Longitudinal Changes of Handgrip, Knee Extensor Muscle Strength, and the Disability of the Arm, Shoulder and Hand Score in Cardiac Patients During Phase II Cardiac Rehabilitation.

Kazuhiro Izawa,Yusuke Kasahara,Koji Hiraki,Koichiro Oka,Yasuyuki Hirano,Satoshi Watanabe

doi:10.3390/diseases7010032

Abstract

Handgrip strength (HS) and knee extensor muscle strength (KEMS) showed a negative correlation with the Disabilities of the Arm, Shoulder, and Hand (DASH) score at one month following cardiac surgery. We performed a longitudinal study to examine changes in HS/KEMS and DASH score during phase II cardiac rehabilitation (CR) in patients after cardiac surgery. We measured and assessed HS, KEMS, and DASH score in 41 consecutive patients at one and three months following cardiac surgery and examined the relation between these factors at three months following cardiac surgery. Wilcoxon signed-rank test and Spearman correlation coefficients were used to analyze the results. Finally, 26 patients (63.2 years, 73.1% male) were analyzed. There were significant differences from one month to three months following cardiac surgery in HS (26.78 ± 8.26 to 31.35 ± 9.41 kgf, p < 0.001), KEMS (1.53 ± 0.42 to 1.72 ± 0.46 Nm/kg, p = 0.001), and DASH score (14.76 ± 12.58 to 7.62 ± 9.29, p < 0.001). DASH score correlated negatively with HS (r = −0.41, p = 0.01) but not with KEMS (r = −0.32, p = 0.09) after three months of phase II CR. Although HS, KEMS, and DASH scores changed significantly from one to three months following cardiac surgery during phase II CR, only HS correlated negatively with DASH score at three months following cardiac surgery.

Highlights

The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a reliable and previously validated patient-reported outcome measure which can be used to assess self-reported upper extremity symptoms and disabilities in relation to having surgical treatment for a variety of upper extremity conditions [1,2,3,4]
We previously reported on our cross-sectional investigation on the relationship between handgrip and knee extensor muscle strength and the DASH score of cardiac surgery patients at one month following surgery (74.4% men, age: 62.1 years) [7] and found that both strength factors correlated negatively with the DASH score [7]
The findings reported on handgrip and knee extensor muscle strength in cardiac surgery patients supported the improvements that can be attained with phase II cardiac rehabilitation (CR) [11,14]

Summary

Introduction

The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a reliable and previously validated patient-reported outcome measure which can be used to assess self-reported upper extremity symptoms and disabilities in relation to having surgical treatment for a variety of upper extremity conditions [1,2,3,4]. A previous report suggested that postoperative muscle weakness was associated with inflammation immediately after cardiac surgery [5]. Diseases 2019, 7, 32 result from both the limitation of upper extremity movement and infection in these patients. Upper extremity muscle strength may limit patients’ activities of daily living. The items in the DASH questionnaire to no small extent include upper extremity function and its relation to lower extremity function [1,2]

Methods

Results

Discussion

Conclusion