Upper-extremity Disability Research Articles

The Effect of Yoga on Barriers to Occupational Engagement in African American Breast Cancer Survivors

Objective: The purpose of this pilot study was to determine if occupational therapy informed yoga could decrease barriers to occupational engagement in African American breast cancer survivors. Methods: A single-arm pretest-posttest design was used to study African American breast cancer survivors who participated in six weekly group yoga sessions that were delivered by occupational therapists. Variables were selected to operationalize barriers to occupational engagement and included mental health, bodily pain, role-physical and emotional, fatigue, self-efficacy, acute pain, balance, and upper extremity disability. Descriptive statistics and repeated measures analysis via linear mixed effects modeling were conducted to describe the participants and determine the efficacy of occupational therapy informed yoga. Results: Barriers to occupational engagement (health related quality of life, self-efficacy and balance, pain, upper-extremity disability) were evident in participants at baseline. Occupational therapy informed yoga reduced some of these barriers through significant changes in pain, mental health, and balance. Conclusion: These findings provide initial support for the development of group programming to deliver occupational therapy informed yoga to African American breast cancer survivors.

Quantitative assessment of upper extremities motor function in multiple sclerosis.

Upper extremity (UE) motor function deficits are commonly noted in multiple sclerosis (MS) patients and assessing it is challenging because of the lack of consensus regarding its definition. Instrumented biomechanical analysis of upper extremity movements can quantify coordination with different spatiotemporal measures and facilitate disability rating in MS patients. To identify objective quantitative parameters for more accurate evaluation of UE disability and relate it to existing clinical scores. Thirty-four MS patients and 24 healthy controls (CG) performed a finger-to-nose test as fast as possible and, in addition, clinical evaluation kinematic parameters of UE were measured by using inertial sensors. Generally, a higher disability score was associated with an increase of several temporal parameters, like slower task performance. The time taken to touch their nose was longer when the task was fulfilled with eyes closed. Time to peak angular velocity significantly changed in MS patients (EDSS > 5.0). The inter-joint coordination significantly decreases in MS patients (EDSS 3.0-5.5). Spatial parameters indicated that maximal ROM changes were in elbow flexion. Our findings have revealed that spatiotemporal parameters are related to the UE motor function and MS disability level. Moreover, they facilitate clinical rating by supporting clinical decisions with quantitative data.

Amniotic membrane improves force production after repair of a massive rotator cuff tear

Rotator cuff tears are a common cause of upper extremity disability, with nearly 250,000 surgical repairs performed annually. Chronically torn rotator cuff muscles display profound muscle atrophy, fibrosis and accumulation of fat in and around muscle fibers. Even after undergoing surgical repair, many patients continue to have persistent muscle atrophy, and re‐tear rates are 40% or more. Identifying novel therapies that can promote muscle regeneration after rotator cuff repair could lead to substantial improvements in our ability to treat chronic rotator cuff tears. Human amniotic‐derived grafts are a type of allograft that is thought to have the potential to improve tissue regeneration, although the mechanism of these products is not well characterized and to our knowledge has not been studied in respect to rotator cuff regeneration. Using a preclinical rotator cuff tear model in rats, our objective was to determine the efficacy of human amniotic derived grafts on rotator cuff muscle regeneration. To accomplish this, we induced a chronic rotator cuff tear for 30 days and then repaired the tear in the presence or absence of the human amniotic stem cell graft. We then analyzed the contractile function of muscle fibers from control and treated muscles. Muscle cross‐sectional area (CSA), maximum isometric force (Fo) and the force per cross‐sectional area, or specific force (sFo) were recorded from muscle fibers isolated from each of these groups. We hypothesized that treatment with human amniotic cell graft would improve sFo in rats compared to rats without these grafts. The CSA of the amniotic membrane repair group was 53% greater than the control repair group (p<0.01), and the Fo was also 55% higher with membrane supplementation (p<0.01). Further, sFo of the membrane repair group was 13% larger than the control repair (p=0.02). Combined, the augmentation of chronic rotator cuff repair surgery with a human amniotic derived graft in rats markedly improved muscle function. Based on this promising preclinical data, further study of human amniotic stem cell grafts in patients with chronic rotator cuff tears in warranted.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Review of scapular movement disorders among office workers having ergonomic risk.

