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Tossini NB, Melo CDS, Braz de Oliveira MP, Moreira RDFC, Serrão PRMDS. Effect of physical therapy interventions in individuals with primary thumb carpometacarpal osteoarthritis: a systematic review and meta-analysis. Disabil Rehabil 2024:1-15. [PMID: 38450686 DOI: 10.1080/09638288.2024.2325652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE This systematic review and meta-analysis aimed to investigate the effect of physiotherapeutic interventions in individuals with thumb primary CMC OA on the outcomes of pain, hand function, grip or pinch strength. METHODS RCTs that used some type of physiotherapeutic intervention compared to a passive or active control group were included. The quality of the evidence was assessed using the GRADE approach and, for the calculation of the meta-analysis, the standardized difference of means (SMD) was used. RESULTS Nineteen studies (n = 1477) were included and eight studies (n = 568) underwent meta-analysis. Orthosis intervention was superior to passive control group for pain improvement (SMD = -1.02, p = 0.03, very low evidence), grip strength (SMD = 0.45, p = 0.02, very low evidence) and pinch strength (SMD = 1.78, p = 0.01, very low evidence), but there was no improvement in hand function (p = 0.54). The use of a neoprene orthosis was similar to the use of a thermoplastic orthosis in improving pain (p = 0.38), hand function (p = 0.50), grip strength (p = 0.42) and pinch strength (p = 0.14). The use of short thermoplastic orthosis was also similar to long thermoplastic orthosis in improving pain (p = 0.88) and hand function (p = 0.58). CONCLUSION The use of orthoses is superior to no intervention in all outcomes, exception hand function.IMPLICATIONS FOR REHABILITATIONThe use of orthosis is recommended for the treatment of patients with rhizoarthrosisUse of orthosis is better than no intervention in improving pain, grip and pinch strength.The type of orthosis (neoprene or thermoplastic, short or long thermoplastic) does not affect the clinical improvement of the individual to the outcomes of pain, hand physical function, grip and pinch strength.
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Chen X, Xie L, Xia X, Luo X, Chen J, Zhang J, Li Q, Zhang X, Jiang J, Yang M. Effects of measurement protocols and repetitions on handgrip strength weakness and asymmetry in patients with cancer. J Cachexia Sarcopenia Muscle 2024; 15:220-230. [PMID: 38014503 PMCID: PMC10834335 DOI: 10.1002/jcsm.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The use of handgrip strength (HGS) in clinical cancer research is surging. The association between HGS and outcomes in patients with cancer varied across studies, which might be due to the different measurement protocols for HGS. We aimed to answer three questions: (1) Did the use of various protocols for HGS, along with different numbers of repetitions, lead to significant differences in maximum HGS values? (2) If yes, were these differences clinically significant? (3) Did the differences in HGS protocols and repetitions affect the identification of HGS weakness or HGS asymmetry? METHODS We continuously recruited adult patients with solid tumours. Two protocols were used to measure HGS: Method A, following the American Society of Hand Therapists guidelines, and Method B, following the National Health and Nutrition Examination Survey guidelines. To analyse HGS, we used the maximal value obtained from either two or three repetitions of the dominant hand or four or six repetitions of both hands. RESULTS We included 497 patients (326 men and 171 women, median age: 58 years). The maximal HGS values, measured with Method B, were significantly higher than those measured by Method A in both men and women, despite repetitions (all P < 0.05). The maximum HGS values were significantly different across the repetition groups, regardless of measurement protocols and sex (all P < 0.01). The protocol-induced differences in maximal HGS values might be clinically meaningful in over 60% of men and 40% of women despite repetitions. The repetition-induced difference was only clinically significant in 4.3-17.8% of men and 4.1-14.6% of women. To identify HGS weakness, using Method A (six repetitions) as the 'gold' standard, the other protocols demonstrated an overall accuracy of 0.923-0.997 in men and 0.965-1 in women. To identify HGS asymmetry, using Method A (six repetitions) as the 'gold' standard, Method B (six repetitions) demonstrated a diagnostic accuracy of 0.972 in men and 0.971 in women. Method A (four repetitions) showed a diagnostic accuracy of 0.837 in men and 0.825 in women, while Method B (four repetitions) showed a diagnostic accuracy of 0.825 in men and 0.807 in women. CONCLUSIONS Both measurement protocols and repetitions significantly affect the maximal HGS values. The identification of HGS weakness is not significantly affected by either protocols or repetitions, while the identification of HGS asymmetry may be affected by different repetitions but not protocols.
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Affiliation(s)
- Xiaoyan Chen
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingling Xie
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
- Department of Oncology, West China Hospital (Shangjin Nanfu Branch), Sichuan University, Chengdu, China
| | - Xin Xia
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaozhen Luo
- Department of Oncology, West China Hospital (Shangjin Nanfu Branch), Sichuan University, Chengdu, China
| | - Jing Chen
- Department of Oncology, West China Hospital (Shangjin Nanfu Branch), Sichuan University, Chengdu, China
| | - Jing Zhang
- Department of Oncology, West China Hospital (Shangjin Nanfu Branch), Sichuan University, Chengdu, China
| | - QinLan Li
- Department of Oncology, West China Hospital (Shangjin Nanfu Branch), Sichuan University, Chengdu, China
| | - Xuemei Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaojiao Jiang
- Rehabilitation Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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McGee C, Valdes K, Bakker C, Ivy C. Psychometric properties of body structures and functions measures in non-surgical thumb carpometacarpal osteoarthritis: A systematic review. J Hand Ther 2024; 37:22-37. [PMID: 37591727 PMCID: PMC10867279 DOI: 10.1016/j.jht.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Measurement of treatment outcomes and change in health status over time is a critical component of clinical practice and research for people with osteoarthritis. Numerous clinical tools are used to assess the structures and function of the thumb in persons with thumb carpometacarpal osteoarthritis however their psychometrics have not yet been systematically explored. PURPOSE The purpose of this study was to explore the psychometric properties of clinical tools used in persons with non-surgical thumb carpometacarpal osteoarthritis to objectively measure thumb structures and function, evaluate the quality of such studies, and subsequently make clinical and future research recommendations. STUDY DESIGN Systematic review. METHODS A systematic search and screening was conducted across nine databases. Original research published between 2002 and 2022 that involved the assessment of psychometric properties (validity, reliability, precision, responsiveness, sensitivity, specificity, and minimal clinically important difference) of clinical tools were included. Sample characteristics, methods, and psychometric findings from each study were compiled. The methodological quality of included studies was evaluated using the COnsensus-based Standards for the selection of health Measurement Instruments' checklist. Two independent researchers screened articles and assessed methodological quality and when not in agreement, a third party was consulted. RESULTS Eleven studies were included in the review. The mean age of all participants in the studies was 69 years of age. The study designs included prospective case-control, prospective cohort, and cross-sectional to determine the psychometric properties of the measurements and tools. The included studies examined techniques to assess range of motion, strength, and pain-pressure thresholds, and screen for arthritis (ie, provocative tests). The intermetacarpal distance method, Kapandji index, pain-pressure threshold test, and pain-free grip and pinch dynamometry demonstrate excellent reliability and acceptable precision. Metacarpal extension, adduction, and pressure-shear provocative tests have superior sensitivity and specificity and the extension and adduction tests have excellent reliability. Other assessments included in the review yielded less robust psychometric properties. Studies were of variable methodological quality spanning from inadequate to very good. CONCLUSIONS Based on the available literature on the psychometric properties of assessments of body structures and functions in persons with non-operative thumb carpometacarpal osteoarthritis, we offer a limited set of recommendations for use when screening for arthritis symptomology and measuring hand strength, thumb mobility, and pain thresholds. Additional psychometric research is needed in these domains as well as in dexterity, sensation, and objective measures of hand function. Future research should employ best practices in psychometric research.
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Affiliation(s)
- Corey McGee
- Programs in Occupational Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA.
| | - Kristin Valdes
- Program in Occupational Therapy, Touro University, Henderson, NV, USA
| | - Caitlin Bakker
- Archer Library, University of Regina, Regina, SK, Canada
| | - Cindy Ivy
- Program in Occupational Therapy, Northern Arizona University, Phoenix, AZ, USA
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van Beest S, Kloppenburg M, Rosendaal FR, van de Stadt LA. Subluxation of the first carpometacarpal joint and age are important factors in reduced hand strength in patients with hand osteoarthritis. Scand J Rheumatol 2023; 52:637-644. [PMID: 37341472 DOI: 10.1080/03009742.2023.2215016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE To investigate the determinants of hand strength in patients with hand osteoarthritis (OA). METHOD Pinch and cylinder grip strength were measured in 527 patients with hand OA diagnosed by their treating rheumatologist from the Hand OSTeoArthritis in Secondary care (HOSTAS) study. Radiographs of hands (22 joints) were scored 0-3 (scaphotrapeziotrapezoid and first interphalangeal joints 0-1) on osteophytes and joint space narrowing following the Osteoarthritis Research Society International atlas. The first carpometacarpal joint (CMC1) was scored 0-1 for subluxation. Pain was assessed with the Australian/Canadian Hand Osteoarthritis Index pain subscale, and health-related quality of life with the Short Form-36. Regression analysis served to investigate associations of hand strength with patient, disease, and radiographic features. RESULTS Hand strength was negatively associated with female sex, age, and pain. Reduced hand strength was associated with reduced quality of life, although less after adjusting for pain. Radiographic features of hand OA were associated with reduced grip strength when solely adjusted for sex and body mass index, but only CMC1 subluxation in the dominant hand remained significantly associated with pinch grip adjusted additionally for age (-0.511 kg, 95% confidence interval -0.975; -0.046). Mediation analysis showed low and not significant percentages of mediation of hand OA in the association between age and grip strength. CONCLUSIONS Subluxation of CMC1 is associated with reduced grip strength, whereas associations with other radiographic features seem to be confounded by age. In the relationship between age and hand strength, radiographic hand OA severity is not an important mediator.
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Affiliation(s)
- S van Beest
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - L A van de Stadt
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
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Gløersen M, Steen Pettersen P, Neogi T, Sexton J, Kvien TK, Hammer HB, Haugen IK. Associations between pain sensitization and measures of physical function in people with hand osteoarthritis: Results from the Nor-Hand study. Osteoarthritis Cartilage 2023; 31:1388-1395. [PMID: 37495183 PMCID: PMC10528207 DOI: 10.1016/j.joca.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To examine whether pain sensitization is associated with hand and lower extremity function in people with hand osteoarthritis (OA) in the Nor-Hand study. DESIGN Pain sensitization was assessed by pressure pain thresholds (PPTs) and temporal summation (TS). Hand function was assessed by Australian/Canadian Osteoarthritis Hand Index (AUSCAN) (range: 0-36), grip strength and Moberg pick-up test, and lower extremity function was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (range: 0-68), 30-s chair stand test, and 40-m walk test. We examined whether sex-standardized PPT and TS values were cross-sectionally associated with measures of physical function using linear regression analyses. Beta coefficients were presented per sex-specific standard deviation of PPT and TS. The mediating effect of pain was examined by causal-inference based mediation analysis. RESULTS In 206 participants, higher PPTs at/near the hand, indicative of less peripheral and/or central pain sensitization, were associated with greater grip strength and better self-reported hand function (beta for PPT at finger joint on AUSCAN function: -1.41, 95% CI -2.40, -0.42). Higher PPTs at/near the hand, near the knee and at trapezius were associated with lower extremity function, although not statistically significant for all outcomes. Self-reported pain severity mediated the effect of PPT on self-reported function. TS was not associated with hand or lower extremity function. CONCLUSION Peripheral sensitization, and possibly central sensitization, was associated with impaired function. Effects of PPTs on self-reported function were mediated by self-reported pain, whereas there might be a direct effect of sensitization or effects through other mediators on performance-based function.
