Validity and reliability of the Arabic quick disabilities of the arm, Shoulder and Hand (QuickDASH-Arabic)

Minimal important change and responsiveness of the arabic patient-specific functional Scale in patients with upper extremity musculoskeletal disorders

PURPOSE

To assess the responsiveness of the Arabic Patient-Specific Functional Scale (PSFS) and to determine its minimal important change (MIC) for improvement in upper extremity function.

MATERIALS AND METHODS

A total of 115 participants with upper extremity musculoskeletal disorders were included. The PSFS, Disabilities of the Arm, Shoulder, and Hand (DASH), global assessment of function (GAF), and numeric pain rating scale (NPRS), were assessed at baseline and follow-up. Responsiveness was examined by testing seven pre-defined hypotheses and the MIC was determined using the predictive modeling method (MICpred) and the receiver operating curve method (MICROC).

RESULTS

The PSFS change scores demonstrated significant correlations with the global rating of change (r = 0.75), with change scores in DASH (r = 0.76), GAF (r = 0.62), NPRS (r = 0.66), large effect size (ES = 2.34, SRM = 1.63) in improved individuals, and area under the ROC curve of 0.91. The MICROC, MICpred, and adjusted MICpred for proportion of improved participants were 1.71, 1.98, and 2.15 points, respectively, and that the value of MIC was not dependent on baseline status.

CONCLUSION

The Arabic PSFS showed sufficient responsiveness in detecting changes in upper extremity function over time. The adjusted MICpred is recommended to be used as the MIC value in patients with upper extremity musculoskeletal disorders.

Impact of architecture students' study-rest schedules on pain and upper extremity functionality

BACKGROUND

The intensity of architecture students' work-rest schedules can cause work-related musculoskeletal pain and upper extremity disfunction.

OBJECTIVE

The aim of this study is to examine the influence of architectural students' study-rest schedules on the musculoskeletal pain and upper extremity functionality.

METHODS

A total of 174 architectural students (99 female, 75 male) were included in the study. The questionnaire initially recorded demographic information. Data were collected using the body diagram of the Cornell Musculoskeletal Discomfort Questionnaire. The body diagram of the Cornell Musculoskeletal Discomfort Questionnaire was integrated with the Visual Analogue Scale. Pain intensity in the marked regions on the body diagram was evaluated with the VAS, and upper extremity functionality was assessed with the Quick Disabilities of the Arm, Shoulder and Hand questionnaire.

RESULTS

There was a difference in the pain intensity between male and female students (p < 0.05). Students who had longer study duration and longer uninterrupted study duration experienced higher levels of pain intensity in most region of body and more effect on the functionality of the upper extremities (p < 0.05). Conversely, there was a reduction in both pain intensity and upper extremity functionality impairment with increasing total rest time (p < 0.05).

CONCLUSIONS

According to the data obtained from the study indicated that students' study-rest schedules were associated with musculoskeletal pain and upper extremity functionality.

Reliability, measurement error, and validity of the Arabic version of the Patient-Specific Functional Scale in patients with upper extremity musculoskeletal disorders

PURPOSE

To evaluate the measurement properties of the Arabic Patient-Specific Functional Scale (PSFS) in individuals with upper extremity musculoskeletal disorders.

MATERIALS AND METHODS

Participants with upper extremity musculoskeletal disorders (N = 139) completed the PSFS, Upper Extremity Functional Index (UEFI), the Disabilities of the Arm, Shoulder and Hand (DASH), Numeric Pain Rating Scale (NPRS) and the Global Assessment of Function scale (GAF). The same outcome measures were completed again with one week in addition to the Global Rating of Change Scale. The test-retest reliability, measurement error, floor and ceiling effects, and construct validity of the PSFS were examined.

RESULTS

The PSFS demonstrated very good test-retest reliability (ICC2,1 = 0.82; 95% CI: 0.71-0.88), with no evidence of floor or ceiling effects. The standard error of measurement was determined to be 0.74 while the minimal detectable change was 1.73 points. The PSFS demonstrated significant negative correlation with DASH, NPRS (-0.58, -0.35), and significant positive correlation with the UEFI and GAF (0.56, 0.50). The PSFS demonstrated statistically higher correlation with the DASH and UEFI compared with the NPRS (p < 0.004) supporting our predefined construct validity hypotheses.

