Validity of the Visual, Musculoskeletal, and Balance Complaints Questionnaire.

PURPOSE: To evaluate the reliability and validity of the 15-item Visual, Musculoskeletal, and Balance Complaints Questionnaire (VMB) for people with visual impairments, using confirmatory factor analysis (CFA) and with Rasch analysis for use as an outcome measure. METHODS: Two studies evaluated the VMB. In Study 1, VMB data were collected from 1249 out of 3063 individuals between 18 and 104 years old who were registered at a low vision center. CFA evaluated VMB factor structure and Rasch analysis evaluated VMB scale properties. In Study 2, a subsample of 52 individuals between 27 and 67 years old with visual impairments underwent further measurements. Visual clinical assessments, neck/scapular pain, and balance assessments were collected to evaluate the convergent validity of the VMB (i.e. the domain relationship with other, theoretically predicted measures). RESULTS: CFA supported the a priori three-factor structure of the VMB. The factor loadings of the items on their respective domains were all statistically significant. Rasch analysis indicated disordered categories and the original 10-point scale was subsequently replaced with a 5-point scale. Each VMB domain fitted the Rasch model, showing good metric properties, including unidimensionality (explained variances ≥66% and eigenvalues <1.9), person separation (1.86 to 2.29), reliability (0.87 to 0.94), item fit (infit MnSq's >0.72 and outfit MnSq's <1.47), targeting (0.30 to 0.50 logits), and insignificant differential item functioning (all DIFs but one <0.50 logits) from gender, age, and visual status. The three VMB domains correlated significantly with relevant visual, musculoskeletal, and balance assessments, demonstrating adequate convergent validity of the VMB. CONCLUSIONS: The VMB is a simple, inexpensive, and quick yet reliable and valid way to screen and evaluate concurrent visual, musculoskeletal, and balance complaints, with contribution to epidemiological and intervention research and potential clinical implications for the field of health services and low vision rehabilitation.

Effect of reduced visual acuity on precision of two-dimensional tracing movements / Efecto de la reducción de la agudeza visual sobre la precisión de los movimientos bidimensionales de trazado

Purpose: We intended to assess consequences of reduced visual acuity for performance in a natural simple motor task (tracing) using objective kinematic performance measures. Specifically, we intended to elucidate the kind of relationship between the task performance and best corrected binocular visual acuity and to determine the threshold of visual acuity when task performance starts to deteriorate. Methods: Ninety-five individuals with different best corrected visual acuity participated in the study (age 49±12 years, mean±SD, 27 men and 68 women). The participants manually traced maze-like visual patterns of different spatial complexity presented on the screen of a portable notebook computer using Clinical Kinematic Assessment Tool software. Tracing error was computed as performance measure in each trial with a spatial pattern matching technique - rigid point set registration method. Results: The segmented linear regression analysis showed that the relation between visual acuity and tracing errors was best described with a regression function having a break point between two data segments. Tracing performance was unaffected by values of visual acuity below 0.2 on logMAR scale, but when logMAR values increased above this critical limit (i.e. when visual acuity is further reduced), tracing errors linearly increased. The rate of the increase of the tracing error correlated with the complexity of visual stimulus shape. Conclusion: Testing of fine motor functions with objective kinematic measures during visuomotor tasks may help differentiating between actual effects of reduced visual acuity on eye-hand coordination in individuals with similar levels of impairment of visual acuity (AU)

Objetivo: Tratamos de evaluar las consecuencias de la reducción de la agudeza visual sobre el desempeño de una tarea motora simple y natural (trazado) utilizando mediciones cinemáticas y objetivas del desempeño. De manera específica, tratamos de esclarecer el tipo de relación entre el desempeño de la tarea y la agudeza visual binocular mejor corregida, así como determinar el umbral de la agudeza visual a partir del cual el desempeño de la tarea comienza a deteriorarse. Métodos: Participaron en el estudio noventa y cinco personas con diferente agudeza visual mejor corregida (edad 49±12 años, media±DE, 27 hombres y 68 mujeres). Los participantes trazaron manualmente patrones visuales de tipo laberíntico de diferente complejidad espacial, presentados en la pantalla de un ordenador portátil utilizando el software Clinical Kinematic Assessment Tool. El error de trazado se computó como medición del desempeño en cada ensayo, con una técnica de correspondencia del patrón espacial: el método de registro del conjunto de puntos rígidos. Resultados: El análisis de la regresión lineal segmentada reflejó que la relación entre la agudeza visual y los errores de trazado se describía mejor con una función de regresión con un punto de ruptura entre los dos segmentos de datos. El desempeño del trazado no se vio afectado por valores de agudeza visual inferiores a 0,2 en una escala logMAR (superior a 0,63 en una escala decimal), pero cuando los valores de logMAR superaban este límite crítico (es decir, cuando la agudeza visual empeoraba aún más), los errores de trazado se incrementaban de modo lineal. La tasa de incremento del error de trazado se correlacionó con la complejidad de la forma del estímulo visual. Conclusión: Las técnicas de medición objetiva del desempeño motor durante las tareas visomotoras en personas con diferente agudeza visual pueden aportar un punto de corte ecológicamente válido y preciso para la definición de la discapacidad debida a la disfunción visual (AU)

Effect of reduced visual acuity on precision of two-dimensional tracing movements.