Work-related musculoskeletal disorders are the most common health problems which affect millions of office workers. The objective of this study is to determine scapular positioning at rest and different anatomical planes, the assessment of pain, postural changes and the functionality of upper extremity that is caused by the lack of ergonomic principles among office workers of civil servants in TRNC (Turkish Republic of Northern Cyprus). 183 individuals participated in the study and 2 groups were created by grand scores of Rapid Upper Limb Assessment (RULA) tool. Scapular dyskinesis, pain of upper extremity and back, physical functions and symptoms of upper extremity, the self-rated neck disability, cervical and upper thoracic posture of workers were assessed. The difference between pain situation and the results of upper extremity and neck disability scores of the participants among the groups was significant (p< 0.05). No significant difference has been found statistically among the postural angle values of individuals (p> 0.05). A significant statistical difference has been found among the groups when the results of Lateral Scapular Slide Test (LSST) is examined (p< 0.05). Working environment and conditions cause the wrong of working posture and thus, lead individuals to spend more energy together with physical difficulty, and consequently affect general health.

Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial

Background. Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many. Objective. To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes. Methods. On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases. Results. Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log–28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences. Conclusions. Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier (ClinicalTrials.gov: Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at www.ClinicalTrials.gov/ClinicalTrials.gov. Identifier: NCT00871715).

Effectiveness of Pelotherapy in carpal tunnel síndrome

Carpal tunnel syndrome (CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-tomoderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1) (n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2) (n = 28), patients received splint treatment (every night for 6 weeks) alone. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), hand grip strength (HGS), finger grip strength (FGS), and Short Form-12 (SF-12). The data were obtained before treatment (W0), immediately after treatment (W2), and one month after treatment (W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0 (p < 0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2 (p < 0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 (p < 0.05). The results of our study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment (W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

The assessment of psychological factors on upper extremity disability: A scoping review

IntroductionThe primary purpose of this scoping review was to describe the nature and extent of the published research that assesses the relationship between psychological features and patient-reported outcome following surgery or rehabilitation of upper extremity disease or injury. MethodsTwenty-two included studies were examined for quantitative study design, outcome measure, inclusion/exclusion criteria, follow-up and recruitment strategy. Patient population and psychological assessment tools were examined for validity. ResultsTwenty-two studies met the inclusion criteria for this study. Only 7 of the 22 studies were longitudinal and the rest were cross sectional studies. Depression was the most common psychological status of interest and was included in 17 studies. Pain catastrophizing was the psychological status of interest in 5 of the studies. Four studies considered anxiety, 3 considered pain anxiety, 3 considered distress, 2 considered coping, 2 considered catastrophic thinking, and 2 considered fear avoidance beliefs. DiscussionThe majority of studies in this review were cross-sectional studies. Cross-sectional studies may not provide conclusive information about cause-and-effect relationships. This review encourages clinicians to be mindful of the psychological implications found in rehabilitation of individuals with upper extremity disease or injury along with being cognizant of choosing appropriate measurement tools that best represent each patient's characteristics and diagnoses. ConclusionsThe nature of the research addressing psychological factors affecting outcomes after hand injury focus on negative traits and have limited strength to suggest causation as most have used cross-sectional designs. Stronger longitudinal designs and consideration of positive traits are needed in future studies.

Relation between the Disability of the Arm, Shoulder and Hand Score and Muscle Strength in Post-Cardiac Surgery Patients.

Background: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a valid and reliable patient-reported outcome measure. DASH can be assessed by self-reported upper extremity disability and symptoms. We aimed to examine the relationship between the physiological outcome of muscle strength and the DASH score after cardiac surgery. Methods: This cross-sectional study assessed 50 consecutive cardiac patients that were undergoing cardiac surgery. Physiological outcomes of handgrip strength and knee extensor muscle strength and the DASH score were measured at one month after cardiac surgery and were assessed. Results were analyzed using Spearman correlation coefficients. Results: The final analysis comprised 43 patients (men: 32, women: 11; age: 62.1 ± 9.1 years; body mass index: 22.1 ± 4.7 kg/m2; left ventricular ejection fraction: 53.5 ± 13.7%). Respective handgrip strength, knee extensor muscle strength, and DASH score were 27.4 ± 8.3 kgf, 1.6 ± 0.4 Nm/kg, and 13.3 ± 12.3, respectively. The DASH score correlated negatively with handgrip strength (r = −0.38, p = 0.01) and with knee extensor muscle strength (r = −0.32, p = 0.04). Conclusion: Physiological outcomes of both handgrip strength and knee extensor muscle strength correlated negatively with the DASH score. The DASH score appears to be a valuable tool with which to assess cardiac patients with poor physiological outcomes, particularly handgrip strength as a measure of upper extremity function, which is probably easier to follow over time than lower extremity function after patients complete cardiac rehabilitation.

