Duruoz Hand Index Research Articles

The association between injury severity and psychological morbidity, hand function, and return to work in traumatic hand injury with major nerve involvement: A one-year follow-up study.

We aimed to investigate the association between the severity of the injury and psychological morbidities, hand functions, and return to work (RTW) in traumatic hand injury (THI) with major nerve involvement. Thirty-two patients had THI with major nerve involvement were enrolled in this study. The demographic and clinical characteristics of the patients were recorded after the injury. The severity of the injury was evaluated using the modified Hand Injury Severity Score (MHISS). The Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score and Duruöz Hand Index (DHI) were used to assess the hand function. Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Impact of Event Scale-Revised (IES) were performed to assess psychological morbidity. These assessments were performed after injury and at the end of the first year. Time to RTW was recorded in the first year after the injury. Jamar Hand Dynamometer and pinch meter were used for the measurement of hand and finger grip strength at the end of the first year. There were significant improvements in IES-R, BDI, BAI, Q-DASH, and DHI scores at the end of the first year compared with baseline scores. We found a significant correlation between MHISS and time of RTW, Q-DASH, and pinch strengths. We found no significant correlation between MHISS and IES-R, BDI, BAI, and grip strength. The severity of the injury is significantly associated with hand functions, pinch strengths, and RTW in THIs with major nerve involvement. The findings showed that there was no association between the severity of the injury and psychological morbidities in the present study.

Reliability and Validity of the Turkish Version of the ABILHAND Questionnaire in Rheumatoid Arthritis Individuals, Based on Rasch Analysis.

This study aims to assess the reliability and validity of the Turkish version of the ABILHAND questionnaire in individuals with rheumatoid arthritis (RA) [ABILHAND-RA (TR)] using the Rasch analysis. A total 90 individuals (15 males, 75 females; mean age 51.8±10.9 years; range, 20 to 65 years) diagnosed as RA according to the criteria of the American College of Rheumatology were included. The ABILHAND-RA (TR) was used to determine manual ability, while disease activity was evaluated by the use of Disease Activity Score 28 (DAS28). Jamar hand dynamometer and pinch-meter were used to examine grip and pinch strength of the participants. Nine Hole Peg Test (NHPT) and Duruoz Hand Index (DHI) measured hand disability level. Nottingham Health Profile (NHP) was used to assess quality of life. ABILHAND-RA (TR) results were analyzed using the Rasch analysis method. Item 20 was excluded from the 27-item ABILHAND-RA (TR) as 96% of the individuals rated this item as "easy". The new set of 18 items (7 subtests and 11 items) were found to sustain item invariance and fit to the Rasch model. Significant relationships were found between ABILHAND-RA (TR) and DAS28, bilateral grip strength, NHPT dominant side results, DHI, and NHP. Turkish version of the ABILHAND-RA was found to be clinically valid, reliable, and sensitive enough to be used in clinical evaluations, rehabilitation interventions, and for progression follow-up in individuals with RA.

Site-specific Patient-reported Outcome Measures for Hand Conditions: Systematic Review of Development and Psychometric Properties.

Background:There are a number of site-specific patient-reported outcome measures (PROMs) for hand conditions used in clinical practice and research for assessing the efficacy of surgical and nonsurgical interventions. The most commonly used hand-relevant PROMs are as follows: Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH (qDASH), Michigan Hand Questionnaire (MHQ), Patient Evaluation Measure (PEM), Upper Extremity Functional Index (UEFI), and Duruoz Hand Index (DHI). There has been no systematic evaluation of the published psychometric properties of these PROMs.Methods:A PRISMA-compliant systematic review of the development and validation studies of these hand PROMs was prospectively registered in PROSPERO and conducted to assess their psychometric properties. A search strategy was applied to Medline, Embase, PsycINFO, and CINAHL. screening was performed in duplicate. Assessment of psychometric properties was performed.Results:The search retrieved 943 articles, of which 54 articles met predefined inclusion criteria. There were 19 studies evaluating DASH, 8 studies evaluating qDASH, 13 studies evaluating MHQ, 5 studies evaluating UEFI, 4 studies evaluating PEM, and 5 studies evaluating DHI. Assessment of content validity, internal consistency, construct validity, reproducibility, responsiveness, floor/ceiling effect, and interpretability for each PROM is described.Conclusions:The psychometric properties of the most commonly used PROMs in hand research are not adequately described in the published literature. DASH, qDASH, and MHQ have the best-published psychometric properties, though they have either some poor psychometric performance or incompletely studied psychometric properties. There are more limited published data describing the psychometric properties of the UEFI, PEM, and DHI.