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Affiliation(s)
- Marthe Gløersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Faculty of Medicine, Oslo, Norway.
| | - Pernille Steen Pettersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, United States of America.
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Tore K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Faculty of Medicine, Oslo, Norway.
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Faculty of Medicine, Oslo, Norway.
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
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Algar L, Naughton N, Ivy C, Loomis K, McGee C, Strouse S, Fedorczyk J. Assessment and treatment of nonsurgical thumb carpometacarpal joint osteoarthritis: A modified Delphi-based consensus paper of the American Society of Hand Therapists. J Hand Ther 2023; 36:982-999. [PMID: 37798185 DOI: 10.1016/j.jht.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND While the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus. PURPOSE This study aimed to ascertain if consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting. STUDY DESIGN This was a consensus paper via the modified Delphi approach. METHODS A modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A consensus paper steering committee (from the American Society of Hand Therapist's research division) designed the surveys and analyzed responses. Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel. RESULTS The expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey. Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient's unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention. CONCLUSIONS The findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA.
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Affiliation(s)
- Lori Algar
- Orthopaedic Specialty Group PC, Fairfield, CT, USA
| | | | - Cynthia Ivy
- Northern Arizona University, Phoenix, AZ, USA
| | - Katherine Loomis
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Corey McGee
- Programs in Occupational Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
| | - Stephanie Strouse
- Center of Hand, Upper Limb & Health Perfromance, Leigh Valley Health Network, Pottsville, PA, USA
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Costa JQ, Leite MJ, Relvas M, Vieira P, Negrão P, Vidinha V. Ulnar-Sided Upper Extremity Traumatic Wounds: What Should We Expect to Find? J Hand Surg Asian Pac Vol 2023; 28:435-440. [PMID: 37758486 DOI: 10.1142/s2424835523500480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: Upper limb traumatic injuries have a significant impact on social and professional life; however, there is still a paucity of studies focusing on the injuries of the ulnar border of the forearm, wrist and hand. Methods: We designed a retrospective single-blinded study, including all patients with deep traumatic wounds affecting the ulnar side of the forearm, wrist or hand, that received surgical treatment from 2006 until 2016. A characterisation of the sample, assessment of concomitant injuries and clinical outcomes, as well as neurological and functional evaluation were performed. Results: We obtained a sample of 61 patients, 69% with injuries affecting the wrist and 90% of patients with a neurological lesion, most frequently of the ulnar nerve lesion (UNL). Concomitant injuries included tendinous lesions, more frequently of the flexor carpi ulnaris (64%) and fractures (13%). And 39% of patients presented an ulnar artery lesion, without significant differences in outcomes regarding the completion of arteriorrhaphy or not. At the end of the 8.6 years follow-up, 34% of patients had no deficits; however, patients with UNL showed worse functional scores and greater risk of sequelae. Besides motor function compromise, sensory deficits were also associated with worst functional outcomes. Conclusions: The UNL subgroup showed important impairment of the first ray, probably related to the level of UNL. Furthermore, besides the implications of the motor sequelae, sensory deficits were also associated with worst functional scores. Due to the high percentage of neurovascular and tendinous lesions in ulnar-sided upper extremity wounds, the authors recommend surgical exploration of these lesions. Level of Evidence: Level IV (Therapeutic).
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Krijbolder DI, Wouters F, Niemantsverdriet E, van der Helm-van Mil AHM. Grip strength reduction in clinically suspect arthralgia: natural trajectories and improvement after treatment. RMD Open 2023; 9:e003110. [PMID: 37220995 PMCID: PMC10230977 DOI: 10.1136/rmdopen-2023-003110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Affiliation(s)
- Doortje I Krijbolder
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Fenne Wouters
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Chen X, Liu G, Li S, Lin X, Han Z, Hu X, Wu J, Yang M. Handgrip Measurement Method Affects Asymmetry but Not Weakness Identification in Community-Dwelling Older Adults. J Am Med Dir Assoc 2023; 24:284-291.e3. [PMID: 36423678 DOI: 10.1016/j.jamda.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The Asian Working Group for Sarcopenia (AWGS) 2019 recommends different measurement protocols for handgrip strength (HGS). We aimed to explore (1) whether these protocols induce a significant difference in HGS; (2) whether these differences be clinically meaningful; and (3) whether these protocols affect the identification of HGS weakness or asymmetry. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 356 community-dwelling older adults (mean age 67.9 years; 146 women). METHODS Maximal HGS was measured according to protocols from the National Health and Nutrition Examination Survey (Method A, standing with full elbow extended) and the American Society of Hand Therapists (Method B, sitting with elbow flexed at 90°). HGS was analyzed using the maximal value of 2 or 3 repetitions of the dominant hand or 4 or 6 repetitions of both hands. RESULTS The difference in maximal HGS between Method A and Method B might have clinical meaning in approximately half of the participants. When measured using Method A, respective proportions of individuals with differences in HGS between the 6 repetitions group and the other repetition groups beyond the noninferiority threshold were 42%, 20%, and 25% in men and 39%, 21%, and 17% in women. Using Method B, the corresponding percentages were 25%, 18%, and 6% in men, and 27%, 20%, and 5% in women, respectively. Different protocols did not significantly affect the identification of HGS weakness, as different protocols reached diagnostic accuracies of 0.910 to 0.967 in men and 0.911 to 0.986 in women when using Method A (6 repetitions) as the reference standard. However, different protocols significantly affected the identification of HGS asymmetry, as different protocols had diagnostic accuracies of 0.667 to 0.886 in men and 0.658 to 0.863 in women. CONCLUSIONS AND IMPLICATIONS The different protocols recommended by the AWGS 2019 update significantly affect maximal HGS values and the identification of HGS asymmetry but not HGS weakness.
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Affiliation(s)
- Xiaoyan Chen
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Gongxiang Liu
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China; Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Siyuan Li
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China; Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiufang Lin
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China; Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenli Han
- Health Management Department, Shangjin Nanfu Hospital, Sichuan University, Chengdu, China
| | - Xiaoyi Hu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; Health Management Department, Shangjin Nanfu Hospital, Sichuan University, Chengdu, China
| | - Jinhui Wu
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China; Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| | - Ming Yang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China; Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
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Risk factors predictive of adverse drug events and drug-related falls in aged care residents: secondary analysis from the ReMInDAR trial. Drugs Aging 2023; 40:49-58. [PMID: 36422825 PMCID: PMC9686455 DOI: 10.1007/s40266-022-00983-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Residents of aged-care facilities have high rates of adverse drug events. This study aimed to identify risk factors for adverse drug events in aged-care residents. METHOD This was a secondary study using data from a multicentre randomised controlled trial. Data from 224 residents for whom there was 6 months of baseline information were analysed. We assessed the risk of adverse drug events and falls (post hoc) in the subsequent 6 months. Adverse events were identified via a key word search of the resident care record and adjudicated by a multidisciplinary panel using a modified version of the Naranjo criteria. Covariates identified through univariable logistic regression, including age, sex, medicines, physical activity, cognition (Montreal Cognitive Assessment), previous adverse events and health service use were included in multivariable models. RESULTS Overall, 224 residents were included, with a mean age of 86 years; 70% were female. 107 (48%) residents had an adverse drug event during the 6-month follow-up. Falls and bleeding were experienced by 73 (33%) and 28 (13%) residents, respectively. Age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01-1.10), weight (OR 1.02, 95% CI 1.002-1.04), previous fall (OR 2.58, 95% CI 1.34-4.98) and sedative or hypnotic medicine use (OR 1.98, 95% CI 1.52-2.60) were associated with increased risk of adverse drug events. Increased cognition (OR 0.89, 95% CI 0.83-0.95) was protective. Risk factors for falls were previous fall (OR 3.27, 95% CI 1.68-6.35) and sedative or hypnotic medicines (OR 3.05, 95% CI 1.14-8.16). Increased cognition (OR 0.88, 95% CI 0.83-0.95) was protective. CONCLUSION Our results suggest residents with a previous fall, reduced cognition, and prescription of sedative or hypnotic medicines were at higher risk of adverse drug events and should be considered for proactive prevention.
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McGinley BM, Siracuse BL, Gottschalk MB, Wagner ER. Treatment of First Carpometacarpal Osteoarthritis with Arthroscopy: A Systematic Review. J Wrist Surg 2022; 11:509-520. [PMID: 36504539 PMCID: PMC9731745 DOI: 10.1055/s-0042-1744493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
Background First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated superiority in managing this disease. Purpose This study performed a systematic review of arthroscopic techniques for treating first CMC arthritis to assess the effectiveness of different arthroscopic techniques. Methods Grip strength, pinch strength, visual analog scale, the Disability of Arm, Shoulder, and Hand (DASH) score, range of motion (ROM), and complications were recorded. Two subgroup analyses were performed, comparing outcomes of (1) trapeziectomy of any type versus debridement alone and (2) trapeziectomy alone versus interposition versus suspension techniques. Results Preoperative and postoperative scores significantly improved for DASH scores and pain at rest and with activity with variable improvements in ROM. Complications occurred in 13% of cases in publications that reported complications. When comparing studies that utilized techniques with any type of trapeziectomy to debridement alone, only the trapeziectomy subgroup showed significant improvements in pain. When comparing trapeziectomy alone to interposition and suspension techniques, mean DASH scores and pain levels significantly improved in interposition and suspension subgroups. Conclusions The existing literature describes a predominantly female population with Eaton-Littler stage II and III disease. In the subgroup analysis, arthroscopic techniques involving a trapeziectomy seem to be more effective at lowering pain scores compared to techniques involving debridement alone. Likewise, interposition and suspension techniques may show improved outcomes compared to techniques involving trapeziectomy alone. Level of evidence This is a Level III study.
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Affiliation(s)
- Beau M McGinley
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | | | | | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
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Auroux M, Merle B, Fontanges E, Duvert F, Lespessailles E, Chapurlat R. The disability associated with hand osteoarthritis is substantial in a cohort of post-menopausal women: the QUALYOR study. Osteoarthritis Cartilage 2022; 30:1526-1535. [PMID: 35995128 DOI: 10.1016/j.joca.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/10/2022] [Accepted: 07/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Our primary aims were to assess current prevalence of HOA and the disability associated with this condition, in the group usually most affected, i.e., women older than 55. METHODS We performed hand radiographs, clinical examination, grip strength measurement, AUSCAN and COCHIN questionnaires in a cohort of postmenopausal women aged at least 55. Radiographic hand OA (RHOA) was defined as at least 2 affected joints among 30, grading 2 or more using the Kellgren Lawrence score but without any HOA symptom. Symptomatic HOA (OA ACR) was defined according to ACR criteria for hand OA. Moderate to severe symptomatic HOA was defined as having OA ACR and AUSCAN total score of >43/100. RESULTS We enrolled 1,189 participants. The mean age was 71.7 years. Inter-reader reliability of radiographs reading was good (ICC = 0.86) and intra-reader reliability was excellent (ICC = 0.97). Among the 1,189 women, 333 (28.0%) had RHOA, 482 (40.5%) patients fulfilled the ACR criteria for symptomatic HOA and 82 of these (17% of OA ACR population) had moderate to severe symptomatic HOA. The prevalence of symptomatic erosive osteoarthritis was 11.8%. Mean AUSCAN and Cochin scores were higher and grip strength lower in patients with symptomatic HOA compared to patient without HOA. Differences were more noticeable in patients with moderate to severe HOA. CONCLUSIONS We have assessed disability associated with HOA in greater detail than previously and found that a third of postmenopausal women had RHOA, two fifths had symptomatic HOA and one sixth of symptomatic patients had moderate to severe HOA related disability and a tenth had symptomatic erosive osteoarthritis, representing a substantial burden of disease in our population-based cohort.
