Upper-limb Disorders Research Articles

Grip strength ratio: a grip strength measurement that correlates well with DASH score in different hand/wrist conditions.

BackgroundGrip strength correlates with personal factors such as gender, age and nutritional status and has a good inter-rater reliability. It reflects fairly well how much people can use their hands.The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure 3 is a 30-item, self-report, questionnaire that reflects the patients’ opinion on their disability due to upper-limb disorders. We assessed if grip strength and grip strength ratio correlate with DASH score.MethodsIn 3 groups (20 healthy volunteers, 17 patients after distal radius fractures, 12 patients with different hand/wrist conditions) grip strength and DASH scores (items 1–21, 22–30 and total) were assessed. To exclude personal factors grip strengths in the injured or non-dominant hand and grip strength ratios (grip strength in the injured or non-dominant hand divided by grip strength in the non-injured or dominant hand) were assessed too. Results were analyzed groups using Pearson Correlation Coefficients and with a multivariate ANOVA.ResultsGrip strength ratio was 0.97 in healthy volunteers, 0.52 in patients after distal radius fracture and 0.74 in patients with various other hand/wrist disorders.Significant correlations were found between the grip strength ratio and DASH as well as DASH subsections in all groups and between DASH scores and grip strength in some. The correlations between the ratio of the grip strength (GSR) and DASH were much stronger than the correlation between grip strength and DASH. This emphasizes the value of the GSR. Age showed no correlation with grip strength ratio using a multivariate ANOVA.ConclusionGrip strength ratio correlates well with the DASH score in different hand and wrist conditions. It is a valuable tool to assess patients that speak a different language and have problems with the non-dominant hand and probably easier to follow over time than the DASH score, which is time consuming to fill in and process.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-336) contains supplementary material, which is available to authorized users.

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

A Questionnaire-Based Survey: Therapists Response towards Upper Limb Disorder Learning Tool

Work-related Musculoskeletal Disorders in Korea and Japan: A Comparative Description.

ObjectivesWork related Musculoskeletal disorders (WMSD) is one of the most important problem in occupational health system of Korea and Japan, where the OHS system developed in similar socio-cultural environment. This study compared WMSD in Korea and Japan to review similarities and differences in their historical background, and development of prevention policies.MethodsScientific articles, government reports, and related official and non-official statistics on WMSD since the 1960s in Japan and Korea were reviewed.ResultsThe historical background and basic structure of the compensation system in Korea and Japan largely overlapped. The issuing of WMSD in both countries appeared as upper limb disorder (ULD), named occupational cervicobrachial diseases (OCD) in Japan, and neck-shoulder-arm syndrome (NSA) 30 years later in Korea, following the change from an industrial structure to automated office work. Both countries developed manuals for diagnosis, guidelines for workplace management, and prevention policies. At present, compensation cases per covered insurers for WMSD are higher in Korea than in Japan, due to the social welfare system and cultural environment. Prevention policies in Korea are enforced more strongly with punitive measures than in Japan. In contrast, the Japanese system requires autonomous effort toward risk control and management, focusing on specific risky processes.ConclusionsWMSD in Korea and Japan have a similar history of identification and compensation structure, yet different compensation proportions per covered insurer and prevention policies. Follow-up study with international cooperation is necessary to improve both systems.

AB1167-HPR Cross-Cultural Adaptation, Reliability and Validity of the Turkish Version of the Upper Limb Functional Index (ULFI)

BackgroundThe Upper Limb Functional Index (ULFI) is a patient reported outcome measure with sound clinimetric properties and clinical viability for determination of upper limb status and impairment. To date, no...

301. Upper Limb Disorders in Computer Keyboard Operatives: Comparison of Clinical Features with Community-Derived Controls

301. Upper Limb Disorders in Computer Keyboard Operatives: Comparison of Clinical Features with Community-Derived Controls