Leap Motion Controller–based training for upper extremity rehabilitation in children and adolescents with physical disabilities: A randomized controlled trial

Study DesignRandomized controlled trial. IntroductionJuvenile idiopathic arthritis (JIA), cerebral palsy (CP), and brachial plexus birth injury (BPBI) are the most common disorders that cause upper extremity impairments in children and adolescents. Leap Motion Controller–based training (LMCBT) is a novel therapeutic method for upper extremity rehabilitation. Purpose of the StudyThe aim of the present study was to investigate the potential efficacy of an 8-week LMCBT program set as an upper extremity rehabilitation program by comparing conventional rehabilitation program in children and adolescents with physical disabilities such as JIA, CP, and BPBI. MethodsA randomized control trial which included children and adolescents of different disabilities (JIA, CP, BPBI) were grouped according to their diagnosis. All patients were randomized into 2 groups namely LMCBT (group I) and conventional treatment (group II) for the treatment (3 days/8 weeks). Duruoz Hand Index and Jebson Taylor Hand Function Test were used as primary outcomes. Secondary outcomes included the nine-hole peg test, Childhood Health Assessment Questionnaire, and assessments of grip and pinch strength using a dynamometer. ResultsOne hundred three patients were included in the study, and 92 of them completed the treatment. After treatment, significant differences were found in Childhood Health Assessment Questionnaire, Duruoz Hand Index, Jebson Taylor Hand Function Test, nine-hole peg test, and grip and pinch strength scores in almost all groups (effect size [ES] = 0.10 to −0.77 for group I and 0.09 to −0.70 for group II in CP; ES = 0.31 to 2.65 for the group I and 0.12 to 1.66 for group II in JIA; and ES = 0 to −0.44 for group I and 0.08 to −0.62 for group II in BPBI) (P < .05). Comparisons between LMCBT and conventional treatment groups showed similar results in all parameters in all disease groups (P > .05). ConclusionsThis study has quantitatively shown that LMCBT should be used as an effective alternative treatment option in children and adolescents with physical disabilities.

Effects of Video Games–Based Task-Oriented Activity Training (Xbox 360 Kinect) on Activity Performance and Participation in Patients With Juvenile Idiopathic Arthritis

The aim of the study was to compare the effects of two different task-oriented activity training programs on activity performance and participation in children/adolescents with juvenile idiopathic arthritis. Sixty-two patients were randomized into group I and group II for task-oriented activity training. In group I, activities of daily living were practiced using real materials from daily life, and in group II, activities of daily living were practiced using video-based games (Xbox 360 Kinect) for 3 d/wk for 8 wks. Pain by the Numeric Rating Scale, upper limb muscle, grip, and pinch strengths by a dynamometer, activity performance and participation by the Childhood Health Assessment Questionnaire, Canadian Occupational Performance Measure, and Duruoz Hand Index were evaluated. After treatment in both groups, significant changes were found in the Numeric Rating Scale, muscle strength, grips strength, Childhood Health Assessment Questionnaire, Canadian Occupational Performance Measure, and Duruoz Hand Index (P < 0.05). Group II was statistically superior to group I in changes of almost all upper limb muscle strengths, palmar pinch strength, Canadian Occupational Performance Measure satisfaction, and Duruoz Hand Index scores (P < 0.05). Video games-based task-oriented activity training is an alternative and feasible treatment for children/adolescents with juvenile idiopathic arthritis. This new method may have widespread applicability in future research, given the rapidly growing interest in virtual reality-based therapy in rehabilitation. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand the rehabilitation benefits of task-oriented activity in patients with neurologic and musculoskeletal conditions; (2) Appreciate the role of video games-based task oriented activity in rehabilitation; and (3) Appropriately incorporate video games-based task oriented activity in the rehabilitation program of individuals with Juvenile Idiopathic Arthritis. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Is dry heat treatment (fluidotherapy) effective in improving hand function in patients with rheumatoid arthritis? A randomized controlled trial