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Affiliation(s)
- M Auroux
- Hôpital E Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex 03 Lyon, France.
| | - B Merle
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 Lyon Cedex 03, France
| | - E Fontanges
- Hôpital E Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex 03 Lyon, France
| | - F Duvert
- Hôpital E Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex 03 Lyon, France
| | - E Lespessailles
- Centre Hospitalier Régional d'Orléans, Université d'Orléans, Orléans, France
| | - R Chapurlat
- Hôpital E Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex 03 Lyon, France; INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 Lyon Cedex 03, France
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13
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Zheng WL, Wu YC, Shen YD, Yin HW, Xu WD. Arthroscopy-assisted partial trapeziectomy combined with ligament reconstruction for thumb carpometacarpal joint osteoarthritis: A different technique. Front Surg 2022; 9:945013. [PMID: 36338619 PMCID: PMC9632966 DOI: 10.3389/fsurg.2022.945013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/23/2022] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND There is no consensus on the best surgery option for thumb carpometacarpal osteoarthritis (CMC OA). The traditional method has the risk of large trauma, obvious metacarpal subsidence, and decreased stability. The aim of this study is to introduce a different technique to restore the function and stability of the first carpal metacarpal joint with minimal trauma, rapid pain relief, reduced complications, and the clinical outcomes in the long-term follow-up was evaluated and statistically analyzed. METHODS This was a retrospective study of 10 patients with a mean age of 51.8 years. The surgery consisted of removing partial trapezium through arthroscopy, reconstructing the stability with flexor carpi radialis suspension and tendon interposition. The subjective assessment included visual analog scale (VAS) of pain, quick disabilities of the arm, shoulder, and hand (Quick-DASH) score, and patient satisfaction. The range of motion, grip strength, pinch strength, and radiographic assessment, which can reflect stability of the thumb, were objectively evaluated and statistically analyzed. RESULTS Ten patients were monitored at a mean follow-up of 6.8 years. The mean grip strength improved significantly from 16.64 to 22.57 kg after surgery. Pinch strength improved significantly from 3.72 to 5.71 kg on average. The Kapandji score improved significantly from 5.7 to 8.6 on average. 80% (8/10) of the patients were satisfied with this surgery. On objective indicators, the VAS score decreased significantly from 6.4 to 1.3 on average. The mean Quick-DASH score improved significantly from 6.1 to 28.9. Postoperative x-ray showed slight subsidence and dislocation of the first metacarpal in two patients and did not affect the function by measurement. CONCLUSION Arthroscopy-assisted partial trapezium resection combined with ligament reconstruction could be a workable and promising surgical technique in patients with thumb CMC OA. It can offer the advantages of minimizing surgical injury by preserving the first carpal metacarpal joint capsule to protect its stability, with a rapid pain relief, function improvement, and satisfactory results in patients' clinical measurements.
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Affiliation(s)
- Wan-Ling Zheng
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yang-Chun Wu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
| | - Yun-Dong Shen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
- Priority Among Priorities of Shanghai Municipal Clinical Medicine Center, Shanghai, China
| | - Hua-Wei Yin
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
- Institute of Engineering and Application Technology, Fudan University, Shanghai, China
| | - Wen-Dong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Priority Among Priorities of Shanghai Municipal Clinical Medicine Center, Shanghai, China
- Institute of Engineering and Application Technology, Fudan University, Shanghai, China
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14
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Campos-Villegas C, Pérez-Alenda S, Carrasco JJ, Igual-Camacho C, Tomás-Miguel JM, Cortés-Amador S. Effectiveness of proprioceptive neuromuscular facilitation therapy and strength training among post-menopausal women with thumb carpometacarpal osteoarthritis. A randomized trial. J Hand Ther 2022:S0894-1130(22)00080-1. [PMID: 35948454 DOI: 10.1016/j.jht.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Thumb carpometacarpal osteoarthritis (CMC OA) greatly affects post-menopausal women. It is characterized by pain and functional deficits that limit the performance of activities of daily life and affect quality of life. PURPOSE Analyze the effects of 4/weeks strength training, with and without proprioceptive neuromuscular facilitation (PNF) on the disability among post-menopausal women with thumb CMC OA. Secondly, analyze the effects on pain, mobility, and strength. STUDY DESIGN Superiority randomized clinical trial. METHODS 42 women were randomly allocated to strength training program (SEG, n = 21) and to a strength training plus PNF therapy program (PNFG, n = 21). The Disability (disabilities of the arm, shoulder and hand questionnaire), pain (visual analogue scale), mobility (Kapandji Test), and hand strength were evaluated pre, post intervention (at 4 weeks) and follow-up (at 8 weeks). RESULTS Disability was significantly reduced in both groups after intervention, but reduction was statistically superior in PNFG (between-group mean difference [MD] = -16.69 points; CI = -21.56:-11.82; P<.001; d = 2.14). Similar results were observed for secondary outcomes: pain (MD = -2.03; CI = -2.83:-1.22; P<.001; d = 1.58), mobility (MD = 0.96; CI = 0.52:1.38; P<.001; d = 1.40) and strength (grip: MD = 3.47kg; CI = 1.25:5.69; P = .003; d = 0.97, palmar: MD = 0.97kg; CI = 0.14:1.80; P = .024; d = 0.72, tip: MD = 1.12kg; CI = 0.41:1.83; P = .003; d = 0.99 and key pinch: MD = 0.85kg; CI = 0.001:1.70; P = .049; d = 0.62). These improvements were maintained at follow-up. CONCLUSIONS The combination of PNF exercises and strength training is more effective for reducing disability pain and improve mobility and strength in post-menopausal women with CMC OA than a programme based solely on strength.
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Affiliation(s)
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Celedonia Igual-Camacho
- Group of Physiotherapy in the Ageing Process, Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Sara Cortés-Amador
- UBIC research group, Department of Physiotherapy, University of Valencia, Valencia, Spain
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15
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Wilcke MK, Evans K, Franko MA, Arner M. Trapeziectomy with or without a tendon-based adjunct: a registry-based study of 650 thumbs. J Hand Surg Eur Vol 2022; 47:728-733. [PMID: 35313770 DOI: 10.1177/17531934221086220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to assess the outcomes after simple trapeziectomy and trapeziectomy with ligament reconstruction and/or tendon interposition based on data in the Swedish national healthcare quality registry for hand surgery (HAKIR). Six-hundred and fifty thumbs were included, and 265 were assessed up to 12 months after operation. There was significant and clinically relevant improvement in patient-reported measures (pain on load, pain on motion without load, pain at rest, stiffness, weakness, and ability to perform activities of daily living and the Quick Disabilities of the Arm, Shoulder and Hand score) and objective measures (strength and thumb mobility) at 3 and 12 months for all procedures. The use of the abductor pollicis longus tendon had better improvement in some respects compared with the use of flexor carpi radialis or extensor carpi radialis tendons. However, overall, the use of a tendon adjuncts yielded no better outcomes than simple trapeziectomy.Level of evidence: III.
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Affiliation(s)
- Maria K Wilcke
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Kajsa Evans
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | | | - Marianne Arner
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden
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16
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McVeigh KH, Kannas SN, Ivy CC, Garner HW, Barnes CS, Heckman MG, Brushaber DE, Murray PM. Dynamic stabilization home exercise program for treatment of thumb carpometacarpal osteoarthritis: A prospective randomized control trial. J Hand Ther 2022; 35:435-446. [PMID: 34312043 DOI: 10.1016/j.jht.2021.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Randomized control trial. INTRODUCTION Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common cause of hand pain and disability. Standard conservative therapy (SCT) for thumb CMC OA includes an orthosis and instruction in joint protection, adaptive equipment, and pain relieving modalities. The dynamic stability home exercise (HE) program is complementary conservative therapy designed to strengthen the stabilizing muscles of the thumb CMC. PURPOSE OF THE STUDY To investigate whether the addition of HE to SCT (SCT+HE) was more effective at reducing pain and disability in thumb CMC OA compared to SCT alone. METHODS The study compared 2 groups: SCT and SCT+HE. The SCT group received SCT with in-home pain management instructions, joint protection strategies with adaptive equipment, and a hand-based thumb-spica orthosis. The SCT+HE group received HE program instructions for adductor stretching and opponens and first dorsal interosseous strengthening in addition to SCT. Our primary outcome measure was the numerical rating scale (NRS) with secondary outcome measures of QuickDASH (shortened Disabilities of the Arm, Shoulder and Hand questionnaire), range of motion, grip strength, and pinch strength. Outcome measurements were assessed at first visit, 6 weeks, and 6 months. RESULTS There was no statistical difference between the 2 groups for NRS and QuickDASH at 6 weeks (P = .28 and P = .36, respectively) or 6 months (P = .52 and P = .97, respectively). However, there was a statistically significant decrease in NRS and QuickDASH scores at 6 weeks and 6 months within both groups. CONCLUSIONS Both SCT and SCT+HE are effective at reducing pain and disability in OA of the thumb CMC joint. Neither therapy program was superior to the other at improving NRS or QuickDASH scores at 6-week or 6-month follow-up.
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Affiliation(s)
- Kimberly H McVeigh
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Jacksonville, FL, USA.
| | - Stephanie N Kannas
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Cynthia C Ivy
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Phoenix, AZ, USA; Occupational Therapy Program, Northern Arizona University, Flagstaff, AZ, USA
| | - Hillary W Garner
- Division of Musculoskeletal Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Carolyn S Barnes
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Phoenix, AZ, USA; Occupational Therapy Program, Northern Arizona University, Flagstaff, AZ, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Danielle E Brushaber
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Peter M Murray
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
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17
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Magni NE, McNair PJ, Rice DA. Mobilisation or immobilisation-based treatments for first carpometacarpal joint osteoarthritis: A systematic review and meta-analysis with subgroup analyses. HAND THERAPY 2022; 27:37-48. [PMID: 37904729 PMCID: PMC10584044 DOI: 10.1177/17589983221083994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/04/2022] [Indexed: 11/01/2023]
Abstract
Introduction Both joint mobilisation and immobilisation are thought to be effective in the treatment of first carpometacarpal joint (CMCJ) osteoarthritis (OA). The objective of this review was to establish whether either intervention reduced pain and improved pinch strength in people with first CMCJ OA in the short term and assess whether one intervention is superior to the other. Method This was a systematic review and meta-analysis. Seven databases were searched until May 2021. Only RCTs were included. The Cochrane Risk of Bias Tool and the Grade of Recommendations Assessment, Development and Evaluation system were utilised to rate the evidence. Random-effects meta-analysis with subgroup analyses were used. Results Eight studies were included with a total of 417 participants. Mobilisation treatments included manual therapy with or without exercise while immobilisation interventions utilised thumb splinting with several different designs. Very low-quality and low-quality evidence showed that mobilisation led to statistically but not clinically significant improvements in pain (standardised mean difference (SMD) = 0.53; 95% confidence interval (CI) = 0.03 to 1; I2 = 60%; p = 0.06) and pinch strength (SMD = 0.35; 95% CI = 0.03 to 0.7; I2 = 12%; p = 0.3) compared to placebo. Very low-quality and low-quality evidence showed no effect on pain and pinch strength compared to a control or no intervention. Subgroup analyses revealed no difference between interventions. Discussion Neither mobilisation nor immobilisation alone led to clinically important improvements in pain or pinch strength in the short term in people with symptomatic first CMCJ OA. Neither therapeutic strategy appeared to be superior.
