Hand Mobility In Scleroderma Test Research Articles

Investigating performance-based hand functions in patients with systemic sclerosis.

Systemic sclerosis (SSc) is aconnective tissue disorder characterized by collagen deposits in various organs. Skin involvement is one of the most common symptoms and along with vascular damage, may deteriorate hand functions. However, the status of hand functions has generally been investigated using patient-reported measures in patients with SSc. The aim of the present study was to investigate performance-based hand functions in patients with SSc using the Sollerman Hand Function Test (SHFT). A total of 39patients with SSc (33females) were included in the study. Twenty-four patients were classified as limited cutaneous SSc (lcSSc), while 15patients were classified as diffuse cutaneous SSc (dcSSc). Hand-related physical characteristics were evaluated using the Modified Hand Mobility in Scleroderma Test, grip strength, and pinch strengths. The Duruoz Hand Index (Cochin Hand Functional Disability Scale), Disability of Arm, Shoulder, and Hand Questionnaire, Health Assessment Questionnaire, and Scleroderma Health Assessment Questionnaire were used as patient-reported measures. Performance-based hand functions were evaluated using SHFT. No significant differences were observed between lcSSc and dcSSc subtypes regarding performance-based and patient-reported hand functions (p > 0.05). SHFT scores significantly correlated with hand-related physical characteristics and patient-reported hand functions (p < 0.05). The highest correlation was determined between SHFT and the Duruoz Hand Index (rho: -0.652, p < 0.001). According to our results, performance-based hand functions seem not to be affected by disease subtype. Performance-based hand functions may partially be captured by the patient-reported outcomes, especially the Duruoz Hand Index, in patients with SSc.

Turkish version of modified Hand Mobility in Scleroderma test: A translation and validation study.

Hand Mobility in Scleroderma (HAMIS) is a hand function test used to determine the degree of dysfunction of hand movements. The Modified Hand Mobility in Scleroderma (mHAMIS), on the other hand, was developed later and consists of 4 items. The aim of this study was to determine the reliability and validity of mHAMIS. This study included a total of 39 patients with systemic sclerosis (SSc) who were assessed with mHAMIS. The Cronbach's α coefficient, Kappa concordance, and intraclass correlation were respectively used to assess the internal consistency, intra- and inter-observer agreement, and inter-observer reliability of the test. The correlation between the Health Assessment Questionnaire (HAQ), the Duruoz Hand Index (DHI), and the Turkish version of mHAMIS were evaluated. The internal consistency of the test items was between .912 and .939. The total internal consistency of the test was excellent, with a Cronbach's alpha value of .954. The intra- and inter-observer agreement were good, with Kappa values of 0.954 (95% CI 0.89-1.6) and 0.965 (95% CI 0.82-1.4), respectively. The inter-observer reliability was 0.966 (95% CI 0.936-0.982; P<.0001). There was a strong correlation between DHI, HAQ, and mHAMIS (r: .7-.8). The Turkish version of the mHAMIS test showed good intra- and inter-observer agreement, intra-observer reliability, and internal consistency. This test is a reliable and valid tool to assess hand functions in Turkish SSc patients.

Inter-rater reliability of modified hand mobility in scleroderma test.

Systemic sclerosis (SSc) is a chronic autoimmune disease of unknown etiology characterized by excessive collagen production, endothelial cell injury, microvascular obliteration, cutaneous fibrosis and progressive visceral disease. The hands are frequently involved during the progression of the disease, with symmetrical skin thickening as a prominent feature. Modified hand mobility in scleroderma (mHAMIS) test is a measurement method to assess hand mobility in patients with SSc. Knowing the inter-rater reliability of the instrument is important in order for the results from different examiners to be accurately interpreted. The aim of this study was to test inter-rater reliability of the mHAMIS test. Hand mobility for both hands was assessed in 25 female patients with SSc by 2 physiotherapists who have different years of experience. Patients who had flexion contracture in at least 1 finger and undergone hand surgery in the last year due to any injuries, were excluded from the study since hand mobility was prevented. Inter-rater reliability was determined using intra-class correlation coefficients (ICCs). The ICCs were excellent between raters for dominant and non-dominant hands. The values were 0.92 and 0.93, respectively. The inter-rater reliability of the mHAMIS was found to be excellent. This research contributes to the literature by proving that the test can be used without causing bias in clinical trials.