Objective: To evaluate the efficacy of dry heat treatment (fluidotherapy) in improving hand function in patients with rheumatoid arthritis. Design: Prospective randomized controlled trial. Setting: Departments of Physical Medicine and Rehabilitation and Rheumatology in a university hospital. Subjects: Patients with rheumatoid arthritis. Interventions: All patients were randomly divided into two groups. Group 1 underwent dry heat treatment (fluidotherapy) and Group 2 was a control group. Patients in both groups participated in a joint protection and exercise program. Main measures: Primary outcome measures were Health Assessment Questionnaire and Duruoz Hand Index. Secondary outcome measures were pain and stiffness, Grip Ability Test, Disease Activity Score-28, and grip strength. These assessments were performed at the hospital at baseline, week 3, and week 12. Results: A total of 93 participants were allocated to Group 1 (n = 47) and Group 2 (n = 46). The mean age of these groups was 54.19 ± 11.15 years and 53.00 ± 10.15 years, respectively (P = 0.592). At baseline, there were no significant differences between the groups in any parameter except significantly poorer Health Assessment Questionnaire score in Group 1 (P = 0.007). At week 3, there were no significant differences between the groups in any of the parameters (P > 0.005). At week 12, Duruoz Hand Index scores were significantly better in Group 2 (P = 0.039). Conclusion: Dry heat treatment (fluidotherapy) was not effective in improving hand function in patients with rheumatoid arthritis. Moreover, no positive effect on any other clinical parameters was observed.

Reliability and validity of Duruoz Hand Index in carpal tunnel syndrome.

The aim of this study is to investigate the reliability and validity of Duruoz Hand Index (DHI) in patients with carpal tunnel syndrome (CTS). A total of 55 patients (50 females, 5 males; mean age 51.0±10.2 years: range, 30 to 73 years) aged ≥18 years who were admitted to the outpatient clinic of a rehabilitation hospital between December 2010 and December 2012 with the diagnosis of CTS both clinically and electrophysiologically were included in this study. All patients completed DHI at baseline and repeated after a week interval. The Boston Questionnaire (BQ) and Health Assessment Questionnaire Disability Index (HAQ-DI) were filled out at baseline. And the internal consistency reliability was tested using the Cronbach's alpha. For the test-retest reliability, intraclass correlation coefficients (ICC) were calculated. The correlations between the DHI and both BQ and HAQ-DI were investigated for the construct validity. Of the patients, 41 (74.5%) were housewives. Carpal tunnel syndrome was bilateral in 29 patients (52.7%). The Mean Body Mass Index was 31.2±5.5 kg/m2. The mean symptom duration was 22.8±23.7 months. The mean DHI scores for the first and second evaluations were 23.25±20.64 and 20.45±20.07, respectively. The mean BQ symptom severity and functional status scores were 2.87±0.80 and 2.72±1.03, respectively. The mean HAQ-DI score was 0.91±0.66. The Cronbach's alpha was 0.97 indicating excellent internal consistency reliability. There was a statistically significant correlation between the two measurements of DHI. The ICC value for total score was 0.88 indicating good reliability. There was a statistically significantly positive correlation between the DHI and BQ (r=0.638, p<0.001). Also, DHI was significantly correlated with the HAQ-DI (0.613, p<0.001). Our study results suggest that DHI is a reliable and valid test which can be used for evaluating hand functions in CTS patients.

Hand functions in patients with schizophrenia: A clinical comparison with bipolar disorder and healthy subjects

ObjectiveFailure to achieve expected level of motor functioning may be a significant contributor to social withdrawal and further attenuation of life quality in patients with schizophrenia. Hand functioning is one of the most crucial entities in that manner. This study aimed to reveal this question by means of comparing patients with schizophrenia and bipolar disorder who are receiving similar antipsychotic psychopharmacological agents along with healthy control subjects. Methods99 patients with schizophrenia were compared to 40 patients with bipolar disorder matched according to the received pharmacotherapy comprising similar antipsychotics and 81 medication-free socio-demographically matched healthy control subjects. The materials were Hand Functional Index (HFI), Duruoz Hand Index (DHI), Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS) along with clinical characteristics. ResultsDifference in total scores of DHI and HFI between schizophrenia, bipolar disorder and control groups were extremely significant (p < 0.001). Further post-hoc subgroup analysis revealed that patients with schizophrenia demonstrated higher scores of HFI indicating worse performance when compared to both bipolar disorder and control group. Significantly higher scores of DHI in patients with schizophrenia than healthy controls were noted. ConclusionIndependent from the impact of the medication use, impairment in hand functions was found to be more frequently seen in schizophrenia when compared to patients with bipolar disorder and healthy subjects. It is evident that hand function impairment is seen independent from psychopharmacological side effect, and is recommended to be assessed as a possible preventable and retractable manifestation of schizophrenia.