Usefulness of QuickDASH in patients with cervical laminoplasty

PurposeClumsiness and numbness of the upper extremity is one of the most common complaints of patients with cervical myelopathy. However, most previous evaluations after cervical laminoplasty have only been based on physicians’ points of view. We used Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) self-report questionnaire, which was designed to measure physical function and symptoms in people with upper-limb disorders to evaluate functional outcomes after laminoplasty. MethodsNinety-four patients who underwent laminoplasty for cervical myelopathy and replied to the questionnaire were included in this study. The average age was 62 years, and mean follow-up period was 61 months. The Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI), Short-Form Health Questionnaire of 36 questions (physical component score, PCS), upper-extremity pain (Numerical Rating Scale), and QuickDASH (0-100, 0 being least severe) were used to evaluate surgical outcomes. Satisfaction with treatment was also investigated, and internal consistency and criterion-related validity were evaluated. The QuickDASH cutoff value for patient satisfaction was determined by receiver operating characteristic curve (ROC) analysis. ResultsThe mean total JOA scores were 10 before and 13 after surgery, and average postoperative QuickDASH score was 30. Cronbach a of the QuickDASH was 0.94. QuickDASH was significantly correlated with JOA score for upper-extremity motor and sensation, NDI, PCS, and pain. Cutoff value of the QuickDASH was 34.0 by ROC analysis. Significantly better QuickDASH scores were found for patients who were satisfied with treatment than for those who were not, whereas JOA score for upper-extremity motor function did not show a significant difference. DiscussionQuickDASH had significant correlations with disease-specific JOA scores and other generic outcome measures. Moreover, QuickDASH significantly reflected patients’ satisfaction with treatment, whereas the JOA score for upper-extremity motor function did not. ConclusionQuickDASH was useful in evaluating upper-extremity functional outcomes after cervical laminoplasty.

RELIABILITY OF THE HAND20 QUESTIONNAIRE: COMPARISON WITH THE 36-ITEM SHORT-FORM HEALTH SURVEY

Hand20 is an illustrated, self-administered questionnaire comprising 20 short and easy-to-understand questions to assess upper limb disorders. This study aimed to test the reliability, validity, and responsiveness of Hand20. Eighty-five patients with three upper limb disorders (51 with trigger finger, 29 with ulnar impaction syndrome, and five with carpal tunnel syndrome) completed Hand20, the Japanese Society for Surgery of the Hand version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH-JSSH), and the 36-Item Short-Form Health Survey (SF-36). Reliability was assessed by internal consistency. To test the validity, a factor analysis of Hand20 was performed and the correlation coefficients between Hand20 and DASH-JSSH and those between Hand20 and SF-36 were calculated. Responsiveness was evaluated in 47 patients with trigger finger as the standardized response mean and effect size after treatment. A Cronbach's α coefficient of 0.967 confirmed the unidimensionality of Hand20. The correlation coefficient between Hand20 and DASH-JSSH was 0.84. The correlations between Hand20 and the SF-36 subscales ranged from -0.236 to -0.596. Moderate correlations were observed for "Role-physical" (r = -0.596) and "Bodily pain" (r = -0.557). The correlation between the Hand20 and "Physical functioning" was weak (r = -0.313). The standardized response mean and effect size of Hand20 was 1.50 and 1.60, respectively. The Hand20 has evaluation capacities equivalent to those of DASH-JSSH. There was a moderate correlation between Hand20 and SF-36.

An assessment of hand volumetric and temperature changes during office related repetitive activities

Hand usage and movement is routinely performed by all individuals daily irrespective of age. These movements can vary and can be repetitive in nature. Exposure of the hard and soft tissues of the hand to prolonged repetitive activities could contribute to the development of work related upper limb disorders (WRULD). Within the work setting, work related upper limb disorders (WRULDs) rank high in the United Kingdom (UK), second only to back complaints. This paper reports the amount of tendon travel and swelling that occurs in the hand during repetitive office activities associated with WRULDs. Nine healthy adults (five males; four females) participated in the study. A 30-minute laboratory-based simulated office activity that consisted of data entry, mouse clicking and dragging, and mouse scrolling tasks was performed. Participants wore a custom-made cost effective flexible electrogoniometric glove (FEG) as two experimental conditions were tested; namely, FEG - only, and FEG using a Splint (FEG - Splint). The FEG - only condition produced a higher overall tendon travel compared to the FEG - Splint condition. Both hands presented no statistically significant differences in hand temperature (p > 0.05) and hand volume increments (p > 0.05) with respect to the FEG - only and FEG - Splint office activity experiments. All participants that showed a decrease in hand volumetric measurement produced final temperature measurements lower than initial temperature measurements taken at the commencement of the experiment. Based on participants' perception, the mouse scrolling task was deemed as most strenuous. The findings can help to advise patients on biomechanical 'risks' associated with repetitive activities.