A randomised controlled trial of wax baths as an additive therapy to hand exercises in patients with systemic sclerosis

ObjectiveThe musculoskeletal features of systemic sclerosis (SSc) are a major cause of disability, causing limitations to movement and function. The study aim was to compare the effects of daily hand exercises with or without daily home wax bath hand treatment in patients with SSc. DesignAssessor-blinded randomised controlled trial of parallel group design. SettingSingle participating centre, undertaken in secondary care and in participants homes. Participants36 participants with hand skin tightening of SSc, two participants lost to follow up. InterventionsParticipants were randomised into wax bath versus no wax bath groups. Both groups in addition performed regular hand exercises as part of standard care. The study period was 9weeks, with further measures of outcome undertaken at 18weeks. Main outcome measuresThe primary outcome measure was the Hand Mobility in Scleroderma test (HAMIS). Secondary outcomes measures were the Scleroderma Health Assessment Questionnaire, grip and pinch strength and the Cochin Hand Function Scale. ResultsBetween group comparisons of HAMIS scores showed no evidence of effectiveness of the wax bath treatment at 9-week follow up (adjusted difference in means (95% CI) experimental-control −1.47 (−3.55 to 0.61), P=0.16) or at 18-week follow up (adjusted difference in means (95% CI) experimental-control 1.94 (−1.07 to 4.95), P=0.20). Analysis of secondary outcomes also showed no evidence for effectiveness of the wax bath treatment at either 9 or 18weeks. ConclusionOur findings suggest that the addition of regular wax bath treatment confers no additional beneficial effect to standard care with daily home exercises. Trial registrationISRCTN registry (http://www.isrctn.com) ISRCTN 66736089.

The Modified Hand Mobility in Scleroderma Test and Skin Involvement - A Followup Study.

To study the change in the modified Hand Mobility in Scleroderma (mHAMIS) test from early to advanced stages of systemic sclerosis (SSc), and the relationship between mHAMIS and skin involvement during followup. This retrospective study includes 65 patients with baseline disease duration of ≤ 3 years who were assessed with the mHAMIS test at baseline and at 1 or 2 predefined followup points (3.1-5 yrs and 5.1-9 yrs after disease onset). Studied measures were the modified Rodnan skin score (mRSS), mRSS of the hand, serum cartilage oligomeric matrix protein, and digital vascular lesions. The mHAMIS and the mRSS hand changed synchronously during the first 5 years after disease onset (rs = 0.44, p = 0.001). In the group with high mHAMIS at baseline, both mHAMIS and mRSS hand improved significantly at the first followup (p < 0.05), and the improvement sustained during the followup in the mRSS hand. Patients with antitopoisomerase I and anti-RNA polymerase III antibodies had significantly higher mHAMIS at baseline (p = 0.003) and at the second followup (p = 0.030) compared to patients with anticentromere antibodies. Patients with digital vascular lesions at baseline had significantly higher mHAMIS during the followup (p < 0.05) compared to patients without. The mHAMIS improved significantly during the followup in patients with immunosuppressive treatment in early disease (p < 0.05), but not in patients without this treatment. The mHAMIS reflects disease activity in fibrosis in early stages of SSc. In later stages it can be regarded as a measure of damage arising from fibrotic and vascular involvement, making it suitable as an endpoint in followup examinations.

Telemedicine applied to kinesiotherapy for hand dysfunction in patients with systemic sclerosis and rheumatoid arthritis: recovery of movement and telemonitoring technology.