Trunk control: The essence for upper limb functionality in patients with multiple sclerosis

BackgroundMultiple sclerosis (MS) involves impaired trunk control, leading to impaired upper-limb functionality, dexterity, and independence. Deciding early on a comprehensive approach pointing of functional disturbances and personal needs is essential for a multimodal, individualized, goal-oriented assessment and treatment program, recognizing the broad range of symptoms and disabilities associated with MS. In clinical practice, postural control of the trunk is purported to be an important contributor to voluntary upper-limb function, including motor control and dexterity. The objective of this study was to point out the impairments of and relationship between trunk control and comprehensive upper-limb functions in individuals with MS. MethodsTasks that were sought are optimal screening for deterioration in trunk control (Trunk Control Test [TCT] and Trunk Impairment Scale [TIS]) and upper-limb functionality by comparing them with the Expanded Disability Status Scale (EDSS), Nine Hole Peg Test (NHPT), Duruoz's Hand Index (DHI), and Functional Independence Measurement (FIM) results of 49 well-defined relapsing-remitting MS (RRMS) participants with those of 49 age-gender matched healthy subjects. ResultsSignificant differences between the groups were evident across all tasks of the clinical tests studied (p < 0.05), except the TCT-balance in sitting position subscore. EDSS, NHPT, DHI, and FIM scores were highly correlated with the TCT subscores (rolling to weak side, sitting up from lying down) and TCT-total score, as well as TIS subscores (dynamic and coordination) and TIS total score (p ≤ 0.005). While TIS subscores were highly correlated with almost all parameters, just TIS-static subscore did not correlate with the DHI and FIM-cognitive scores. Also, DHI-hygiene subscore correlated poorly just with the TIS-coordination and TCT-coming to sitting position (p < 0.05). ConclusionWe found that patients with MS would present impaired upper-limb movement and decreased trunk control with high correlation between them, even in RRMS and in the very mild form of the disease. Identifying trunk control deficits provides better insight into dexterous difficulties of patients with MS and allows a more targeted neurorehabilitation focusing on upper limbs. In future studies, it would be of interest to examine the prognostic value of trunk control and upper-limb functionality in patients with MS using a longitudinal approach.

Exploring the relation between impairment rating by DAS-28 and body function, activity participation, and environmental factors based on ICF hand core set in the patient with rheumatoid arthritis.

Hand problems associated with rheumatoid arthritis lead to subjective impairment, activity limitation, and restrictions on participation. This relation is very complex. Assessment of individuals' activities is important to determine how hand problems affect not only body functions but also daily life activities. The aim of this study was to link and allocate items of disability questionnaires with ICF components based on ICF hand core set. The other objective was to examine the relationship between impairment and ICF components determined on the basis of disability questionnaires in participants with rheumatoid arthritis. Impairment was evaluated by use of Disease Activity Score-28. Disability questionnaires were Disabilities of Arm, Shoulder and Hand Questionnaire, Michigan Hand Outcomes Questionnaire, Duruoz Hand Index, and Arthritis Impact Measurement Scales 2 (n = 100). Items of disability questionnaires were linked with ICF hand core set as a result of three expert opinions. Michigan Hand Outcomes Questionnaire covered the highest number of body function categories and Arthritis Impact Measurement Scales 2 covered the highest number of ICF hand core set. For all questionnaires, while impairment (Disease Activity Score-28) had moderate correlation with subjective impairment (body function scores) and activity/participation; subjective impairment had high and moderate correlation with activity participation. Arthritis Impact Measurement Scale 2 is the most appropriate to perform a more comprehensive biopsychosocial assessment. Clinician's assessments and impairment levels reported by patients with rheumatoid arthritis are interrelated. Impairment levels reported by patients with rheumatoid arthritis are also affected by environmental factors.