Occupational Therapy Management for Work Related Upper Limb Disorders in Computer Users

Objective : 1) To administer an Occupational Therapy treatment program for managing Work Related Upper Limb Disorders (WRULD's) 2) To know the effectiveness of the treatment program for the Management of WRULD's Method : Study was undertaken on 19 patients who were using computer for more than 20hours/ week. They were given conservative Occupational Therapy treatment and the effect of the treatment was evaluated on neck and shoulder joint stiffness, pain intensity, edema, sensation, Grip Strength, typing speed and overuse syndrome. Outcome Measures : 1) Functional Grading Scale 2) VAS 3) Typing Speed Test Statistics and Results : The data was statistically analyzed and it was found that the mean scores of Pain, Edema, Numbness, AROM, Grip Strength, Typing Speed, and symptoms of overuse Syndrome showed significant difference after the administration of Occupational Therapy Treatment program. Conclusion : The findings of the study suggests that it is possible with a conservative treatment program to decrease pain, edema, numbness, symptoms of overuse syndrome and Improve AROM, typing speed ad grip strength.

Ergonomic risk factors and their association with musculoskeletal disorders among Indian dentist: a preliminary study using Rapid Upper Limb Assessment.

Ergonomics is the scientific study of people and their work. The manufacturers typically do not design to accommodate the dimensions of the individual user. Work-related musculoskeletal disorders (MSDs) have emerged as major health problem among workers in both industrialized and industrially developing countries. Rapid Upper Limb Assessment (RULA) was developed to investigate the exposure of the individual workers to risk factors associated with work-related upper limb disorders. The assessment of the posture using RULA, which is quick reliable tool to determine the posture, has not been done in the Indian dentist population, indicating the need for the same. A total of 104 subjects were included from New Delhi/NCR. The procedure was explained, and the questionnaire was distributed and assessment was done using RULA. The MSDs can be recorded using the standard Nordic questionnaire. The data were collected from 104 subjects out of the 192 evaluated and was statistically analyzed using SPSS software. The study sample included 70 male and 34 female dentists. The posture of the subjects and the MSDs are not associated with a significant difference as according to Pearson's Chi-square test (0.231). RULA can be used as a screening tool for postural risks following a short training session regardless of the assessor's experience in postural risk assessments.

Comparative ergonomic evaluation of the hand-pieces of three instrument series for root planning

Introduction: Musculoskeletal disorders (MSD) are the most frequent cause of disability in the working population, exceeding accidental trauma in frequency. The risk of developing work-related upper limb disorders (WURLDs) is high among dental hygienists and the most frequently affected are elderly subjects and women. Since such disorders can have a negative effect on the working life and on the quality of life, it is of vital importance to put in place preventive measures. Aim: To make a comparative analysis of the hand-pieces of three different manual instruments used for root planning. Materials and Methods: To evaluate the physical characteristics (section, diameter, external surface, weight) of the hand-pieces of three series of instruments for root planning, twenty-nine dental hygienists students were videoed while working clinically. They were also interviewed using a specific questionnaire to determine subjective preferences in terms of perceived efficacy, safety, comfort and general acceptability of the hand-piece used. Results: Lightness, full-cylindrical section with larger-diameter ends, and coating with anti-slip silicone are the most appreciated characteristics of a hand-piece. Conclusions: Ergonomic analyses of manual instruments are not frequent in the dental field, and the literature reports no guidelines to guide selection of the type of hand-piece of manual instruments. The data gathered may help manufacturers in designing new manual instruments, and guiding professionals in their selection.

Work-Related Upper Limb Disorders: How can We Improve Prevention and Management?

Work-related upper limb disorders remain a challenge to the clinician because an estimated 75% are regarded as diagnostically unclassifiable. Evidence-based prevention and treatment of these frequent and disabling disorders have therefore been limited and largely unsuccessful. It is essential to identify the involved tissues and structures as well as the responsible pathologies. To do so would require improved diagnostic approaches.

Conservative interventions for treating work-related complaints of the arm, neck or shoulder in adults