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Affiliation(s)
- Nicoló Edoardo Magni
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Peter John McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - David Andrew Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
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18
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Milner Z, Klaic M, Withiel T, O'Sullivan H. Targeted sensorimotor retraining in the clinical setting: Improving patient outcomes following distal upper extremity injury. J Hand Ther 2022; 35:107-114. [PMID: 33573827 DOI: 10.1016/j.jht.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 10/28/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Existing theoretical evidence indicates sensorimotor retraining is beneficial following wrist injury. However, there are no large cohort studies applying the knowledge in a clinical setting. PURPOSE OF THE STUDY To Determine the clinical benefits of sensorimotor rehabilitation following distal upper extremity injury. STUDY DESIGN Prospective cohort study. METHODS A sensorimotor rehabilitation program was evaluated following distal upper extremity injury. A battery of clinical and patient-rated outcome measures (PROM) were taken before and after group completion. RESULTS Ninety-three patients, 49 males (53%) and 44 females (47%), completed the program. There were statistically significant improvements in 12 clinical measures. However, improvements in 11 of the clinical measures only had a small effect size (<0.5). Joint position sense had the greatest clinical change with a median improvement of 4° on the left and 3.9° on the right, and these had moderate effect sizes of 0.5 and 0.7, respectively. There were statistically significant improvements in all PROMs. PRWE had a median improvement of 21 (ES = 1.2). UEFI showed median improvements of 19.7 (ES = 1.4) and NRS (pain) median improved 2.5 (ES = 1.2). All PROM improvements had mean change greater than associated MCIDs. DISCUSSION These results indicate the benefits of sensorimotor group rehabilitation and supports existing literature regarding the importance of sensorimotor control for JPS accuracy and function. Group based sensorimotor programs present an efficient and low-cost opportunity to provide intervention to patients following upper extremity injury. CONCLUSION A sensorimotor group rehabilitation program may improve patient outcomes following distal upper extremity injury. LEVEL OF EVIDENCE Level 2b prospective cohort.
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Affiliation(s)
- Zoe Milner
- Masters Health Sciences (Occupational Therapy), Allied Health (Occupational Therapy), Clinical Lead Hand Therapy, Royal Melbourne Hospital, Victoria, Australia.
| | - Marlena Klaic
- Allied Health (Research and Translation Leader) Royal Melbourne Hospital, Victoria, Australia
| | - Toni Withiel
- Allied Health (Psychology) Royal Melbourne Hospital, Victoria, Australia
| | - Hayley O'Sullivan
- Allied Health (Occupational Therapy), Senior Clinician Hand Therapy, Victoria, Australia
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19
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Eraslan U, Kitis A, Demirkan AF, Ozcan RH. Effect of electromyographic biofeedback training on functional status in zone I-III flexor tendon injuries: a randomized controlled trial. Physiother Theory Pract 2022:1-11. [PMID: 35229697 DOI: 10.1080/09593985.2022.2043499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite advances in hand therapy and surgery, functional deficits persist after flexor tendon repair especially in zone I-III. This suggests that methods applied may be insufficient. Electromyographic (EMG) biofeedback may provide an effective tendon gliding through visual and auditory feedback. PURPOSE The purpose of this study was to investigate the effect of EMG biofeedback training applied in addition to early passive motion protocol on functional status in zone I-III flexor tendon injuries. METHODS Patients were randomly assigned into two groups, each consisted of 11 patients. In addition to early passive motion method, EMG biofeedback training was applied in the first group. The second group was followed only with early passive motion protocol. Joint range of motion (ROM), Michigan Hand Outcomes Questionnaire (MHQ) and grip strength were evaluated. RESULTS There were no significant differences between the groups in terms of the ROM, MHQ scores and grip strength (p ≥ .087). However, there were clinically important differences in the results of the 12th week ROM (effect size = 0.70), 24th week activity of daily living (ADL) score in MHQ (effect size = 0.68), 12th week gross, tip pinch and lateral grip strength (effect sizes = 0.59, 0.52, 0.81, respectively) and 24th week gross, tip pinch and lateral grip strength (effect sizes = 0.69, 0.73, 0.69, respectively) between the two groups. CONCLUSIONS EMG biofeedback training was clinically but not statistically superior to early passive motion method in terms of the effect on functional status.
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Affiliation(s)
- Umut Eraslan
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ali Kitis
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ahmet Fahir Demirkan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ramazan Hakan Ozcan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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20
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Hile E, Neuhold R. Using frequency to bolus-dose resistance training for brief pre-operative windows in geriatric abdominopelvic cancers prehabilitation. J Geriatr Oncol 2022; 13:747-753. [DOI: 10.1016/j.jgo.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/05/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
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21
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Gil JA, Kleiner J, McQuillan TJ, Kenney D, Ladd AL, Weiss APC, Crisco JJ. The Association of AUSCAN and PRWHE Patient-reported Outcome Measures With Radiographic Progression of Early Thumb Carpometacarpal Arthritis at 36-Month Follow-up Is Limited to Subtle Changes in the Pain Subscale. Hand (N Y) 2022; 17:354-360. [PMID: 32935579 PMCID: PMC8984720 DOI: 10.1177/1558944720928489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a paucity of literature that examines how patient-reported outcomes correspond to early radiographic progression of thumb carpometacarpal (CMC) osteoarthritis (OA). This study examines how Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Patient-Rated Hand and Wrist Evaluation (PRWHE) scores change over 36 months in subjects with early CMC OA. METHODS Ninety-one subjects with symptomatic early thumb CMC OA were enrolled. Differences in AUSCAN and PRWHE scores were measured between subjects at baseline and at 18-month follow-up, and between the subjects at baseline and at 36-month follow-up. Radiographic progression was defined as an increase in modified Eaton Stage. Differences in AUSCAN and PRWHE scores were compared between these 2 groups in order to determine if radiographic progression was associated with a greater change in AUSCAN and PRWHE at 18- and 36-month follow-up. RESULTS At 18- and 36-month follow-up visits, there were no significant differences in AUSCAN or PRWHE compared to baseline. Multivariable logistic regression analysis did not reveal any significant differences between subjects with radiographic progression to subjects without radiographic progression at 18-month follow-up. At 36-month follow-up, this analysis did demonstrate that subjects with evidence of radiographic progression had a significant increase in the PRWHE pain subscale. CONCLUSION AUSCAN and PRWHE scores were not found to significantly progress at 18-month and 36-month follow-up. However, when comparing the subset of subjects with and without radiographic OA, subjects with early CMC OA who had 1 stage of radiographic progression were found to have a significantly higher intensity of pain on the PRWHE pain subscale at 36-month follow-up.
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Affiliation(s)
- Joseph A. Gil
- Warren Alpert Medical School of Brown
University, Providence, RI, USA,Joseph A. Gil, Department of Orthopaedic
Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown
University, 593 Eddy Street, Providence, RI 02903, USA.
| | - Justin Kleiner
- Warren Alpert Medical School of Brown
University, Providence, RI, USA
| | | | | | - Amy L. Ladd
- Stanford School of Medicine, Redwood
City, CA, USA
| | | | - Joseph J. Crisco
- Warren Alpert Medical School of Brown
University, Providence, RI, USA
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22
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van Laarhoven CMCA, Tong MCY, van Heijl M, Schuurman AH, van der Heijden BEPA. Effect of Tendon Strip (FCR vs APL) on Outcome of CMC Thumb Joint Arthroplasty With Pyrocarbon Disk Interposition. Hand (N Y) 2022; 18:87S-95S. [PMID: 35086351 PMCID: PMC10052627 DOI: 10.1177/15589447211040879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pyrocarbon disk interposition for carpometacarpal (CMC) thumb joint osteoarthritis can be performed with a flexor carpi radialis (FCR) or abductor pollicis longus (APL) tendon strip. With the FCR technique, a ligament reconstruction is performed in addition to disk fixation, whereas with the APL technique the disk is simply secured in place. Our aim is to compare long-term postoperative outcomes between both techniques. METHODS In this observational study, we included 106 patients in 2 centers operated on between 2006 and 2011. We assigned patients to the FCR group or the APL group based on the respective tendon strip used. As a primary outcome, we analyzed postoperative key pinch. In addition, we analyzed postoperative tip pinch and tripod pinch, grip strength, range of motion, thumb height maintenance, and patient-reported outcome measures (PROMs). RESULTS The analysis showed clinically important stronger key pinch for the APL group (β = 1.28 kg). Tip pinch and grip strength showed higher outcome for the FCR group (β = 1.22 kg and 5.14 kg, respectively). Palmar abduction was in favor of the FCR group and opposition in favor of the APL group, but these were interpreted as not clinically relevant. Radiological thumb height maintenance and PROMs showed no clinical difference. CONCLUSIONS Pyrocarbon disk interposition arthroplasty for CMC thumb joint osteoarthritis can be secured with an APL or FCR tendon strip. At long-term follow-up, use of an APL tendon strip results in significantly higher key pinch and better opposition. Tip pinch, grip strength, and palmar abduction were better after use of the FCR tendon strip. The choice of the tendon strip can be based on outcomes considered most important for the individual patient.
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Affiliation(s)
| | | | - Mark van Heijl
- University Medical Center Utrecht, The Netherlands.,Diakonessenhuis, Utrecht, The Netherlands
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23
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Letzelter JP, Ahmad R, Tagliarino J, Woeckener J, Bello R, Melamed E. Hand Function Following Simulated Fusion of Thumb Metacarpophalangeal and Interphalangeal Joints. Hand (N Y) 2022; 17:74-78. [PMID: 32100564 PMCID: PMC8721794 DOI: 10.1177/1558944720906495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: There is poor understanding regarding functional limitation of thumb strength and dexterity following thumb metacarpophalangeal (MCP) and interphalangeal (IP) arthrodesis. The purpose of this investigation was to quantitatively evaluate the functional limitations of MCP and IP joint fusion using an orthosis to simulate fusion. Methods: Thirty-two healthy volunteers underwent simulated MCP and IP thumb arthrodesis using custom-molded orthoses. Each volunteer was independently assessed for hand and thumb function using the Jebsen-Taylor Hand Function test, lateral pinch strength, tip pinch strength, and Grooved Pegboard test. Comparisons between the 3 groups in all functional tests were carried out. Results: The mean lateral pinch strength was significantly greater in the unsplinted group (8.3 kg) compared with the MCP- (6.3 kg) and IP-splinted (5.7 kg) groups. Mean tip pinch strength was also significantly higher in the unsplinted group than in MCP- and IP-splinted thumbs (4.6 kg vs 4.1 and 3.9 kg). There was no difference in the Jebsen-Taylor or Grooved Pegboard test between the 3 groups. Conclusion: Our study suggests that with a fused MCP joint the lateral and tip pinch strength will decrease by 24% and 10%, respectively, compared with a healthy nonsplinted thumb. A fused IP joint will decrease lateral and tip pinch by 31% and 16%, respectively. This information does not take into account an arthritic thumb. We found that the Jebsen-Taylor test and Grooved Pegboard test were not affected by simulated thumb MCP and IP fusion.