To describe a feasibility study focused on a telemonitoring approach to self-managed kinesiotherapy sessions for the rehabilitation of hand function in patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA). Ten patients with SSc and 10 with RA were enrolled in a 3-month controlled trial (approval no. 9751/2012 - Italian Department of Health) to perform a home kinesiotherapy protocol, consisting of strengthening and mobility exercises, using a newly developed telemedicine system (a portable device and the related telemonitoring infrastructure). A further 10 patients with SSc and 10 with RA were enrolled as controls to perform a similar home kinesiotherapy protocol with the aid of common daily-life objects. Both groups were evaluated at baseline and at followup, after 6 and 12 weeks. The primary outcome of the trial was hand function measured by Dreiser's index (Functional Index for Hand OA, FIHOA), Health Assessment Questionnaire (HAQ), and the Hand Mobility in Scleroderma (HAMIS) test (only for SSc). Patients with SSc showed an improvement of FIHOA in both arms (p < 0.01) but the HAQ (p = 0.016) and the HAMIS test (right hand p = 0.016, left hand p = 0.075) improved significantly only in the experimental arm. Patients with RA showed a statistically significant improvement of FIHOA (p = 0.013) and HAQ (p = 0.015) in the experimental arm, while patients in the control arm did not significantly improve. However, no statistically significant differences in outcome measures between treatment methods were observed. Withdrawals were higher in control arms (SSc 20%; RA 30%) than in experimental arms (SSc 10%; RA 10%). Telemonitoring of self-administered kinesiotherapy programs is a promising approach to the rehabilitation of hand functions in patients with rheumatic disease.

Sexual Function in Italian Women with Systemic Sclerosis Is Affected by Disease-related and Psychological Concerns

In patients with systemic sclerosis (SSc), sexual function is somewhat impaired. Our aim was to evaluate sexual function in women with SSc in comparison to controls, and to investigate the association with sociodemographic and disease characteristics, and physical and psychological variables. Forty-six women with SSc and 46 healthy women were assessed for sociodemographic characteristics and gynecological development and administered the Female Sexual Function Index (FSFI), Medical Outcomes Study Short Form-36 (SF-36), Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale, Coping Orientation to Problems Experienced-New Italian Version, and Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Patients were also assessed for disease duration and subset, Female Sexual Function in SSc, Hand Mobility in Scleroderma test (HAMIS), Cochin Hand Functional Disability Scale, Mouth Handicap in Systemic Sclerosis Scale (MHISS), Disability Sexual and Body Esteem Scale (PDSBE); and fist closure, hand opening, and mouth opening. In patients with SSc, only FSFI desire subscale score was significantly lower (p = 0.035) versus controls. Total FSFI score, similar to controls, was related with Medical Outcomes Study Short Form-36 mental component, HAQ (p = 0.022), MHISS (p = 0.038), and HAMIS (p = 0.037). In SSc, the main factors independently associated with sexual functioning were vaginal dryness [regression coefficient (B) = -0.72; p < 0.001], PDSBE (B = 0.42; p = 0.001), and HADS depression scale (B = -0.23; p = 0.035). Together, these variables explained 70% of the variance in the FSFI total score. In SSc, sexual function, although not different from controls, is influenced by specific disease-related and psychological concerns. Thus it should be included in patient evaluations and assessed in daily clinical practice.

FRI0247 Developing a who international classification of functioning, disabiltiy and health (ICF) language for systemic sclerosis (SSC): A eustar initiative

BackgroundSSc affects multiple organ systems resulting in an unlimited combination of types and degrees of disability in patients. Skin fibrosis, ischemic pain, ulceration, arthritis, contractures of small and large joints,...

THU0548 Hand Function in Systemic Sclerosis: A Clinical and Ultrasonographic Study

BackgroundHand involvement is one of the earliest clinical manifestations of systemic sclerosis (SSc) that results in major functional compromise. Several factors may be responsible including skin and periarticular thickening, arthralgias...

Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase

In systemic sclerosis (SSc; scleroderma) patients in edematous phase, hand edema is often present. Manual lymph drainage (MLD) stimulates the lymphatic system and reduces edema. Our aim was to evaluate the efficacy of MLD in reducing edema and in improving functionality of the hands and perceived quality of life (QOL) in SSc patients in edematous phase. Of 35 SSc patients with edematous hands, 20 were treated with MLD according to the Vodder technique once a week for 5 weeks (intervention group), and 15 served as the observation group. Patients were evaluated at enrollment, at the end of treatment (T1), and after 9 weeks of followup (T2) by volumetric test (assessing hand volume), the Hand Mobility in Scleroderma (HAMIS) test, and 4 visual analog scales (VAS; scored 0-10) evaluating the perception of hand edema and pain and their interference on daily activities. QOL and disability were assessed by the physical synthetic index (PSI) and mental synthetic index (MSI) of the Short Form 36 (SF-36) and by the Health Assessment Questionnaire (HAQ). In the intervention group, hand volume, the HAMIS test, and the 4 VAS were improved significantly at the end of treatment (P < 0.001). The results were maintained at T2 (P < 0.001). The HAQ and the PSI and MSI of the SF-36 also improved significantly at T1 (P < 0.001), but only PSI improvement was maintained at T2 (P < 0.001). In the observation group, no improvement at T1 and at T2 was observed. In SSc, MLD significantly reduces hand edema and improves hand function and perceived QOL.