PURPOSE: We intended to assess consequences of reduced visual acuity for performance in a natural simple motor task (tracing) using objective kinematic performance measures. Specifically, we intended to elucidate the kind of relationship between the task performance and best corrected binocular visual acuity and to determine the threshold of visual acuity when task performance starts to deteriorate. METHODS: Ninety-five individuals with different best corrected visual acuity participated in the study (age 49±12 years, mean±SD, 27 men and 68 women). The participants manually traced maze-like visual patterns of different spatial complexity presented on the screen of a portable notebook computer using Clinical Kinematic Assessment Tool software. Tracing error was computed as performance measure in each trial with a spatial pattern matching technique - rigid point set registration method. RESULTS: The segmented linear regression analysis showed that the relation between visual acuity and tracing errors was best described with a regression function having a break point between two data segments. Tracing performance was unaffected by values of visual acuity below 0.2 on logMAR scale, but when logMAR values increased above this critical limit (i.e. when visual acuity is further reduced), tracing errors linearly increased. The rate of the increase of the tracing error correlated with the complexity of visual stimulus shape. CONCLUSION: Testing of fine motor functions with objective kinematic measures during visuomotor tasks may help differentiating between actual effects of reduced visual acuity on eye-hand coordination in individuals with similar levels of impairment of visual acuity.

Effects of Feldenkrais method on chronic neck/scapular pain in people with visual impairment: a randomized controlled trial with one-year follow-up.

OBJECTIVE: To determine whether the Feldenkrais method is an effective intervention for chronic neck/scapular pain in patients with visual impairment. DESIGN: Randomized controlled trial with an untreated control group. SETTING: Low vision center. PARTICIPANTS: Patients (N=61) with visual impairment (mean, 53.3 y) and nonspecific chronic (mean, 23.8 y) neck/scapular pain. INTERVENTIONS: Participants were randomly assigned to the Feldenkrais method group (n=30) or untreated control group (n=31). Patients in the treatment group underwent one 2-hour Feldenkrais method session per week for 12 consecutive weeks. MAIN OUTCOME MEASURES: Blind assessment of perceived pain (visual analog scale [VAS]) during physical therapist palpation of the left and right occipital, upper trapezius, and levator scapulae muscle areas; self-assessed degree of pain on the Visual, Musculoskeletal, and Balance Complaints questionnaire; and the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain scale. RESULTS: Patients undergoing Feldenkrais method reported significantly less pain than the controls according to the VAS and Visual, Musculoskeletal, and Balance Complaints questionnaire ratings at posttreatment follow-up and 1-year follow-up. There were no significant differences regarding the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain scale ratings. CONCLUSIONS: Feldenkrais method is an effective intervention for chronic neck/scapular pain in patients with visual impairment.

Eye-neck interactions triggered by visually deficient computer work.

OBJECTIVES: To study the joint occurrence of eye-and-neck/scapular area symptoms and their association with occupational risk factors in a cross-sectional sample of professional information technology users. STUDY POPULATION: The participants consisted of 3,971 employees who worked with computers for a minimum of one hour a day. 2,551 (73%) were men and 945 (27%) women, with an age range of 18 up to 64 years. The mean age was 38.1 (SD=10.7) for men and 37.6 (SD=12.0) for the women. The measures were obtained via a self-administered survey in combination with a visual examination conducted by an optometrist. METHODS: Two complementary logistic regression analyses with forced entry was conducted on n=3,496 (88% adjusted response rate) cases. The effect of ocular symptoms on the risk of reporting musculoskeletal symptoms, or vice versa, was examined first in two separate binominal logistic regression analyses. Age, Gender, Near work variable and Visual functioning variables were included in these analyzes. Variables associated with the risk of developing an increase in either symptom category were also examined in two additional binomial logistic regression analyses. RESULTS: Exposure to spectacles (single vision, multifocal, or progressive correction) in combination with a visual acuity <1 surfaced as a key mediator of symptoms from the neck/scapular area (p<0.01). A vergence disparity (uncompensated vergence error) similarly was associated with an augmented risk of developing an increase in neck/scapular area symptoms (p<0.05). The most influential risk factor for neck/scapular area symptoms were ocular symptoms and vice versa (p<0.0001). CONCLUSIONS: The results support the hypothesis which postulates that eye-neck/scapular area symptoms interaction may be due to a functional coupling from and between the eye-neck/scapular area muscles [28].