ACCUMULATIVE REPETITIVE STRAIN INJURY AMONG BUSINESS PROCESS OUTSOURCING EMPLOYEES: A SURVEY STUDY

Objective: Computer overuse syndrome or repetitive strain injury is the most common problem among the people in all age groups. Several studies have found the adverse effect of using computers for a long duration. In the modern tech-savvy world, usage of computers is something unavoidable. The objective of this survey study is to find out the accumulative repetitive strain injury among the business process outsourcing employees.Methods: This study was conducted in different business process outsourcings in Noida, and a convenient sampling method was used to collect data through Neck Pain Disability Index (NPDI) and disabilities of the arm, shoulder and hand (DASH) questionnaire. The study comprised of total 230 subjects.Results: The mean and standard deviation (SD) of NPDI score was found to be 32.12 and 11.26, respectively, whereas the mean and SD for DASH score was 24.34 and 7.44, respectively. The Chi-square value for NPDI and DASH was found to be 263.043 and 139.461. The study shows that upper extremity pain is a common problem in employees working in the IT sector. The employees showed high rates of computer use–associated with upper extremity musculoskeletal symptoms and symptom-related functional limitation.Conclusion: The findings of the study suggest a need to begin to evaluate interventions and to reduce the risks of developing computer overuse syndrome such as developing upper extremity symptoms, disability, and disorders among employees working in the IT sector who use computers for more than 40 hrs/week. Intervention to reduce symptoms should include effective training in work rest patterns, good-working postures coupled with availability of appropriate equipment.

Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis

BackgroundConstraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined.MethodsThis protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL).DiscussionThis multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation.Trial registrationClinicaltrials.gov, NCT02631850.

Cross-cultural adaptation and psychometric properties of the Nigerian (IGBO) version of the Disabilities of the Arm, Shoulder and Hand questionnaire (I-DASH)

Introduction The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is a self-administered region-specific outcome questionnaire developed to measure upper extremity disability and symptoms. The aim of this study was to translate, culturally adapt and validate the Igbo version of the DASH in order to enhance its use in the Igbo-speaking population. Method This cross-sectional survey involved 100 participants (56 males, 44 females) with upper extremity musculoskeletal disorders, in the South-Eastern part of Nigeria. Participants completed both English and Igbo versions of the DASH on two occasions. Internal consistency was evaluated with Cronbach’s alpha. Test–retest reliability was analysed by intraclass coefficient (ICC) and the Bland and Altman method. Construct validity was investigated with the Spearman rank correlation coefficient, and a principal component analysis was performed. Alpha was set at 0.05. Results Test–retest reliability was excellent (ICC = 0.99). The Cronbach’s alpha coefficient was high (0.979) for the entire items on the scale. There was a significant strong correlation (r = 0.994; p = 0.001) between the scores obtained on the English and Igbo versions of the DASH indicating excellent construct validity. Thirty linear components were identified within the data set. The communalities were above 0.4. Conclusion Principal component analysis of the Igbo DASH revealed a two-factor structure, having fulfilled all necessary conditions. The Igbo version of the DASH questionnaire is a valid and reliable outcome measure for individuals with upper extremity musculoskeletal disabilities.

The effects of KinesioTape on the treatment of lateral epicondylitis

Study DesignRandomized clinical trial. IntroductionKinesioTape (KT) is a noninvasive method to treat pain and muscular dysfunction. PurposeTo investigate the effect of KT with and without tension on pain intensity, pain pressure threshold, grip strength and disability in individuals with lateral epicondylitis, and myofacial trigger points in forearm muscles. MethodsThirty women with lateral epicondylitis and myofacial trigger point in forearm muscles were randomly assigned to KT with tension and placebo (KT without tension). The treatment was provided 3 times in one week, and outcome measures were assess pre-post treatment. ResultsThe mean score of visual analogue scale (VAS) during activity decreased significantly from 6.4 and 6 pretest to 2.53 and 4.66 posttest, respectively, for the KT with and without tension groups. The mean score of Disabilities of the Arm, Shoulder and Hand decreased significantly from 16.82 and 22.79 pretest to 8.65 and 8.29 posttest, respectively, for the KT with and without tension groups. A paired t-test revealed a significant reduction in VAS during activity and Disabilities of the Arm, Shoulder and Hand before and after treatment in both groups (P < .05). Pain pressure threshold, grip strength, and VAS using an algometer revealed no significant differences. The study showed no significant difference in variables immediately after intervention. DiscussionImprovements in functional disability were superior when KT was used with tension, than obtained with a placebo-no tension application. ConclusionThe application of KT produces an improvement in pain intensity and upper extremity disability in subjects with LE and MTP in forearm muscles, and KT with tension was more effective than placebo group. Level of EvidenceNA. Trial Registration Number100-216.