Randomized comparison of a multidisciplinary team care program with usual care in patients with systemic sclerosis

To compare the effectiveness of a multidisciplinary team care program with usual outpatient care in patients with systemic sclerosis (SSc; scleroderma). We performed a randomized controlled trial comparing a 12-week multidisciplinary team care program (1 day per week; individual treatments, group exercises, and group education) with outpatient clinic care. Outcome measures included the Hand Mobility in Scleroderma (HAMIS) test, grip strength, maximal mouth opening (MMO), 6-minute walk distance (6MWD), maximum aerobic capacity (VO(2max) ), Checklist Individual Strength 20 (CIS-20), SSc Health Assessment Questionnaire (HAQ), and Short Form 36 (SF-36), assessed at 0, 12, and 24 weeks. Statistical comparisons of change scores were done by analysis of covariance. Twenty-eight patients were assigned to the intervention group (mean age 53.9 years, 15 of 28 with diffuse SSc) and 25 were assigned to the control group (mean age 51.7 years, 15 of 25 with diffuse SSc). Twenty-five patients (89%) in the intervention group completed the treatment program. At 12 weeks, there was a significantly greater improvement in grip strength (2.2 versus -1.8 kg; P = 0.001), MMO (1.4 versus -0.9 mm; P = 0.011), 6MWD (42.8 versus 3.9 meters; P = 0.021), and HAQ score (-0.18 versus 0.13; P = 0.025) in the intervention group, whereas differences for the other outcome measures did not reach significance. At 24 weeks, the effect on grip strength persisted. In patients with SSc, a 12-week multidisciplinary day patient treatment program was more effective than regular outpatient care with respect to 6MWD, grip strength, MMO, and HAQ score, but not for VO(2max) , HAMIS test, CIS-20, SF-36, and visual analog scale for pain. This study provides a first step in quantifying the effect of a multidisciplinary team care program and warrants the conduct of further intervention studies.

Comparative Analysis of Different Specific Indices of Hand Impairment in Systemic Sclerosis

To the Editor: Hand involvement is often the first clinical manifestation of systemic sclerosis (SSc) during the disease course. Some indices such as finger-to-palm distance in flexion (FTP)1, the Hand Anatomic Index (HAI)2, and the Hand Mobility in Scleroderma test (HAMIS)3 have been developed to assess functional impairment by testing the reduction in range of motion or evaluating inability, but there is still no consensus whether they yield different information or are mutually interchangeable. We compared these 3 assessment tools used to quantify hand impairment in SSc, considering their associations with organ involvement. Our analyses were based on 80 consecutive patients with SSc (68 women, 12 men) referred to the Division of Rheumatology, Istituto Gaetano Pini, Milan; 60 were classified as having limited cutaneous disease (lcSSc; mean age 61.3 yrs) and 20 as having diffuse cutaneous disease (dcSSc; mean age 58.9 yrs). Judged from the first symptom attributable to SSc, 20 (33.3%) lcSSc and 6 (30%) dcSSc patients had disease of recent onset (< 5 and 3 years, respectively), whereas 40 (66.7%) lcSSc and 14 (70%) dcSSc patients had intermediate/late onset disease (≥ 5 and 3 years)4. To determine patients’ disease profiles on the basis of the pattern of … Address correspondence to Dr. Ingegnoli; E-mail: francesca.ingegnoli{at}unimi.it