Effects of local mud pack and saline bath therapy in hand osteoarthritis; randomized single-blind study

Hand osteoarthritis is a degenerative disease of hyaline cartilage which harms the hand joints. It affects the entire structure of the joints and causes a significant disability. In its etiology, gender, genetics, obesity and trauma play a crucial role. The prevalence increases with age, and although no difference is observed in its occurrence between men and pre-menopausal women, it is frequently seen in postmenopausal women. As it was claimed in the evidence based recommendations for the management of hand osteoarthritis Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics and Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee; thermal therapies are among the treatment options of hand osteoarthritis. In our trial we aim to prove how and of hands into thermomineral are beneficial on patient's pain and functioning, and to investigate which method is more effective. We have compared the immersion of hands into thermomineral water and the local peloidotherapy methods. 70 patients who have been observed at Istanbul University, Istanbul Medical Faculty, Medical Ecology and Hydroclimatology Department and diagnosed with hand osteoarthritis according to the ACR criteria were included to our trial. The participants have been divided into two groups by computer-based randomization. The method of immersion of hands into the 38°C thermomineral has been applied to one group and the method of application of 42°C peloid has been applied to the other group. The treatment has been applied in cures to the patients in both groups for 2 weeks in total, 20 minutes every day for ten days. Patients have been examined by a blind doctor four times: before the treatment, after the treatment, three and six months after the beginning of the treatment. They were examined by Visual Analog Scale (VAS) (pain, patient's overall assessment, physicians global assessment), Australian/Canadian (AUSCAN) Index (pain, stiffness, and function), Health Assessment Questionnaire (HAQ), Duruoz Hand Index (DHI), Grip strength by Jamar hand dynamometer. When the results have been analyzed it has been observed that both treatment groups have reached statistically significant results for improvements of pain and function which show parallelism. These improvements have also been observed in their 3rd and 6th month follow-up controls. In this trial, it has been demonstrated that two different balneological methods – of hands into thermomineral and of hands – have similar positive effects on pain and function and that these effects continue for a long time.

Comparison Between Extracorporeal Shock Wave Therapy and Intra-articular Hyaluronic Acid Injections in the Treatment of First Carpometacarpal Joint Osteoarthritis.

ObjectiveTo compare extracorporeal shockwave therapy (ESWT) with hyaluronic acid (HA) intra-articular injections in terms of pain relief, improvement in hand function, and strength in subjects with first carpometacarpal (CMC) joint osteoarthritis.MethodsFifty-eight patients received either focused ESWT or HA injection once a week for 3 consecutive weeks. In the ESWT group, 2,400 consecutive pulses were performed during each treatment session using a frequency of 4 Hz and an energy flux density of 0.09 mJ/mm2. The HA group underwent one cycle of three injections of 0.5 cm3 HA. The main outcome measures were pain and hand function as measured by the visual analogue scale (VAS) and Duruoz Hand Index (DHI), respectively. The secondary outcomes were grip and pinch strength. Each assessment was performed at baseline, at the end of treatment, and at 3- and 6-month follow-up visits.ResultsAccording to VAS and DHI scores, a significant change in test performance was observed over time in both groups (p<0.001), with a greater average improvement in painful symptomatology at the 6-month follow-up in the ESWT group. A significant improvement in strength was observed in both groups, but the ESWT group showed better results on the pinch test starting immediately at the end of treatment.ConclusionThe use of ESWT in patients with first CMC joint osteoarthritis leads to a reduction in pain, an improvement in pinch test performance that persists for at least 6 months, and a decrease in hand disability up to the 6-month follow-up visit.

Evaluation of Neural Therapy Effects in Patients with Lateral Epicondylitis: A Randomized Controlled Trial

Objectives: The purpose of the study is to explore neural therapy (NT) and the effect of it on pain and the functional status of patients with lateral epicondyl i tis (LE) and to determine whether clinical changes and demographic characteristics have any correl a tion. Materials and Methods: Forty-two patients with LE were randomly allocated into two groups; NT & control. The control group was given rest, non-steroidal anti-inflammatory drugs, stretching exercises and a wrist splint. The p a tients in the NT group received 8 sessions of NT. The visual analog scale (VAS), pain pressure threshold (via algometry) and Duruöz hand index (DHI) scores were noted before and at the end of the treatment in both groups. Results: All parameters improved in both groups. However, improvement of VAS, a l gometry and DHI scores were more obvious in the NT group. The clinical change and d e mographic features of the groups showed no correlation. Conclusion: NT is a safe and effective treatment method for treatment of p a tients with LE.