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Affiliation(s)
- Joseph Paul Letzelter
- New York University, New York City, USA,Joseph Paul Letzelter III, Department of Orthopedic Surgery, New York University, 301 E 17th Street, New York City, NY 10003, USA.
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Acute Whole-Body Vibration Exercise Promotes Favorable Handgrip Neuromuscular Modifications in Rheumatoid Arthritis: A Cross-Over Randomized Clinical. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9774980. [PMID: 34901282 PMCID: PMC8660187 DOI: 10.1155/2021/9774980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Objective Rheumatoid arthritis (RA) causes progressive changes in the musculoskeletal system compromising neuromuscular control especially in the hands. Whole-body vibration (WBV) could be an alternative for the rehabilitation in this population. This study investigated the immediate effect of WBV while in the modified push-up position on neural ratio (NR) in a single session during handgrip strength (HS) in women with stable RA. Methods Twenty-one women with RA (diagnosis of disease: ±8 years, erythrocyte sedimentation rate: ±24.8, age: 54± 11 years, BMI: 28 ± 4 kg·m−2) received three experimental interventions for five minutes in a randomized and balanced cross-over order: (1) control—seated with hands at rest, (2) sham—push-up position with hands on the vibration platform that remained disconnected, and (3) vibration—push-up position with hands on the vibration platform turned on (45 Hz, 2 mm, 159.73 m·s−2). At the baseline and immediately after the three experimental interventions, the HS, the electromyographic records (EMGrms), and range of motion (ROM) of the dominant hand were measured. The NR, i.e., the ratio between EMGrms of the flexor digitorum superficialis (FDS) muscle and HS, was also determined. The lower NR represented the greater neuromuscular efficiency (NE). Results The NR was similar at baseline in the three experimental interventions. Despite the nonsignificance of within-interventions (p = 0.0611) and interaction effect (p = 0.1907), WBV exercise reduced the NR compared with the sham and control (p = 0.0003, F = 8.86, η2 = 0.85, power = 1.00). Conclusion Acute WBV exercise under the hands promotes neuromuscular modifications during the handgrip of women with stable RA. Thus, acute WBV exercise may be used as a preparatory exercise for the rehabilitation of the hands in this population. This trial is registered with trial registration 2.544.850 (ReBEC-RBR-2n932c).
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Update on Thumb Basal Joint Arthritis Surgery. Plast Reconstr Surg 2021; 148:811e-824e. [PMID: 34705791 DOI: 10.1097/prs.0000000000008487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Comprehend anatomy and biomechanics of the normal and arthritic trapeziometacarpal joint. 2. Evaluate best evidence for diagnosis and for operative and nonoperative treatment of thumb osteoarthritis. 3. Understand treatment pitfalls of basilar joint arthritis and complication avoidance. SUMMARY Articular and ligamentous anatomy of the trapeziometacarpal joint enables complex motions. Disability from arthritis, common at the trapeziometacarpal joint, is debilitating. Furthering the understanding of how trapeziometacarpal arthritis develops can improve treatment. The authors provide current best evidence for diagnosis and treatment of basilar joint arthritis. Pitfalls in treatment are discussed.
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Ise M, Saito T, Katayama Y, Nakahara R, Shimamura Y, Hamada M, Senda M, Ozaki T. Relationship between clinical outcomes and nerve conduction studies before and after surgery in patients with carpal tunnel syndrome. BMC Musculoskelet Disord 2021; 22:882. [PMID: 34656102 PMCID: PMC8520296 DOI: 10.1186/s12891-021-04771-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background Nerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS. Method Of the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months postoperatively. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement. Results The average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6–12 months, r = 0.67; 0–12 months, r = 0.60) and DASH (0–12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6–12 months, r = − 0.33; 0–12 months, r = − 0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below. Conclusion NCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04771-y.
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Affiliation(s)
- Masato Ise
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama, 700-8558, Japan.,Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Yoshimi Katayama
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Ryuichi Nakahara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yasunori Shimamura
- Department of Sports Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masanori Hamada
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Masuo Senda
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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Gutiérrez Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Valenzuela-Fuenzalida J, Jorquera-Aguilera R, Gutiérrez-Monclus R, Castillo-Alcayaga J, Retamal-Pérez P. Effectiveness of manual therapy in patients with thumb carpometacarpal osteoarthritis: a systematic review and meta-analysis. Physiother Theory Pract 2021; 38:2368-2377. [PMID: 34074220 DOI: 10.1080/09593985.2021.1926026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear.Objective: This study aimed to determine the effectiveness of MT for functional outcomes in patients with thumb carpometacarpal OA. Design: Systematic review and meta-analysis of randomized clinical trials. Methods: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared MT versus other interventions in functional outcomes, such as thumb and/or hand function questionnaires, pinch and/or grip strength, thumb and/or hand range of motion, and pain intensity or pressure pain threshold in patients with thumb carpometacarpal OA. Results: Five clinical trials met the eligibility criteria; for the quantitative synthesis, four studies were included. The mean difference (MD) for grip strength was 0.87kg (95% CI = 0.29-1.44, p = .003), for pinch strength was 0.10kg (95% CI = -0.01-0.20, p = .06), and for the pressure pain threshold was 0.64kg/cm2 (95% CI = 0.07-1.20, p = .03). All differences were in favor of the MT group. Conclusions: In the short-term, there was moderate to high evidence, with statistically significant differences in the functional outcomes, in favor of MT versus sham interventions in patients with thumb carpometacarpal OA. However, these differences are not clinically important.
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Affiliation(s)
| | | | - Cristian Olguín-Huerta
- Rehabilitation in Health Research Center (CIRES), Universidad De Las Américas, Santiago, Chile
| | | | | | | | - Jaime Castillo-Alcayaga
- Rehabilitation in Health Research Center (CIRES), Universidad De Las Américas, Santiago, Chile
| | - Patricio Retamal-Pérez
- Rehabilitation in Health Research Center (CIRES), Universidad De Las Américas, Santiago, Chile
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An Up-Date of the Muscle Strengthening Exercise Effectiveness in Postmenopausal Women with Osteoporosis: A Qualitative Systematic Review. J Clin Med 2021; 10:jcm10112229. [PMID: 34063906 PMCID: PMC8196674 DOI: 10.3390/jcm10112229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Osteoporosis (OP) is a systemic disease that is characterized by decreased bone density and quality. Purpose: The purpose of this systematic review was to determine the effects of muscle strengthening exercise in postmenopausal women with OP. Methods: A literature search was conducted systematically in MEDLINE, CINAHL, EMBASE databases for human studies up to 31 March 2021. Two researchers screened the articles against predefined inclusion criteria; a third resolved discrepancies. Articles were included if they assessed the effects of muscle strengthening exercise in postmenopausal women with OP. The protocol for this systematic review was registered on PROSPERO (CRD42021207917) and a qualitative systematic review was carried out following the PRISMA statement. Methodological quality was evaluated through the scientific validity scales PEDro. Finally, RTCs and NRCTs risk of bias was assessed with the Cochrane risk of bias tool (Risk of Bias-ROB 2.0) and ROBINS-1, respectively. Results: A total of 16 studies (1028 subjects) that met the different eligibility criteria previously established were selected. There is evidence of good methodological quality and a low to moderate risk of bias that supports that muscle strengthening exercise alone or in combination with other therapeutic modalities improves BMD (9, n = 401) in proximal femur and lumbar vertebra body, muscle strength (10, n = 558), balance (4, n = 159), functionality (7, n = 617), and quality of life (5, n = 291). CONCLUSIONS Exercise programs focused on muscle strengthening have benefits for all variables studied in postmenopausal women with OP.
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Bula-Oyola E, Belda-Lois JM, Porcar-Seder R, Page Á. Effectiveness of electrophysical modalities in the sensorimotor rehabilitation of radial, ulnar, and median neuropathies: A meta-analysis. PLoS One 2021; 16:e0248484. [PMID: 33735212 PMCID: PMC7971482 DOI: 10.1371/journal.pone.0248484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION People with ulnar, radial or median nerve injuries can present significant impairment of their sensory and motor functions. The prescribed treatment for these conditions often includes electrophysical therapies, whose effectiveness in improving symptoms and function is a source of debate. Therefore, this systematic review aims to provide an integrative overview of the efficacy of these modalities in sensorimotor rehabilitation compared to placebo, manual therapy, or between them. METHODS We conducted a systematic review according to PRISMA guidelines. We perform a literature review in the following databases: Biomed Central, Ebscohost, Lilacs, Ovid, PEDro, Sage, Scopus, Science Direct, Semantic Scholar, Taylor & Francis, and Web of Science, for the period 1980-2020. We include studies that discussed the sensorimotor rehabilitation of people with non-degenerative ulnar, radial, or median nerve injury. We assessed the quality of the included studies using the Risk of Bias Tool described in the Cochrane Handbook of Systematic Reviews of Interventions and the risk of bias across studies with the GRADE approach described in the GRADE Handbook. RESULTS Thirty-eight studies were included in the systematic review and 34 in the meta-analysis. The overall quality of evidence was rated as low or very low according to GRADE criteria. Low-level laser therapy and ultrasound showed favourable results in improving symptom severity and functional status compared to manual therapy. In addition, the low level laser showed improvements in pinch strength compared to placebo and pain (VAS) compared to manual therapy. Splints showed superior results to electrophysical modalities. The clinical significance of the results was assessed by effect size estimation and comparison with the minimum clinically important difference (MCID). CONCLUSIONS We found favourable results in pain relief, improvement of symptoms, functional status, and neurophysiological parameters for some electrophysical modalities, mainly when applied with a splint. Our results coincide with those obtained in some meta-analyses. However, none of these can be considered clinically significant. TRIAL REGISTRATION PROSPERO registration number CRD42020168792; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168792.