Self-Reports of Hand Function in Persons with Diabetes

ABSTRACTThe purpose of this study was to examine the reliability and validity of three self-reports of hand function for persons with diabetes. Thirty-six people with type II diabetes completed self-report questionnaires of hand function including the Hand Function Disability Scale (HFDS), Michigan Hand Outcomes Questionnaire (MHQ), and Dreiser's Functional Hand Index (DFI) at two points in time to assess test–retest reliability. To determine validity, participants were also administered performance-based tests of hand strength, dexterity, and joint motion using the Keital Function Test, and Hand Mobility in Scleroderma Test. Test–retest reliability intraclass correlation coefficients for test–retest reliability ranged from 0.89 to 0.96 for the HFDS; 0.58 to 0.94 for the MHQ; and 0.90 for the DFI. Spearman Rho correlations showed fair correlations between the HFDS and applied hand strength. Fair correlations were also found between the scores on the MHQ and hand strength and joint motion, while scores on the DFI did not correlate with hand strength, dexterity, or joint motion. Overall, the HFDS and the MHQ appear to be reliable and valid measures of hand function in persons with diabetes and may help occupational therapists determine the level of difficulty with daily tasks and monitor outcomes of therapy in persons with diabetes.

The thickness of the A1 pulleys reflects the disability of hand mobility in scleroderma. A pilot study using high-frequency ultrasound

Background Hand involvement in scleroderma is a serious concern. Clinical tests to asses hand dysfunction are based on the experience of the clinician. Objective To asses if utrasonographic (US) measurement of A1 pulley thickness may be used as an indicator of hand mobility in scleroderma. Materials and methods Institutional review board approval and patient informed consent was obtained. Twenty-eight patients affected suffering from scleroderma and 40 healthy controls were prospectively evaluated by two blinded radiologists with US, with a transducer operating at 17 MHz. A1 pulley thickness was measured and correlated with the Hand Mobility in Scleroderma Test (HAMIS) and disease duration. Results The thickness of the A1 pulley was greater in sclerodermic patients than in controls ( p < 0.05). Intra and inter-observer agreement were better for ultrasound (0.94;0.88) than for HAMIS tests (0.71;0.70). A good correlation between pulley thickness, hand mobility and disease duration was found ( r = 0.78, p < 0.018; r = 0.54, p < 0.05). Conclusion A1 pulley thickness measured on ultrasound correlates with hand mobility and disease duration. Ultrasound is an useful tool to evaluate hand disability in scleroderma.

Efficacy of connective tissue massage and Mc Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis

Rehabilitation may contribute to the management of systemic sclerosis (SSc) dealing with disabilities due to hand involvement. The aim of this study is to evaluate the efficacy of a rehabilitation programme based on the combination of connective tissue massage and Mc Mennell joint manipulation specifically conceived for SSc patients' hands. Forty SSc patients were enrolled: 20 (interventional group) were treated for a 9-week period (twice a week, 1 h per session) with a combination of connective tissue massage, Mc Mennell joint manipulation and home exercise programme, and 20 (control group) were assigned only to home exercise programme. Patients of both groups were assessed at baseline (T0), after 9 week (T1) and at a 9 weeks follow-up (T2). They were evaluated for quality of life by SF-36 and Health Assessment Questionnaire (HAQ), hands involvement by Hand Mobility in Scleroderma (HAMIS) test, Cochin hand functional disability scale and the measurements of ROM. In the interventional group, fist closure, HAMIS test and Cochin hand functional disability scale improved at the end of the treatment (p < 0.0001) as well as HAQ, Physical Synthetic Index (PSI) and Mental Synthetic Index (MSI) of SF-36 scores (HAQ and PSI, p < 0.0001; MSI, p < 0.001). In the control group, the programme of home daily exercises improved only fist closure at the end of the treatment (p < 0.0001). The combination of connective tissue massage, Mc Mennell joint manipulation and home exercise programme is effective in the rehabilitative treatment of SSc hands. This combined treatment may lead to an improvement of hand function and quality of life.