CONCLUSION

The Arabic PSFS is an applicable, reliable, and valid outcome measure of upper-extremity activity limitations for patients with upper extremity musculoskeletal disorders.

Clinical efficacy of Ni-Ti memory alloy four-corner arthrodesis concentrator in the treatment of scaphoid nonunion advanced collapse: a follow-up of over 10 years

PURPOSE

Exploring the therapeutic effects of Ni-Ti shape memory alloy four-corner arthrodesis concentrator (NT-FCAC) in treating scaphoid nonunion advanced collapse (SNAC) and providing a decade-long follow-up report.

MATERIALS AND METHODS

Twenty-six patients with SNAC underwent scaphoidectomy, along with four-corner arthrodesis fusion involving the capitate, lunate, triquetrum, and hamate, using NT-MFCAC. Grip strength was measured using a Jamar dynamometer, while wrist joint mobility was assessed using a goniometer. Preoperative and postoperative assessments were conducted using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire to monitor limb functionality restoration. Pain levels at the wrist joint were evaluated using the visual analog scale (VAS). Postoperative wrist bone fusion status was assessed through anteroposterior and lateral radiographs of the wrist joint.

RESULTS

After a 3-month postoperative period, all 26 patients exhibited osseous union at the wrist joint. Over a follow-up spanning 10-15 years, no severe postoperative complications were observed in any patient. Grip strength in the affected side of all patients recovered to 81.96% compared to the healthy side, while wrist joint mobility in the affected side reached over 60% of the healthy side's functionality. VAS scores decreased significantly from 5.85 ± 0.73 preoperatively to 0.19 ± 0.40 at the final follow-up; Quick DASH scores reduced from 69.88 ± 5.12 preoperatively to 6.30 ± 1.25 at final follow-up. Statistically significant differences were noted in VAS and Quick DASH scores for all patients (p < 0.05). However, beyond 60 months postoperatively, subsequent follow-ups did not yield statistically significant differences in VAS and Quick DASH scores for all patients (p > 0.05).

CONCLUSIONS

Utilizing NT-FCAC for SNAC treated with four-corner arthrodesis fusion results in a high rate of wrist bone fusion, preserving a significant portion of wrist joint function and exhibiting favorable long-term outcomes. This approach is suitable for treating patients with SNAC requiring four-corner arthrodesis fusion.

Additional Effect of Extracorporeal Shockwave Therapy with Lidocaine Injection on Clinical and MRI Findings in Frozen Shoulder: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial

INTRODUCTION

Frozen shoulder is a very common musculoskeletal condition and the evidence related to the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in individuals with frozen shoulder is rare. Therefore, this study aims to compare and investigate the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in a frozen shoulder.

METHODS

Sixty eligible participants with frozen shoulder were included and the active group (n = 30, age 52.12 ± 5.2 years) received a lidocaine injection (1% lidocaine (Xylocaine) and 2cc (80 mg) methylprednisolone acetate) with active ESWT (3.5 bar air pressure and 2000 pulses with an energy flux density (EFD) ¼ 0.16 mJ/mm2) three sessions a week for 4 weeks. The placebo group (n = 30, age 53.56 ± 5.5 years) received lidocaine injection with placebo treatment (a special head that blocked the shock waves) three sessions a week for 4 weeks. Both groups received progressive resistance exercises (PRE) to the shoulder muscles. The primary outcome was pain intensity, measured with the visual analogue scale. The other outcome measures were the thickness of the coracohumeral ligament (CHL) measured by magnetic resonance imaging (MRI), abduction, and lateral rotation range of motion (ROM), functional disability, kinesiophobia, depression status, and quality of life. Participants were assessed at baseline, after 4 weeks, 8 weeks, and at 6-month follow-up.