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Affiliation(s)
- Ena Bula-Oyola
- Universitat Politècnica de València, Valencia, Spain
- Departamento de Diseño, Universidad del Norte, Barranquilla, Colombia
| | - Juan-Manuel Belda-Lois
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Valencia, Spain
- Grupo de Tecnología Sanitaria del IBV, CIBER de Bioingeniería, Biomateriales y Nanomedicina, Valencia, Spain
| | - Rosa Porcar-Seder
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Valencia, Spain
| | - Álvaro Page
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Valencia, Spain
- Departamento de Física Aplicada, Universitat Politècnica de València, Valencia, Spain
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Effects of Ischemic Compression on Trigger Points in the First Dorsal Interosseous Muscle in Patients with Thumb Carpometacarpal Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062961. [PMID: 33799341 PMCID: PMC7999225 DOI: 10.3390/ijerph18062961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/21/2022]
Abstract
Background: Thumb carpometacarpal osteoarthritis (CMC OA) is a common disorder that interferes with the ability to perform the activities of daily life. The purpose of this study was to investigate the immediate effects of ischemic compression on myofascial trigger points (MTrPs) in the first dorsal interosseous (FDI) muscle in patients with the diagnosis of thumb CMC OA. Methods: In a quasi-experimental clinical trial, thirty-one patients, 87% female (age: 82 ± 9.4 years), with thumb CMC OA, were consecutively assigned to either an experimental treatment that included the ischemic compression of the FDI MTrP or a sham treatment of the FDI MTrP for one session. The main outcome considered in the study was the pressure pain threshold (PPT). Measurements were taken pre- and post-treatment and at a 1-week follow-up period. Results: The PPT over the right (affected) FDI muscle showed statistically significant differences between groups at 1-week follow up (F = 3.518; p = 0.04) in favor of the experimental group. Conclusions: The ischemic compression of FDI-MTrPs is an appropriate part of a multimodal treatment to decrease local pain sensitivity in patients with CMC OA.
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Lee SY, Jin H, Arai H, Lim JY. Handgrip strength: Should repeated measurements be performed in both hands? Geriatr Gerontol Int 2021; 21:426-432. [PMID: 33709458 DOI: 10.1111/ggi.14146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/24/2021] [Accepted: 02/21/2021] [Indexed: 01/25/2023]
Abstract
AIM We aimed to determine whether both hands should be tested for handgrip strength and whether it is necessary to perform repeated measurements in each hand. METHODS The data were obtained from the Korea National Health and Nutrition Examination Survey conducted from 2014 to 2018. The participants performed three trials of handgrip strength measurement for each hand alternately, with 60-s rest between the trials. From this pool of data, we included 23 901 participants aged ≥19 years who had completed surveys on the handgrip strength test, and obtained their medical history. RESULTS The dominant hand had a significantly stronger handgrip strength than the non-dominant hand (32.75 ± 0.10 vs. 30.95 ± 0.09 kg, P < 0.001); however, 26.4% of the subjects had stronger handgrip strength in the non-dominant hand. During the three repeated measurements, the handgrip strength gradually increased; however, the mean difference between the trials (0.579 and 0.104 kg) was below the noninferiority threshold. In older adults, however, the mean difference in the handgrip strength between the first and the second trial was higher than the noninferiority threshold. CONCLUSIONS While the handgrip strength gradually increased during three repeated measurements, the difference was clinically important only in older adults. Hence, we suggest that the handgrip strength should be measured in both hands and at least twice in older adults, whereas a single attempt provides a maximal value in younger adults. Geriatr Gerontol Int 2021; 21: 426-432.
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Affiliation(s)
- Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Heejin Jin
- Medical Research Collaborating Center, SMG-SNU Boramae Medical Center, Seoul, South Korea.,Research & Business Development Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Institute of Aging, Seoul National University, Seoul, South Korea
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Oigawa H, Musha Y, Ishimine Y, Kinjo S, Takesue Y, Negoro H, Umeda T. Visualizing and Evaluating Finger Movement Using Combined Acceleration and Contact-Force Sensors: A Proof-of-Concept Study. SENSORS 2021; 21:s21051918. [PMID: 33803456 PMCID: PMC7967163 DOI: 10.3390/s21051918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 11/17/2022]
Abstract
The 10-s grip and release is a method to evaluate hand dexterity. Current evaluations only visually determine the presence or absence of a disability, but experienced physicians may also make other diagnoses. In this study, we investigated a method for evaluating hand movement function by acquiring and analyzing fingertip data during a 10-s grip and release using a wearable sensor that can measure triaxial acceleration and strain. The subjects were two healthy females. The analysis was performed on the x-, y-, and z-axis data, and absolute acceleration and contact force of all fingertips. We calculated the variability of the data, the number of grip and release, the frequency response, and each finger’s correlation. Experiments with some grip-and-release patterns have resulted in different characteristics for each. It was suggested that this could be expressed in radar charts to intuitively know the state of grip and release. Contact-force data of each finger were found to be useful for understanding the characteristics of grip and release and improving the accuracy of calculating the number of times to grip and release. Frequency analysis suggests that knowing the periodicity of grip and release can detect unnatural grip and release and tremor states. The correlations between the fingers allow us to consider the finger’s grip-and-release characteristics, considering the hand’s anatomy. By taking these factors into account, it is thought that the 10-s grip-and-release test could give us a new value by objectively assessing the motor functions of the hands other than the number of times of grip and release.
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Affiliation(s)
- Hitomi Oigawa
- Department of MBT, Graduate School of Medicine, Nara Medical University, Nara 634-8521, Japan;
| | - Yoshiro Musha
- Toho University Ohashi Medical Center, Department of Orthopedic Surgery, Toho University, Tokyo 153-8515, Japan; (Y.M.); (Y.I.); (S.K.); (Y.T.)
| | - Youhei Ishimine
- Toho University Ohashi Medical Center, Department of Orthopedic Surgery, Toho University, Tokyo 153-8515, Japan; (Y.M.); (Y.I.); (S.K.); (Y.T.)
| | - Sumito Kinjo
- Toho University Ohashi Medical Center, Department of Orthopedic Surgery, Toho University, Tokyo 153-8515, Japan; (Y.M.); (Y.I.); (S.K.); (Y.T.)
| | - Yuya Takesue
- Toho University Ohashi Medical Center, Department of Orthopedic Surgery, Toho University, Tokyo 153-8515, Japan; (Y.M.); (Y.I.); (S.K.); (Y.T.)
| | - Hideyuki Negoro
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA;
- MBT Institute, Nara Medical University, Nara 634-8521, Japan
| | - Tomohiro Umeda
- MBT Institute, Nara Medical University, Nara 634-8521, Japan
- Correspondence:
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Lim R, Bereznicki L, Corlis M, Kalisch Ellett LM, Kang AC, Merlin T, Parfitt G, Pratt NL, Rowett D, Torode S, Whitehouse J, Andrade AQ, Bilton R, Cousins J, Kelly L, Schubert C, Williams M, Roughead EE. Reducing medicine-induced deterioration and adverse reactions (ReMInDAR) trial: study protocol for a randomised controlled trial in residential aged-care facilities assessing frailty as the primary outcome. BMJ Open 2020; 10:e032851. [PMID: 32327474 PMCID: PMC7204916 DOI: 10.1136/bmjopen-2019-032851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/04/2020] [Accepted: 03/30/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Many medicines have adverse effects which are difficult to detect and frequently go unrecognised. Pharmacist monitoring of changes in signs and symptoms of these adverse effects, which we describe as medicine-induced deterioration, may reduce the risk of developing frailty. The aim of this trial is to determine the effectiveness of a 12-month pharmacist service compared with usual care in reducing medicine-induced deterioration, frailty and adverse reactions in older people living in aged-care facilities in Australia. METHODS AND ANALYSIS The reducing medicine-induced deterioration and adverse reactions trial is a multicentre, open-label randomised controlled trial. Participants will be recruited from 39 facilities in South Australia and Tasmania. Residents will be included if they are using four or more medicines at the time of recruitment, or taking more than one medicine with anticholinergic or sedative properties. The intervention group will receive a pharmacist assessment which occurs every 8 weeks. The pharmacists will liaise with the participants' general practitioners when medicine-induced deterioration is evident or adverse events are considered serious. The primary outcome is a reduction in medicine-induced deterioration from baseline to 6 and 12 months, as measured by change in frailty index. The secondary outcomes are changes in cognition scores, 24-hour movement behaviour, grip strength, weight, percentage robust, pre-frail and frail classification, rate of adverse medicine events, health-related quality of life and health resource use. The statistical analysis will use mixed-models adjusted for baseline to account for repeated outcome measures. A health economic evaluation will be conducted following trial completion using data collected during the trial. ETHICS AND DISSEMINATION Ethics approvals have been obtained from the Human Research Ethics Committee of University of South Australia (ID:0000036440) and University of Tasmania (ID:H0017022). A copy of the final report will be provided to the Australian Government Department of Health. TRIAL REGISTRATION NUMBER Australian and New Zealand Trials Registry ACTRN12618000766213.
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Affiliation(s)
- Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Luke Bereznicki
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Megan Corlis
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Ai Choo Kang
- Southern Cross Care (SA&NT), Adelaide, South Australia, Australia
| | - Tracy Merlin
- Discipline of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Gaynor Parfitt
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Debra Rowett
- UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Stacey Torode
- Southern Cross Care (SA&NT), Adelaide, South Australia, Australia
| | - Joseph Whitehouse
- Pharmacy Improvement Centre Ltd, Welland, South Australia, Australia
| | - Andre Q Andrade
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca Bilton
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Justin Cousins
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Lan Kelly
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Camille Schubert
- Discipline of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Elizabeth Ellen Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Cole TS, Almefty KK, Godzik J, Muma AH, Hlubek RJ, Martinez-Del-Campo E, Theodore N, Kakarla UK, Turner JD. Functional improvement in hand strength and dexterity after surgical treatment of cervical spondylotic myelopathy: a prospective quantitative study. J Neurosurg Spine 2020; 32:907-913. [PMID: 32032958 DOI: 10.3171/2019.10.spine19685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) is the primary cause of adult spinal cord dysfunction. Diminished hand strength and reduced dexterity associated with CSM contribute to disability. Here, the authors investigated the impact of CSM severity on hand function using quantitative testing and evaluated the response to surgical intervention. METHODS Thirty-three patients undergoing surgical treatment of CSM were prospectively enrolled in the study. An occupational therapist conducted 3 functional hand tests: 1) palmar dynamometry to measure grip strength, 2) hydraulic pinch gauge test to measure pinch strength, and 3) 9-hole peg test (9-HPT) to evaluate upper extremity dexterity. Tests were performed preoperatively and 6-8 weeks postoperatively. Test results were expressed as 1) a percentile relative to age- and sex-stratified norms and 2) achievement of a minimum clinically important (MCI) difference. Patients were stratified into groups (mild, moderate, and severe myelopathy) based on their modified Japanese Orthopaedic Association (mJOA) score. The severity of stenosis on preoperative MRI was graded by three independent physicians using the Kang classification. RESULTS The primary presenting symptoms were neck pain (33%), numbness (21%), imbalance (12%), and upper extremity weakness (12%). Among the 33 patients, 61% (20) underwent anterior approach decompression, with a mean (SD) of 2.9 (1.5) levels treated. At baseline, patients with moderate and low mJOA scores (indicating more severe myelopathy) had lower preoperative pinch (p < 0.001) and grip (p = 0.01) strength than those with high mJOA scores/mild myelopathy. Postoperative improvement was observed in all hand function domains except pinch strength in the nondominant hand, with MCI differences at 6 weeks ranging from 33% of patients in dominant-hand strength tests to 73% of patients in nondominant-hand dexterity tests. Patients with moderate baseline mJOA scores were more likely to have MCI improvement in dominant grip strength (58.3%) than those with low mJOA scores/severe myelopathy (30%) and high mJOA scores/mild myelopathy (9%, p = 0.04). Dexterity in the dominant hand as measured by the 9-HPT ranged from < 1 in patients with cord signal change to 15.9 in patients with subarachnoid effacement only (p = 0.03). CONCLUSIONS Patients with CSM achieved significant improvement in strength and dexterity postoperatively. Baseline strength measures correlated best with the preoperative mJOA score; baseline dexterity correlated best with the severity of stenosis on MRI. The majority of patients experienced MCI improvements in dexterity. Baseline pinch strength correlated with postoperative mJOA MCI improvement, and patients with moderate baseline mJOA scores were the most likely to have improvement in dominant grip strength postoperatively.