Effectiveness of PELOID therapy in carpal tunnel syndrome: A randomized controlled single blind study.

Carpal tunnel syndrome(CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-to-moderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1)(n=35), patients were given splint (every night for 6weeks)+peloid treatment(five consecutive days a week for 2weeks) and in the second group, (Group 2)(n=28), patients received splint treatment(every night for 6weeks) alone. The patients were assessed by using visual analog scale(VAS) for pain, electroneuromyography(ENMG), the Boston Carpal Tunnel Syndrome Questionnaire(BCTSQ), hand grip strength(HGS), finger grip strength(FGS), and Short Form-12(SF-12). The data were obtained before treatment(W0), immediately after treatment(W2), and one month after treatment(W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0(p<0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2(p<0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 (p<0.05). The results of our study demonstrated that in patients with CTS; peloid+splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment(W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

Effect of sensory training of the posterior thigh on trunk control and upper extremity functions in stroke patients

Some studies show that sensorial rehabilitation is effective on functionality. The aim of this study is to investigate the effect of sensory training of the posterior thigh on the functionality of upper extremity and trunk control in stroke patients. Thirteen subjects (53.23±6.82years) were included in the intervention group and 13 subjects (58.69±5.94years) in the control group. The control and intervention groups were treated for ten sessions. The control group was treated only with neurodevelopmental treatment, and the intervention group was treated with sensorial training on the posterior thigh in addition to the neurodevelopmental treatment. Subjects were evaluated three times, pre- and post-treatment and 10days after finishing the treatment. Trunk control was assessed by the Trunk Impairment Scale, reaching function by the Functional Reach Test, balance by the Berg Balance Test, upper extremity symptom and disability severity by the Disabilities of the Arm, Shoulder, Hand and Minnesota, independence level in daily living activities by the Barthel Index, and sensory function of the posterior thigh by sensorial tests. In the post-treatment assessment, it was found that the intervention group was better than the control group in the parameter of functional reach while sitting (p<0.005). In the third assessment, reaching while sitting and independence level were better in the intervention group than the control group (p<0.005). There was no difference in sensorial assessment between the groups. Sensory training of the posterior thigh should be included in the rehabilitation programme of stroke patients.

Return to Function, Complication, and Reoperation Rates Following Primary Pectoralis Major Tendon Repair in Military Service Members.

Pectoralis major tendon ruptures have become increasingly common injuries among young, active individuals over the past 30 years; however, there is presently a paucity of reported outcome data. We investigated the ability to return to full preoperative level of function, complications, reoperation rates, and risk factors for failure following surgical repair of the pectoralis major tendon in a cohort of young, highly active individuals. All U.S. active-duty military patients undergoing pectoralis major tendon repair between 2008 and 2013 were identified from the Military Health System using the Management Analysis and Reporting Tool (M2). Demographic characteristics, injury characteristics, and trends in preoperative and postoperative self-reported pain scale (0 to 10) and strength were extracted. The ability to return to the full preoperative level of function and rates of rerupture and reoperation were the primary outcome measures. Univariate analysis followed by multivariate analysis identified significant variables. A total of 257 patients with pectoralis major tendon repair were identified with a mean follow-up (and standard deviation) of 47.8 ± 17 months (range, 24 to 90 months). At the time of the latest follow-up, 242 patients (94%) were able to return to the full preoperative level of military function. Fifteen patients (5.8%) were unable to return to duty because of persistent upper-extremity disability. A total of 15 reruptures occurred in 14 patients (5.4%). Increasing body mass index and active psychiatric conditions were significant predictors of inability to return to function (odds ratio, 1.56 [p = 0.0001] for increasing body mass index; and odds ratio, 6.59 [p = 0.00165] for active psychiatric conditions) and total failure (odds ratio, 1.26 [p = 0.0012] for increasing body mass index; and odds ratio, 2.73 [p = 0.0486] for active psychiatric conditions). We demonstrate that 94% of patients were able to return to the full preoperative level of function within active military duty following surgical repair of pectoralis major tendon rupture and 5.4% of patients experienced rerupture after primary repair. Increasing body mass index and active psychiatric diagnoses are significant risk factors for an inability to return to function and postoperative failures. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Participants’ experiences of an Education, self-management and upper extremity eXercise Training for people with Rheumatoid Arthritis programme (EXTRA)