Duruöz Hand Index: Is it valid and reliable in children with unilateral cerebral palsy?

ABSTRACTPurpose: To investigate the validity and reliability of the Duruöz Hand Index (DHI) in patients with unilateral cerebral palsy (CP). Methods: Assessments of patients (n = 23) were performed using the Modified Ashworth Scale (MAS), the Manual Ability Classification System (MACS), the grip and pinch strength tests, and DHI. Following the data collection, retest of DHI was administered telephonically within a 2-week period. Results: Test–retest reliability and internal consistency of DHI were found to be excellent with a Cronbach’s alpha value of 0.93 and an intraclass correlation coefficient value of 0.94. The correlation between the DHI and MACS was detected significantly high (r = 0.840, p = < 0.010). The DHI also correlated with grip and pinch strength in the affected side (r = −0.459, p = < 0.050; r = −0.509, p = < 0.050). Conclusions: DHI is a valid and reliable questionnaire for patients with unilateral CP.

Ultrasonographic Evaluation of Acupuncture Effect on Common Extensor Tendon Thickness in Patients with Lateral Epicondylitis: A Randomized Controlled Study.

To explore the effect of acupuncture on common extensor tendon (CET) thickness in patients with lateral epicondylitis (LE). Additionally, to identify whether clinical and ultrasonographic changes showed any correlation. Forty-one patients were randomly assigned to acupuncture and control groups. Conventional treatment (rest, NSAİİ, bracing, exercise) methods for LE were applied to all patients. In addition to this, the acupuncture treatment was applied to the acupuncture group. The visual analog scale (VAS) for pain, the Duruoz Hand Index (DHI) for functioning of the affected limb, the pressure pain threshold, and CET thickness (via ultrasound imaging) were assessed before and end of the treatment in both groups. The VAS and DHI scores in both groups decreased. The pressure pain threshold and CET thickness only demonstrated improvement in the acupuncture group. These findings show that the CET thickness was reduced after 10 sessions of acupuncture treatment in LE patients.

Hand functions in systemic sclerosis and rheumatoid arthritis and influence on clinical variables

Hand joints are the main target in rheumatoid arthritis (RA) and hand involvement in terms of thickening of the skin and contractures are also well known in systemic sclerosis (SSc). Assessment of hand function in SSc is generally an overlooked entity with respect to RA. Therefore the aim of this study was to compare hand functions and potential influence of functional loss on patients' overall physical functions, health-related quality of life (HRQoL) and psychological status in RA and SSc. Age- and gender-matched adult patients with SSc and RA were consecutively recruited. Patients' hand functions were evaluated by using the Duruöz Hand Index (DHI), and hand span and hand grip strength were measured. Patients were evaluated for disease-specific and generic outcome measures including disease activity parameters and HRQoL measures. Fifty patients (44 female, six male) with SSc and 51 (45 female, six male) with RA were included. Despite similar functioning and HRQoL, patients with RA had higher visual analog scale-pain and body mass index. In both groups DHI revealed similar functional loss and correlated with various measurements related to HRQoL. In SSc, hand span, grip strength and modified Rodnan skin score had major influences on hand functions. Assessment of hand function is an important component in the clinical evaluation of patients with RA and SSc. Loss of hand functions is an important feature contributing negatively to the overall physical status and HRQoL in patients with SSc and may be more frequent and important than expected.

The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study

Introduction The aim of this study was to explore the acupuncture effect on the cross-sectional area (CSA) of the median nerve at the wrist in patients with carpal tunnel syndrome (CTS) and, additionally, to identify whether clinical, electrophysiological, and ultrasonographic changes show any association. Methods Forty-five limbs of 27 female patients were randomly divided into two groups (acupuncture and control). All patients used night wrist splint. The patients in the acupuncture group received additional acupuncture therapy. Visual analog scale (VAS), Duruöz Hand Index (DHI), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, electrophysiologic measurements, and median nerve CSAs were noted before and after the treatment in both groups. Results VAS, DHI, Quick DASH scores, and electrophysiological measurements were improved in both groups. The median nerve CSA significantly decreased in the acupuncture group, whereas there was no change in the control group. Conclusion After acupuncture therapy, the patients with CTS might have both clinical and morphological improvement.