An individualized rehabilitation program in patients with systemic sclerosis may improve quality of life and hand mobility

Few data are available to assess the efficacy of rehabilitative interventions in systemic sclerosis (SSc). We refer here the results of an individualized rehabilitation program in 16 patients with SSc. In particular, when possible, the number of patients who achieved a minimal clinically important difference (MCID) was determined. Results were evaluated taking advantage of the development of validated questionnaires and tests to assess quality of life (QOL) and disability in SSc. At the end of a period of 4 months of observation, 69% and 62% of patients reported an improvement of the physical and mental components of the SF-36 higher than the MCID (as established in other rheumatic conditions). Analogously, an improvement of the impact of respiratory disease on patients' QOL, as assessed by the Saint George's Respiratory Questionnaire, was perceived by 67% of them. These results might be explained by better exercise tolerance, which was suggested by the significant reduction of the heart rate and of a visual analogue scale for dyspnoea at the end of the 6-min walking test. Finally, a statistically significant improvement of hand mobility, as assessed by the hand mobility in scleroderma test was obtained. This study suggests that a significant proportion of patients with SSc experience an improvement in their perception of QOL, a better exercise tolerance, and a better hand mobility after a rehabilitation program consisting by a 2-week period of daily individual 30-min sessions as outpatient, followed by at-home exercise program.

Outcome Measures for People with Scleroderma: Relationships between Measures of Impairment and Activity Limitation

This study examined the relationships between impairment and activity limitation outcome measures in people with scleroderma. Forty people with scleroderma received evaluations of body structure and function variables: grip and pinch strength (Arthritis Hand Function Test), dexterity (nine-hole pegboard), joint motion (Hand Mobility in Scleroderma and Keital Function Test) and skin thickness. The participants also completed self-report questionnaires regarding activity limitations (Health Assessment Questionnaire, Hand Functional Disability Scale and Scleroderma Functional Assessment Questionnaire). All grip and pinch strength and dexterity measures correlated significantly but moderately with the activity limitation measures (r = 0.34 to 0.62). The Keital Function Test correlated with the activity limitation measures (r = 0.43 to 0.49) whereas the Hand Mobility in Scleroderma test and skin thickness did not. The results demonstrated that the activity limitations reported by the participants were only partly associated with the impairment variables. The findings from this study might help occupational therapists to decide where to focus intervention and which measures to use when assessing the effectiveness of occupational therapy for people with scleroderma.

Reliability and Validity of a Self-report of Hand Function in Persons with Rheumatoid Arthritis

The purpose of this study was to examine the test–retest reliability and the concurrent validity of the Duruöz Hand Index (DHI) in persons with rheumatoid arthritis (RA). Forty participants with RA and no other major medical problems completed the DHI, a self-report of hand function, at two points in time to assess test–retest reliability. To determine concurrent validity, participants were also administered three performance-based tests, the Arthritis Hand Function Test (AHFT), the Hand Mobility in Scleroderma Test (HAMIS), and the Keitel Functional Test (KFT), and two self-report questionnaires of functional ability, the Health Assessment Questionnaire (HAQ) and the Scleroderma Functional Assessment Questionnaire (SFAQ). Test–retest reliability intraclass correlation coefficients for the DHI ranged from 0.83 to 0.90. Scores on the DHI were significantly correlated with scores on the AHFT ( r s = 0.36–0.54), the HAMIS ( r s = 0.39), the HAQ ( r s = 0.78), the HAMIS ( r s = 0.39), and the SFAQ ( r s = 0.85). Scores on the DHI did not correlate with KFT scores. The results from this study show the DHI to be a reliable and valid test for hand function in persons with RA.

Reliability and validity of the Duruoz Hand Index in persons with systemic sclerosis (scleroderma).

To examine the test-retest reliability and concurrent validity of the Duruoz Hand Index (DHI) in persons with scleroderma. Forty patients with scleroderma and no other major medical problems completed the DHI at 2 points in time to assess test-retest reliability. To assess validity, participants were administered the Arthritis Hand Function Test (AHFT), the Hand Mobility in Scleroderma Test (HAMIS), and the Keital Function Test (KFT), all performance-based tests. In addition, participants completed the Health Assessment Questionnaire (HAQ), a self report of functional ability. Test-retest reliability intraclass correlation coefficients for the DHI ranged from 0.81 to 0.97. Scores on the DHI did not correlate with HAMIS scores, but were significantly correlated with scores from the KFT (rs = 0.48, P < 0.01), HAQ (rs = 0.79, P < 0.01), and all sections of the AHFT (rs = 0.34-0.60, P < 0.05-0.01). The results from this study show the DHI to be a reliable and valid test for persons with scleroderma.