BackgroundThe Education, self-management and upper extremity eXercise Training for people with Rheumatoid Arthritis programme (EXTRA) is an individualized, upper limb, home exercise regimen supplemented by four supervised, group sessions, a handbook and exercise dairy which improves upper extremity disability and self-efficacy. Objective and study designThis qualitative interview study explored participants’ experience of EXTRA to inform development and implementation of EXTRA into practice. ParticipantsAdults with Rheumatoid Arthritis who completed EXTRA were purposively sampled to include a range of ages, upper extremity disabilities, self-efficacy for arthritis self-management and attendance at EXTRA sessions. MethodsIndividual, semi-structured interviews were conducted with a single researcher until data saturation of themes was reached. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. ResultsTwelve participants (10 females; 32 to 87 years) were interviewed. Four overarching themes were identified: (i) empowering self-management; (ii) influence of others and (iii) the challenge of sustaining exercise, which resonate with the Social Cognition Theory, and (iv) refining EXTRA: consistent and personalised. ConclusionsEXTRA enhanced participants’ confidence to manage their arthritis independently and was adaptable so it could be integrated with other life commitments. Whilst healthcare professionals, peers and family and friends influenced exercise uptake, sustaining exercise was challenging. Participants desired consistent and continuing contact with a familiar physiotherapist (e.g. via follow-up appointments, digital health technologies) which accommodated individual needs (e.g. different venues, session frequency). Implementation of EXTRA needs to appreciate and address these considerations to facilitate success.

Upper extremity disability among string instrumentalists–use of the quick DASH and the NDI

AbstractPurpose: Playing the string instrument predisposes musicians to musculoskeletal problems in the upper extremity and trunk which usually affects more than one anatomical region. These musculoskeletal problems could result in difficulty in performing activities of daily living and playing a musical instrument. The aim of this study was to evaluate disability associated with musculoskeletal problems of string instrumentalists in South Africa by using the quick Disability of the Arms, Shoulder and Hands (DASH) and the Neck Disability Index (NDI) as measuring tools. Materials and methods: String instrumentalists from both amateur and professional orchestras were recruited via an electronic and a paper based survey to participate in the study by completing a self-administered questionnaire. The prevalence of musculoskeletal problems affecting performance was 56.6% and the trunk and shoulders were mainly affected. The overall disability scores of the QuickDASH and the NDI were 12.9 ± 13.2 and 11.5 ± 9.8 ...

Exercise training and postural correction improve upper extremity symptoms among touchscreen smartphone users.

Background:Repetitive movements and poor posture are associated with over-use of smartphones when texting or playing games and significantly contribute to the symptoms of pain and discomfort in the upper extremities.Objective:This study investigated the effect of exercise training and postural correction on disabilities of the arm, shoulder, and hand (DASH), hand grip and key pinch strength among smartphone users.Methods:One hundred university students were randomly divided into two groups; the experimental group participated in a 12-week programme of exercise training and postural corrections. The control group were instructed to follow their usual routine for smartphone utilization. Measurements of DASH scores, hand grip strength, and key pinch grip strength were conducted before and after 12 weeks for both groups.Results:There were no significant differences between the start values of both groups for DASH scores, hand grip strength, and key pinch strength (p > 0.05). However, there was a significant improvement in all outcomes measured in the experimental group (p < 0.05), with significant changes in the outcomes of the control group.Conclusion:Postural correction combined with a selected exercise training programme improved the hand grip, key pinch grip strength, and upper extremity disability and symptoms associated with smartphone use among university students.