Hand functions in type 1 and type 2 diabetes mellitus

Introduction/Objective. Hand functions have an enormous impact on activities of daily living in patients with diabetes mellitus (DM), such as self-care, administering insulin injections, and preparing and eating meals. The aim of the study was to evaluate hand functions and grip strength in patients with type 1 and type 2 DM. Methods. This was an observational case-control study investigating the hand functions and grip strength in patients with type 1 and type 2 DM. The study comprised 41 patients with type 1 DM aged 25?50 years sex- and age-matched, 40 non-diabetic controls, and 91 patients with type 2 DM aged 40?65 years sex- and age-matched 60 non-diabetic controls. Patients with documented history of diabetic sensorimotor neuropathy and adhesive capsulitis were excluded. The Duruoz Hand Index was used to assess the functional hand disability. Grip strength was tested with a calibrated Jamar dynamometer. Results. The Duruoz Hand Index scores in patients with type 2 DM were significantly higher than in persons in the control group (p &lt; 0.01), but there was no significant difference between the type 1 DM and the control group (p &gt; 0.05). Grip strength values of patients with type 1 DM were significantly lower compared to those in the control group (p &lt; 0.05), whereas there was no significant difference between patients with type 2 DM and their control group. There was a negatively significant correlation between grip strength and the Duruoz Hand Index scores in patients with both type 1 and type 2 DM (p &lt; 0.05). Conclusion. Patients with type 1 DM and type 2 DM have different degrees of hand disability as compared to healthy control groups.

The effectiveness of transcutaneous electrical nerve stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo-controlled prospective study.

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on clinical recovery in the management of patients with complex regional pain syndrome Type I (CRPS Type I). The study included 30 patients with stage 1 and 2 CRPS Type I in the upper extremities. The patients were randomly assigned into 2 groups, group 1 (n= 15) received conventional TENS therapy for 20 minutes, and group 2 (n= 15) received sham TENS therapy. The standard physical therapy program, which included contrast bath for 20 minutes; whirlpool bath for 15 minutes; assisted active and passive range of motion, and static stretching exercises up to the pain threshold, was also conducted in both groups. Therapy was scheduled for 15 sessions. A visual analogue scale (VAS) was used to assess spontaneous pain. The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) scale and the Douleur Neuropathique en 4 Questions (DN-4) were used to assess neuropathic pain. In addition, range of motion (ROM) was measured using a goniometer and volumetric measurements were taken to assess edema. Functional capacity was assessed using a hand dynamometer and the Duruöz Hand Index (DHI). All measurements were performed at baseline and after therapy. Significant improvements were achieved in spontaneous and neuropathic pain scores, edema, ROM, and functional capacity in both groups (p< 0.05). However, improvement was found to be significantly greater in group 1 regarding pain intensity, neuropathic pain assessed using LANNS, edema, and in the 2nd-3rd finger ROM measurements (p< 0.05). No significant difference was detected between groups regarding improvements in 4th-5th finger and wrist ROM measurements, grip strength, and DN4 and DHI scores (p> 0.05). The addition of TENS to the physical therapy program was seen to make a significant contribution to clinical recovery in CRPS Type 1.

Validation of Duruöz Hand Index in patients with tetraplegia

Study designCross-sectional, clinical measurement. PurposeTo investigate the validity of the Duruöz Hand Index (DHI) in the assessment of hand function in patients with tetraplegia. MethodsA total of 40 patients with tetraplegia participated. Patients' upper extremities were assessed on the level of ‘body function and structure’ [The American Spinal Cord Injury Association (ASIA) Impairment Scale (AIS) 2000 revised criteria, upper extremity motor score (UEMS), neurologic level of injury and visual analogue scale of hand function (VAS-HF)], ‘activity’ [DHI and Quadriplegia index of function-short form (QIF-SF)] and ‘body function and structure, activity and participation’ [Health Survey Short Form-36 (SF-36)] according to International Classification of Function. ResultsThe DHI showed significant correlations with UEMS, AIS, QIF-SF, VAS-HF, physical functioning and physical compound summary scores of SF-36. ConclusionsThe DHI was found a valid method in the assessment of hand functions in patients with tetraplegia. Level of evidenceDiagnostic III.