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Measurement Properties of the Hand Grip Strength Assessment: A Systematic Review With Meta-analysis. Arch Phys Med Rehabil 2019; 101:553-565. [PMID: 31730754 DOI: 10.1016/j.apmr.2019.10.183] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/09/2019] [Accepted: 10/12/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to critically appraise, compare, and summarize the quality of the measurement properties of grip strength (GS) in patients with musculoskeletal, neurologic, or systemic conditions and healthy participants without these conditions. DATA SOURCES We followed the Consensus-based Standards for the Selection of Health Measurement Instruments guideline. To identify studies on measurement properties of GS, we searched the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health, Physiotherapy Evidence, and Cochrane Library databases from inception until June 2019. Meta-analyses were carried out using a random effects model and 95% CIs were calculated. STUDY SELECTION Studies were included if they reported at least 1 measurement property of hand GS in a population with musculoskeletal, neurologic, and systemic conditions or a healthy population without these conditions. DATA EXTRACTION The extracted data included the study population, setting, sample size, measurement evaluated, and the test interval. DATA SYNTHESIS Twenty-five studies were included with 1879 participants. The pooled results indicated excellent intraclass correlation coefficient (ICC) of 0.92 (95% CI, -0.88-0.94 for healthy participants without any conditions, ICC of 0.95 (95% CI, -0.93-0.97) for upper extremity conditions, and an ICC of 0.96 (95% CI, -0.94-0.97) for patients with neurologic conditions. Minimum clinically important difference (MCID) scores for hand GS were 5.0 kg (dominant side) and 6.2 kg (nondominant side) for patients post stroke, 6.5 kg for the affected side after distal radius fracture, 10.5 lb and 10 kPa for immune-mediated neuropathies, 17 kg for patients with lateral epicondylitis, and 0.84 kg (affected side) and 1.12 kg (unaffected side) in the carpometacarpal osteoarthritis group; MCID GS estimates were 2.69-2.44 kg in the healthy group without conditions. CONCLUSION Our synthesized evidence indicated that GS assessment is a reliable and valid procedure among healthy participants as well as across various clinical populations. Furthermore, our MCID summary scores provided useful information for evaluating (clinical importance) new interventions regarding hand GS.
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Lim R, Kalisch Ellett LM, Widagdo IS, Pratt NL, Roughead EE. Analysis of anticholinergic and sedative medicine effects on physical function, cognitive function, appetite and frailty: a cross-sectional study in Australia. BMJ Open 2019; 9:e029221. [PMID: 31488480 PMCID: PMC6731897 DOI: 10.1136/bmjopen-2019-029221] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/21/2019] [Accepted: 08/19/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To test the association between use of medicines with anticholinergic or sedative properties and physical function, cognitive function, appetite and frailty. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study analysed baseline data collected as part of the Australian Longitudinal Study of Ageing, a population-based cohort of 2087 participants aged 65 years or over living in South Australia. MAIN OUTCOME MEASURES Physical function was measured at baseline using measures including hand grip strength, walking speed, chair stands, activities of daily living and instrumental activities of daily living (IADL). Cognitive function was measured using Mini-Mental State Examination. Appetite was measured using Center for Epidemiologic Studies Depression question 2. Frailty was measured using frailty index. The association between use of anticholinergics or sedatives and physical or cognitive function, appetite, or frailty was assessed using analysis of covariance and ordinal or binary logistic regression. RESULTS Almost half of the population were using anticholinergics or sedatives (n=954, 45.7%). Use of anticholinergics was significantly associated with poorer grip strength, slower walking speed, poorer IADL and poorer appetite. Use of sedatives was significantly associated with poorer grip strength, slower walking speed and poorer IADL. We found no significant association between medicine use and cognitive function. Users of anticholinergics or sedatives were significantly more likely to be frail compared with non-users. CONCLUSION Use of medicines with anticholinergic or sedative properties is significantly associated with poorer physical function, poorer appetite and increased frailty. Early identification of signs and symptoms of deterioration associated with medicine use is particularly important in older people so that worsening frailty and subsequent adverse events are prevented.
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Affiliation(s)
- Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Imaina S Widagdo
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth Ellen Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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Tsehaie J, van der Oest MJW, Poelstra R, Selles RW, Feitz R, Slijper HP, Hovius SER, Porsius JT. Positive experience with treatment is associated with better surgical outcome in trapeziometacarpal osteoarthritis. J Hand Surg Eur Vol 2019; 44:714-721. [PMID: 31154893 PMCID: PMC6696737 DOI: 10.1177/1753193419851777] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to investigate the association between patients' experiences with trapeziometacarpal arthroplasty and treatment outcomes in terms of patient-reported outcome measures, grip and pinch strength. We included 233 patients who received a Weilby procedure for trapeziometacarpal osteoarthritis. Before surgery and 12 months after surgery, patients completed the Michigan Hand Outcomes Questionnaire, and their pinch and grip strengths were measured. At 3 months after surgery, a patient-reported experience measure was completed. Using regression analysis, significantly positive associations were found between the Michigan Hand questionnaire and the patient-reported experience measure, with the strongest significant associations being for patients' experiences with information provision. No significant associations were found between the patients' experience and strength outcomes. The results highlight the potential importance of positive experience with the treatment process to improve treatment outcomes in patients undergoing surgery for trapeziometacarpal osteoarthritis. Level of evidence: IV.
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Affiliation(s)
- Jonathan Tsehaie
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands,Jonathan Tsehaie, Erasmus MC Rotterdam, Dr.
Molewaterplein 50, Room EE 15.91b, 3015 GE Rotterdam, The Netherlands.
| | - Mark J. W. van der Oest
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands
| | - Ralph Poelstra
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands
| | - Reinier Feitz
- Hand and Wrist Surgery, Xpert Clinic,
The Netherlands
| | | | - Steven E. R. Hovius
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands
| | - Jarry T. Porsius
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands
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Thumb carpometacarpal osteoarthritis: A musculoskeletal physiotherapy perspective. J Bodyw Mov Ther 2019; 23:908-912. [PMID: 31733781 DOI: 10.1016/j.jbmt.2019.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 01/10/2023]
Abstract
PROPOSAL To perform a literature review to provide the practitioner with a description of the information and techniques to enhance the provision of conservative interventions in clinical practice. METHODS Studies were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to December 2017. Authors independently selected studies, conducted quality assessment, and extracted results. RESULTS There is evidence to support a multimodal approach to the therapeutic management of the patient with CMC OA. This distinct approach includes: patient education, manual therapy, therapeutic exercise programs, and orthotic provision. CONCLUSION There is evidence to support some of the commonly performed conservative interventions to improve hand function and decrease hand pain.
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Liu CH, Yip KS, Chiang HY. Investigating the optimal handle diameters and thumb orthoses for individuals with chronic de Quervain's tenosynovitis - a pilot study. Disabil Rehabil 2019; 42:1247-1253. [PMID: 30689463 DOI: 10.1080/09638288.2018.1522548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: The aims of this study were to compare the differences in forearm muscle activities between two types of thumb orthoses and the optimal handle diameter when the orthosis is worn during a power grasp for individuals with chronic de Quervain's Tenosynovitis.Methods: A 2 × 3 (Group × orthosis) and a 2 × 2 × 3 (Group × orthosis × diameter) repeated factorial design were used. Grip strength and muscle load were measured. A 2 × 3 mixed repeated measures ANOVA was conducted, and the Least Significant Difference (LSD) test was used for post hoc analysis. Cohen's d was used to calculate the effect size between groups and handle diameters.Results: Grip strength was significantly lower (in long/short/no-orthosis conditions) and muscle load was higher in 12 participants with chronic de Quervain's Tenosynovitis than in 16 healthy participants (p < 0.001). No differences in muscle activities were found when the two different orthoses were worn. The muscle activities were higher during grasping of the 33 mm handle diameter.Conclusion: Individuals with chronic de Quervain's Tenosynovitis require greater muscle loads than healthy controls to produce the same power grasp, and when one of the two orthoses is worn, the optimal handle diameters for performing a power grasp are relatively larger (45 and 55 mm).Implications for RehabilitationBoth the long and short thumb orthoses can be worn by individuals with de Quervain's Tenosynovitis during daily activities because wearing both orthoses requires the same exertion of muscle load.When performing a power grasp, individuals with de Quervain's Tenosynovitis tend to exert greater muscle loads than healthy controls to produce the same power grasp.We suggest that patients with de Quervain's Tenosynovitis use utensils with larger handle diameters, such as 45 mm and 55 mm.
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Affiliation(s)
- Chien-Hsiou Liu
- Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Kai-Shun Yip
- Department of Rehabilitation, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Hsin-Yu Chiang
- Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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Benaim C, Blaser S, Léger B, Vuistiner P, Luthi F. "Minimal clinically important difference" estimates of 6 commonly-used performance tests in patients with chronic musculoskeletal pain completing a work-related multidisciplinary rehabilitation program. BMC Musculoskelet Disord 2019; 20:16. [PMID: 30611242 PMCID: PMC6320580 DOI: 10.1186/s12891-018-2382-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background Functional tests are widely used to measure performance in patients with chronic musculoskeletal pain. Our objective was to determine the Minimal Clinically Important Differences (MCID) for the 6-min walk test (6MWT), the Steep Ramp Test (SRT), the 1-min stair climbing test (1MSCT), the sit-to-stand test (STS), the Jamar dynamometer test (JAM) and the lumbar Progressive Isoinertial Lifting Evaluation (PILE) in chronic musculoskeletal pain patients. Methods A single-center prospective observational study was conducted in a rehabilitation center. Patients with upper-limb, lower-limb or neck/back lesions were included over a period of 21 months. We used the anchor-based method as a reference method, supplemented by the distribution-based and opinion-based approaches, to determine the MCIDs. Results 838 chronic musculoskeletal pain patients were included. The estimation method and thelesion location had a significant influence on the results. MCIDs were estimated at +75m and +60m for the 6MWT (lower-limb and neck/back lesions, respectively), +18 steps for the 1MSCT (lower-limb and neck/back lesions) and +6kg for the JAM (upper limb lesions). The anchor-based method could not provide valid estimations for the three other scales, but distribution and opinion-based methods provided rough values of MCIDs for the SRT (+39w to +61w), the STS (-5 sec to -7 sec) and the PILE (+4kg to +7kg). Conclusion The above MCID estimations for the 6MWT, 1MSCT and JAM can be used in chronic musculoskeletal pain patients participating in vocational multidisciplinary rehabilitation programs or in therapeutic trials. The use of specific anchors might give better estimations of MCIDs for the three other scales in future research.