RESULTS

The post-intervention at 4 weeks showed an improvement of 2.0 (CI 95% 1.71-2.28) in the active group compared to the placebo group. Similar effects were noted after 8 weeks (2.2) (CI 95% 1.91-2.48) and at the 6-month (1.9) (CI 95% 1.61-2.18) follow-up. Similar improvements were also found in the thickness of the CHL ligament (0.6) (CI 95% 0.46-0.73), abduction and lateral rotation (ROM) (- 23.6) (CI 95% - 27.47 to -19.72), (- 18.10) (CI 95% - 19.72 to - 16.47), functional disability (16.2) (CI 95% 14.85-17.54), kinesiophobia (11.0 (CI 95% 10.21-11.98), depression status (4.4) (CI 95% 4.03-4.76) and quality of life (0.9) (CI 95% 0.79-1.00) (p = 0.001) at the 6-month follow-up period, where mean estimates and their confidence intervals all included worthwhile effects. There were no adverse reactions or side effects noted in either the active or placebo groups during and after the treatment.

CONCLUSIONS

The study concluded that the addition of extracorporeal shockwave therapy after intra-articular lidocaine injection improves pain, functional disability, range of motion, kinesiophobia, depression status, and quality of life in people with frozen shoulder.

TRIAL REGISTRATION

https://ctri.nic.in , identifier; CTRI/2020/04/024834 prospectively registered on 24/04/2020.

Effect of Adding Shoulder Stabilization Exercises to the Rehabilitation of Postoperative Hand Injuries in Young Adult Patients

BACKGROUND

Hand injuries are common and could have an impact on all upper limb functions. Engaging shoulder muscle training during the rehabilitation protocol postoperatively could have a significant impact on regaining all upper limb function. The purpose of this study was to assess the effect of adding shoulder stabilization exercise to hand rehabilitation postoperatively.

METHODS

Forty patients were randomly assigned to 2 equal groups. Group A received a standard physical therapy program plus shoulder exercise protocol and group B received only a standard physical therapy protocol for hand rehabilitation. Outcome measures were pain intensity; grip strength; Arabic modified Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; and range of motion (ROM). All outcome measures were assessed before and after treatment.

RESULTS

Statistical analysis revealed that both groups, the experimental and control, showed significant improvement in all outcome measures, but experimental group A showed significant improvement than the control group B posttreatment for hand grip strength, ROM, and QuickDASH questioners (P < .001).

CONCLUSION

Adding shoulder stabilizer muscle training to the hand rehabilitation protocol postoperatively has a significant impact on hand function outcomes.

The Efficacy of Muscle Energy and Mulligan Mobilization Techniques for the Upper Extremities and Posture after Breast Cancer Surgery with Axillary Dissection: A Randomized Controlled Trial

Background: Breast cancer surgeries affect the upper extremities and posture. This study aimed to examine the efficacy of muscle energy and Mulligan mobilization techniques on the upper extremities and posture after breast cancer surgery with axillary dissection. Methods: A total of 90 female participants who had undergone breast cancer surgery with axillary dissection were recruited and randomly assigned to three groups. Group A received a combination of the Mulligan and muscle energy techniques, while Groups B and C received either the Mulligan or muscle energy techniques for six weeks, respectively. The study measured the shoulders' range of motion, posture, and upper-extremity disabilities. Outcome measurements were taken at three different time points: baseline, post-intervention, and at eight-week follow-up. Results: All the interventions significantly improved the study outcomes. The combination of the Mulligan and muscle energy techniques was significantly better than a single intervention. Mulligan mobilization was superior to the muscle energy techniques in terms of improving the shoulders' range of motion and disability. The interventions showed a significant effect pre-post-treatment and pre-follow-up but not post-follow-up. Conclusions: The Mulligan mobilization and muscle energy techniques have been found beneficial in improving the postural changes and shoulder outcomes after breast cancer surgery with axillary dissection. The superior effectiveness of the combined interventions points out the importance of integrating multiple therapeutic approaches for optimal outcomes. Regular examination and long-term follow-up assessment are important for studying the effect of rehabilitation interventions in people after the late stages of breast surgery.