Upper Extremity Disability Is Associated With Grip Strength and Psychological Stress in Carpal Tunnel Syndrome According to a Patient-reported Questionnaire

Objective: We investigated which clinical factors influenced upper extremity disability in carpal tunnel syndrome (CTS). Materials and Methods: We analyzed 45 hands with CTS of patients enrolled in a prospective cohort study conducted from December 2012 to January 2015. The age among the participant group of 40 females and 5 males ranged from 30 to 86 (mean, 60.3 years). Forty-three patients were right-handed. Twenty-seven had bilateral CTS (36 hands). Operations were performed on 25 right and 20 left hands. Thirty-nine hands were classified as “Extreme CTS” (absence of median motor and sensory responses) according to the severity scale proposed by Padua. Hand10 was used as a validated upper-extremity disability assessment tool. Clinical assessments were comprised of patients’ characteristic, physical and psychological parameters. Patients’ characteristic consisted of age, body mass index, and duration of symptom. Physical parameters included grip strength, key pinch strength, pulp pinch strength, Semmes Weinstein Monofilament Test, static 2 point discrimination test (s2PD test), numerical rating scale for numbness, visual analogue scale for pain (pain VAS), and Japanese version of Short-Form McGill Pain Questionnaire (SF-MPQ). Psychological parameters included Japanese version of Self-rating Depression Scale, Japanese version of Pain Anxiety Symptom Scale–20 (PASS-20), and Stress Response Scale–18 (SRS-18). These assessments were conducted on the day before operation. Statistical Analysis: Factors that were significantly associated with Hand10 scores in bivariate analysis (Pearson correlation test or Spearman rank correlation test as appropriate) were entered into a multivariable analysis. A multiple regression analysis was used to identify factors that were independently associated with Hand10 scores. Results: Hand10 scores showed no statistical differences in terms of unilateral/bilateral CTS and sex differences. Single regression analysis showed that Hand10 scores correlated significantly with the pain VAS, SF-MPQ, PASS-20, SRS-18, s2PD at index and middle scores, and grip strength. Multiple regression analysis showed that grip strength ( B = 1.47, β = 0.49, P = .00) and SRS-18 score ( B = −0.91, β = −0.36, P = .02) were significant correlation factors for the Hand10 score ( R2 = 0.49). Conclusions: In patients with CTS, grip strength and psychological stress are significant correlating factors of disability according to a patient-administered upper extremity assessment.

Bringing Patient Advisors to the Bedside of Digit Replantation Patients

Purpose: Patient advisors are peer volunteers who have already been through a digit replantation. They are fully trained and viewed as full-fledged members of the care team. This proof-of-concept study was aimed at describing a model of care that brings patient advisors directly to the patient’s bedside. In this model, the patients’ perception of disability, the adherence to the rehabilitation process, and overall satisfaction were reported. Methods: A prospective pilot study was conducted from July 2014 to June 2015. All patients admitted to a center of expertise were offered the option to interact with patient advisor at bedside. Meetings were generally brief (15-30 minutes) and were proposed on the fifth day postsurgery as well as 8 and 16 weeks following surgery. The Disabilities of the Arm, Shoulder and Hand (DASH; 30 items scored 1-5) questionnaire was completed at 8 and 16 weeks follow-up as a measure of self-rated upper extremity disability and symptoms. All patients who had at least 1 interaction with a patient advisor were interviewed by telephone after study completion. The purpose of the interviews was to understand their expectations, the contribution of the patient advisor in their own care, and any possible reluctance or difficulty encountered (particularly when interactions were conducted via videoconferencing). Adherence to the rehabilitation process was also recorded and later compared to an estimate of 35% adherence generated from our Institution. Results: Based on an average of 9 patients, the DASH score completed at week 16 (27.6) showed a decrease of 33.8% when compared with that of week 8 (41.7). Adherence to treatment plan was respected in 55% of patients with patient advisor’s interaction, which was higher than estimations. Several key roles of the patient advisors emerged from the 18 interviews conducted on patients. Patient advisor is perceived as a care team member who will listen and support the patient, simplify the information conveyed by the care team, and finally break the patients’ loneliness, increasing their motivation toward the rehabilitation process. Conclusion: This study underlines the potential of patient advisors to improve the perception of disability and the adherence to the rehabilitation process in patients who have undergone digits replantation. Measurements of hand strength, range of motion, and sensibility as well as self-reported pain, posttraumatic stress disorder, and self-esteem were also performed; analyses are ongoing at present time. Further researches are required before widespread dissemination of the usefulness of patient advisors.