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Affiliation(s)
- Charles Benaim
- Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Av Pierre Decker 4, CH-1011, Lausanne, Switzerland. .,Institute for Research in Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland. .,Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland.
| | - Simon Blaser
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Bertrand Léger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland.,Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Philippe Vuistiner
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - François Luthi
- Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Av Pierre Decker 4, CH-1011, Lausanne, Switzerland.,Institute for Research in Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland.,Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland.,Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
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Villafañe JH, Borboni A, Berjano P. Letter to the Editor: Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial. J Hand Ther 2017; 29:e11. [PMID: 27916146 DOI: 10.1016/j.jht.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 02/03/2023]
Affiliation(s)
| | - Alberto Borboni
- Mechanical and Industrial Engineering Department, University of Brescia, Brescia, Italy
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Rankin IA, Sargeant H, Rehman H, Gurusamy KS. Low-level laser therapy for carpal tunnel syndrome. Cochrane Database Syst Rev 2017; 8:CD012765. [PMID: 35611937 PMCID: PMC6483673 DOI: 10.1002/14651858.cd012765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The role of low-level laser therapy (LLLT) in the management of carpal tunnel syndrome (CTS) is controversial. While some trials have shown distinct advantages of LLLT over placebo and some other non-surgical treatments, other trials have not. OBJECTIVES To assess the benefits and harms of LLLT versus placebo and versus other non-surgical interventions in the management of CTS. SEARCH METHODS On 9 December 2016 we searched CENTRAL, MEDLINE, Embase, and Science Citation Index Expanded for randomised controlled trials (RCTs). We also searched clinical trial registries for ongoing studies. We checked the references of primary studies and review articles, and contacted trial authors for additional studies. SELECTION CRITERIA We considered for inclusion RCTs (irrespective of blinding, publication status or language) comparing LLLT versus placebo or non-surgical treatment for the management of CTS. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials for inclusion and extracted the data. For continuous outcomes, we calculated the mean difference (MD) or standardised mean difference (SMD) with a 95% confidence interval (CI) using the random-effects model, calculated using Review Manager. For dichotomous data, we reported risk ratio (RR) and 95% CI. MAIN RESULTS We identified 22 trials randomising 1153 participants that were eligible for inclusion; nine trials (525 participants, 256 randomised to LLLT) compared LLLT with placebo, two (150 participants, 75 randomised to LLLT) compared LLLT with ultrasound, one compared LLLT with placebo and LLLT with ultrasound, two compared LLLT with steroid injection, and one trial each compared LLLT with other non-surgical interventions: fascial manipulation, application of a pulsed magnetic field, transcutaneous electrical nerve stimulation (TENS), steroid injection, tendon gliding exercises, and applying a wrist splint combined with non-steroidal anti-inflammatory drugs. Three studies compared LLLT as part of multiple interventions. Risk of bias varied across the studies, but was high or unclear in most assessed domains in most studies. Most studies were small, with few events, and effect estimates were generally imprecise and inconsistent; the combination of these factors led us to categorise the quality of evidence for most outcomes as very low or, for a small number, low. At short-term follow-up (less than three months), there was very low-quality evidence for any effect over placebo of LLLT on CTS for the primary outcome of Symptom Severity Score (scale 1 to 5, higher score represents worsening; MD -0.36, 95% CI -0.78 to 0.06) or Functional Status Scale (scale 1 to 5, higher score represents worsened disability; MD -0.56, 95% CI -1.03 to -0.09). At short-term (less than three months) follow-up, we are uncertain whether LLLT results in a greater improvement than placebo in visual analogue score (VAS) pain (scale 0 to 10, higher score represents worsening; MD -1.47, 95% CI -2.36 to -0.58) and several aspects of nerve conduction studies (motor nerve latency: higher score represents worsening; MD -0.09 ms, 95% CI -0.16 to -0.03; range 3.1 ms to 4.99 ms; sensory nerve latency: MD -0.10 ms, 95% CI -0.15 to -0.06; range 1.8 ms to 3.9 ms), as the quality of the evidence was very low. When compared with placebo at short-term follow-up, LLLT may slightly improve grip strength (MD 2.58 kg, 95% CI 1.22 to 3.95; range 14.2 kg to 25.23 kg) and finger-pinch strength (MD 0.94 kg, 95% CI 0.43 to 1.44; range 4.35 kg to 5.7 kg); however, the quality of evidence was low. Only VAS pain and finger-pinch strength results reached the minimal clinically important difference (MCID) as previously published. We are uncertain about the effect of LLLT in comparison to ultrasound at short-term follow-up for improvement in VAS pain (MD 2.81, 95% CI 1.21 to 4.40) and motor nerve latency (MD 0.61 ms, 95% CI 0.27 to 0.95), as the quality of evidence was very low. When compared with ultrasound at short-term follow-up, LLLT may result in slightly less improvement in finger-pinch strength (MD -0.71 kg, 95% CI -0.94 to -0.49) and motor nerve amplitude (MD -1.90 mV, 95% CI -3.63 to -0.18; range 7.10 mV to 9.70 mV); however, the quality of evidence was low. There was insufficient evidence to assess the long-term benefits of LLLT versus placebo or ultrasound. There was insufficient evidence to show whether LLLT is better or worse in the management of CTS than other non-surgical interventions. For all outcomes reported within these other comparisons, the quality of evidence was very low. There was insufficient evidence to assess adverse events, as only one study reported this outcome. AUTHORS' CONCLUSIONS The evidence is of very low quality and we found no data to support any clinical effect of LLLT in treating CTS. Only VAS pain and finger-pinch strength met previously published MCIDs but these are likely to be overestimates of effect given the small studies and significant risk of bias. There is low or very low-quality evidence to suggest that LLLT is less effective than ultrasound in the management of CTS based on short-term, clinically significant improvements in pain and finger-pinch strength. There is insufficient evidence to support LLLT being better or worse than any other type of non-surgical treatment in the management of CTS. Any further research of LLLT should be definitive, blinded, and of high quality.
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Affiliation(s)
- Iain A Rankin
- Aberdeen Royal Infirmary, NHS GrampianDepartment of OrthopaedicsForesterhillAberdeenUKAB25 2ZN
| | - Harry Sargeant
- Aberdeen Royal Infirmary, NHS GrampianDepartment of OrthopaedicsForesterhillAberdeenUKAB25 2ZN
| | - Haroon Rehman
- Aberdeen Royal Infirmary, NHS GrampianDepartment of OrthopaedicsForesterhillAberdeenUKAB25 2ZN
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
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Coughlan MJ, Bourdillon A, Crisco JJ, Kenney D, Weiss AP, Ladd AL. Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis. Clin Orthop Relat Res 2017; 475:522-528. [PMID: 27822895 PMCID: PMC5213951 DOI: 10.1007/s11999-016-5151-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/26/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Advanced thumb carpometacarpal (CMC) osteoarthritis (OA) can cause substantial impairment in hand function, from grasping heavy objects to fine manipulation of implements and tools. In the clinical setting, we commonly measure the grip strength of gross grasp with a hand dynamometer in patients with CMC OA. Cylindrical grasp, which requires more thumb contribution than gross grasp, is an alternative method of measuring grip strength and one that may provide insight into thumb-related conditions. Because gross grasp and cylindrical grasp use the thumb in different planes, measurement of gross grasp alone might underestimate impairment. Therefore, it is important to evaluate cylindrical grasp as well. To our knowledge this tool has yet to be examined in a population with early thumb CMC OA. QUESTIONS/PURPOSES (1) Is cylindrical grasp and gross grasp strength reduced in subjects with early thumb CMC OA compared with asymptomatic control subjects? (2) What is the association of cylindrical and gross grasp to thumb CMC OA after adjusting for age, sex, and hand dominance? METHODS We recruited 90 subjects with early symptomatic and radiographic thumb CMC OA and 38 asymptomatic healthy control subjects for this multisite controlled study. Demographic information, hand examination, comprehensive histories, plain film radiographs, and cylindrical and gross grasp strength data were collected on all 128 subjects. Mean grasp strength was calculated for cylindrical and gross grasp in the population with early CMC OA and the control population. A t-test was performed on cylindrical and gross grasp to evaluate the difference between the mean in the control and early CMC OA populations. We used separate linear regression models for the two types of grasp to further quantify the association of grasp with a diagnosis of early thumb CMC OA controlling for age, sex, and whether the subject used their dominant or nondominant hand in the study. RESULTS Cylindrical grasp was weaker in the population with thumb CMC OA compared with healthy control subjects (6.3 ± 2.7 kg versus 8.4 ± 2.5 kg; mean difference, 2.1; 95% CI, 1.1-3.1; p < 0.001), but there was no difference in gross grasp force (29.6 ± 11.6 kg versus 31.4 ± 10.1 kg; mean difference, 1.7; 95% CI, -2.5 to 6.0; p = 0.425). When adjusting for age, sex, and handedness, cylindrical grasp reduction was related to CMC OA (β = -2.3; standard error [SE], 0.46; p < 0.001) (Y-intercept = 8.2; SE, 1.8; R2 = 0.29), whereas gross grasp was not reduced in early thumb CMC OA (β = -2.8; SE, 1.6; p = 0.072) (Y-intercept = 34.3; SE, 6.3; R2 = 0.48). CONCLUSIONS A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA, whereas gross grasp is not associated with early thumb CMC OA, suggesting that cylindrical grasp may be a better tool to detect changes in thumb and hand function seen during early disease stages. CLINICAL RELEVANCE Cylindrical grasp may serve as a more-sensitive measure for detecting early changes in early CMC OA. The associated decline in hand function also might provide an opportunity for measuring the effectiveness of treatment and intervention.
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Affiliation(s)
- Monica J. Coughlan
- Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor, Dept A26 MC 6342, Redwood City, CA 94063 USA
| | - Alexandra Bourdillon
- Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor, Dept A26 MC 6342, Redwood City, CA 94063 USA
| | - Joseph J. Crisco
- Department of Orthopaedics, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Deborah Kenney
- Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor, Dept A26 MC 6342, Redwood City, CA 94063 USA
| | - Arnold-Peter Weiss
- Department of Orthopaedics, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Amy L. Ladd
- Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor, Dept A26 MC 6342, Redwood City, CA 94063 USA
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CORR Insights ®: Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis. Clin Orthop Relat Res 2017; 475:529-531. [PMID: 27900716 PMCID: PMC5213960 DOI: 10.1007/s11999-016-5183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 01/31/2023]
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Postoperative improvement in DASH score, clinical findings, and nerve conduction velocity in patients with cubital tunnel syndrome. Sci Rep 2016; 6:27497. [PMID: 27263860 PMCID: PMC4893736 DOI: 10.1038/srep27497] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/19/2016] [Indexed: 12/17/2022] Open
Abstract
We investigated a recovery pattern in subjective and objective measures among 52 patients with cubital tunnel syndrome after anterior subcutaneous transposition of the ulnar nerve. Disabilities of the Arm, Shoulder and Hand (DASH) score (primary outcome), numbness score, grip and pinch strength, Semmes-Weinstein (SW) score, static 2-point discrimination (2PD) score, and motor conduction velocity (MCV) stage were examined preoperatively and 1, 3, 6, 12, and ≥24 months postoperatively. Statistical analyses were conducted to evaluate how each variable improved after surgery. A linear mixed-effects model was used for continuous variables (DASH score, numbness, grip and pinch strength), and a proportional odds model was used for categorical variables (SW and 2PD tests and MCV stages). DASH score significantly improved by 6 months. Significant recovery in numbness and SW test scores occurred at 1 month. Grip and pinch strength, 2PD test scores, and MCV stage improved by 3 months. DASH scores and numbness recovered regardless of age, sex, or disease severity. It was still unclear if both subjective and objective measures improved beyond 1-year postoperatively. These data are helpful for predicting postoperative recovery patterns and tend to be most important for patients prior to surgery.
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