Responsiveness and Minimal Important Change of the Arabic Disabilities of the Arm, Shoulder and Hand (DASH) in Patients with Upper Extremity Musculoskeletal Disorders

The aim of this study was to examine the responsiveness of the Arabic Disabilities of the Arm, Shoulder and Hand (DASH) and to quantify its minimal important change (MIC) for improvement. People with upper extremity musculoskeletal problems who were receiving physical therapy were evaluated at baseline and again during a follow-up appointment, with a median time frame of 7 days between the two testing sessions (range of 6 to 72 days). The participants completed the Arabic DASH, Global Assessment of Function (GAF), Numeric Pain Rating Scale (NPRS) and Global Rating of Change Scale (GRC). The responsiveness of the Arabic DASH was assessed by examining the pre-specified hypotheses. The MIC for improvement was determined using the receiver operating characteristic method (MICROC) and the predictive modeling method (MICpred). As hypothesized, a change in the Arabic DASH demonstrated a significant positive correlation with changes in the GAF (r = 0.69), NPRS (r = 0.68) and GRC (r = 0.73). Consistent with our hypotheses, the DASH change scores could be used to differentiate between participants who improved and those who did not improve (area under the receiver operating characteristic curve = 0.87), and they showed a large magnitude of change (effect size = 1.53, standardized response mean = 1.42) in patients who improved. All the hypotheses specified a priori were supported by the results. The Arabic DASH MICROC and MICpred were estimated to be 14.22 and 14.85. The interaction between the DASH change and baseline score was not a significant predictor of status (improved vs. not improved) (p = 0.75), indicating that the DASH MIC was not baseline-dependent. The Arabic DASH demonstrated sufficient responsiveness, supporting the idea that the Arabic DASH is capable of detecting changes in upper extremity function over time. The value of the Arabic DASH MIC was similar when estimated using the predictive modeling and ROC methods, and the MIC was not dependent on baseline status.

Responsiveness of the Arabic Quick Disabilities of the Arm, Shoulder and Hand in Patients with Upper Extremity Musculoskeletal Disorders

This study aimed to examine the responsiveness of the Arabic Disabilities of the Arm, Shoulder and Hand short version (Quick-DASH) in patients with upper extremity musculoskeletal disorders. Participants with upper extremity musculoskeletal disorders (N = 88) under physical therapy care were assessed at initial visit and later at a follow-up visit, and they completed the Arabic Quick-DASH, DASH, Numeric Pain Rating Scale (NPRS), Global Assessment of Function (GAF), and the Global Rating of Change Scale (GRC). Responsiveness of the Arabic Quick-DASH was assessed by examining six pre-defined hypotheses. Consistent with the pre-defined hypotheses, the Arabic Quick-DASH changes scores exhibited significant positive correlation with the change in DASH (r = 0.98), GAF (r = 0.67), NPRS (r = 0.72), and the GRC (r = 0.78). As hypothesized, the Arabic Quick-DASH showed a large effect size above the pre-determined level (ES = 1.61, SRM = 1.49) in patients who reported improved upper extremity function. The Arabic Quick-DASH change score discriminated between patients who reported improvement versus no improvement in upper extremity function (area under the receiver operating characteristic curve = 0.90). The results supported 100% (six out of six) of the pre-defined hypotheses. The Arabic Quick-DASH demonstrated sufficient responsiveness where all the pre-defined hypotheses were supported, leading to the established validity of the Arabic Quick-DASH change score as a measure of change in upper extremity function and symptoms. The minimal importance change in the Arabic Quick-DASH needs to be determined in future studies.

Responsiveness of the Arabic Upper Extremity Functional Index in Patients with Upper Extremity Musculoskeletal Disorders

The aim of this study was to examine the ability of the Arabic Upper Extremity Functional Index (UEFI) to detect change over time in upper extremity function (responsiveness) in patients with upper extremity musculoskeletal disorders. Patients receiving physical therapy care for their upper extremity musculoskeletal disorders completed the Arabic UEFI; Disabilities of the Arm, Shoulder and Hand (DASH); Numeric Pain Rating Scale (NPRS); Global Assessment of Function (GAF); and the Global Rating of Change Scale (GRC) at the initial visit and later at a follow-up assessment. Responsiveness was examined by testing predefined hypotheses regarding the correlations between the change scores in the Arabic UEFI and the other measures. The Arabic UEFI change scores demonstrated a significant positive correlation with the change in the DASH (r = 0.94), GAF (r = 0.65), NPRS (r = 0.63), and GRC (r = 0.73), which was in line with the predefined hypotheses. The Arabic UEFI change scores demonstrated a pattern of correlation with changes in other outcome measures that are consistent with the argument that the Arabic UEFI change scores represent a change in upper extremity function. The responsiveness of the Arabic UEFI was supported, and its use to monitor changes in upper extremity function in patients with upper extremity musculoskeletal disorders was supported.