Work-related upper limb disorder (WRULD), repetitive strain injury (RSI), occupational overuse syndrome (OOS) and work-related complaints of the arm, neck or shoulder (CANS) are the most frequently used umbrella terms for disorders that develop as a result of repetitive movements, awkward postures and impact of external forces such as those associated with operating vibrating tools. Work-related CANS, which is the term we use in this review, severely hampers the working population. To assess the effects of conservative interventions for work-related complaints of the arm, neck or shoulder (CANS) in adults on pain, function and work-related outcomes. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 31 May 2013), MEDLINE (1950 to 31 May 2013), EMBASE (1988 to 31 May 2013), CINAHL (1982 to 31 May 2013), AMED (1985 to 31 May 2013), PsycINFO (1806 to 31 May 2013), the Physiotherapy Evidence Database (PEDro; inception to 31 May 2013) and the Occupational Therapy Systematic Evaluation of Evidence Database (OTseeker; inception to 31 May 2013). We did not apply any language restrictions. We included randomised controlled trials (RCTs) and quasi-randomised controlled trials evaluating conservative interventions for work-related complaints of the arm, neck or shoulder in adults. We excluded trials undertaken to test injections and surgery. We included studies that evaluated effects on pain, functional status or work ability. Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of the included studies. When studies were sufficiently similar, we performed statistical pooling of reported results. We included 44 studies (62 publications) with 6,580 participants that evaluated 25 different interventions. We categorised these interventions according to their working mechanisms into exercises, ergonomics, behavioural and other interventions.Overall, we judged 35 studies as having a high risk of bias mainly because of an unknown randomisation procedure, lack of a concealed allocation procedure, unblinded trial participants or lack of an intention-to-treat analysis.We found very low-quality evidence showing that exercises did not improve pain in comparison with no treatment (five studies, standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -1.08 to 0.03), or minor intervention controls (three studies, SMD -0.25, 95% CI -0.87 to 0.37) or when provided as additional treatment (two studies, inconsistent results) at short-term follow-up or at long-term follow-up. Results were similar for recovery, disability and sick leave. Specific exercises led to increased pain at short-term follow-up when compared with general exercises (four studies, SMD 0.45, 95% CI 0.14 to 0.75)We found very low-quality evidence indicating that ergonomic interventions did not lead to a decrease in pain when compared with no intervention at short-term follow-up (three studies, SMD -0.07, 95% CI -0.36 to 0.22) but did decrease pain at long-term follow-up (four studies, SMD -0.76, 95% CI -1.35 to -0.16). There was no effect on disability but sick leave decreased in two studies (risk ratio (RR) 0.48, 95% CI 0.32 to 0.76). None of the ergonomic interventions was more beneficial for any outcome measures when compared with another treatment or with no treatment or with placebo.Behavioural interventions had inconsistent effects on pain and disability, with some subgroups showing benefit and others showing no significant improvement when compared with no treatment, minor intervention controls or other behavioural interventions.In the eight studies that evaluated various other interventions, there was no evidence of a clear beneficial effect of any of the interventions provided. We found very low-quality evidence indicating that pain, recovery, disability and sick leave are similar after exercises when compared with no treatment, with minor intervention controls or with exercises provided as additional treatment to people with work-related complaints of the arm, neck or shoulder. Low-quality evidence also showed that ergonomic interventions did not decrease pain at short-term follow-up but did decrease pain at long-term follow-up. There was no evidence of an effect on other outcomes. For behavioural and other interventions, there was no evidence of a consistent effect on any of the outcomes.Studies are needed that include more participants, that are clear about the diagnosis of work-relatedness and that report findings according to current guidelines.

Ergonomic issues in ewe cheese production: reliability of the Strain Index and OCRA Checklist risk assessments

Occupational ergonomists often use a variety of methods to identify jobs that are considered at high risk for the development of work-related musculoskeletal illnesses. The Strain Index (SI) and the Occupational Repetitive Actions (OCRA) Checklist are two popular upper limb risk assessment tools used in many industries, including the agro-food industry. Both methods are based on similar biomechanical, physiological and epidemiologic principles, but their approach to quantification and estimation of risk factor magnitude is quite different. The purpose of this study was to assess the inter-method reliability of SI and OCRA Checklist. Methods: Twenty-one jobs were video recorded in a Sardinian cheese manufacturing facility. Eight raters were recruited to assess job exposures to physical risk factors using the SI and OCRA Checklist. Inter-method reliability was characterized using proportion of overall agreement, Cohen’s kappa, and Spearman and Pearson correlations. Results: Strain Index and the OCRA Checklist assessments produced generally reliable results, classifying the risk of 35 of 42 (83%) job exposures similarly. Conclusions: The OCRA Checklist and SI risk assessments are reliable upper limb measures of physical work exposures. Both measures appear useful for assessing risk of upper limb disorders of work tasks in the agro-food industry. However, the SI is specific to disorders of the distal upper limb and perhaps most useful for assessing risk in work primarily involving the wrist and fingers. Whereas the OCRA Checklist, which includes an assessment of the shoulder, may be more appropriate for evaluating jobs that also require extended periods of reaching and shoulder activity.