Reliability of the NK dexterity board

Performance-based outcome measures of dexterity and hand function in person with hands and wrist injuries: A scoping review of measured constructs

BACKGROUND

Dexterity impairments are common and disabling. Currently, there is no consensus on an operational definition to measure dexterity.

PURPOSE

This review aims to provide an overview of constructs measured by performance-based outcome measures of dexterity and hand function (PBOMD) validated for use in persons with musculoskeletal hand and wrist conditions.

STUDY DESIGN

Scoping review, with qualitative content analysis.

METHODS

MEDLINE, Embase, CINAHL, PsycINFO were searched from inception until November 2019. Three reviewers identified studies investigating the psychometric properties of PBOMD in persons with hand and wrist conditions. Original articles and manuals of validated PBOMD were obtained. Reviewers independently extracted and performed a content analysis of constructs comparing the theoretical concepts of dexterity and function.

RESULTS

Twenty PBOMD were identified. PBOMD featured 1-57 tasks and 1-8 potential grasps patterns per tool. Description of the constructs measured indicated overlap between dexterity and hand function. In newer tools, there was a greater representation of daily activities to include domains like self-care and domestic life; and measurement of qualitative aspects of performance. Concurrently, there was less focus on mobility. The majority of identified tools (70%) used speed as the criterion evaluation of performance. None of the PBOMD evaluated dexterity associated with leisure activities or modern technologies like smartphones, nor measured the ability to adapt to changing demands when completing tasks.

CONCLUSIONS

Hand function and dexterity are imprecisely defined and operationalized in PBOMD. Dexterity is a complex construct that current PBOMD incompletely captures. PBOMD often quantified as the speed of movement, ignoring other important aspects like accommodating environmental changes during task performance. Clinicians should consider tasks included in PBOMD, the quantification method, and each PBOMD's limitations when choosing PBOMD.

Evaluation of individual finger forces during activities of daily living in healthy individuals and those with hand arthritis

INTRODUCTION

Measuring finger forces during activities of daily living and how these forces change for individuals with pathologies such as arthritis is valuable to our understanding of hand function.

PURPOSE OF THE STUDY

The purpose of this study was to determine the forces of individual fingers during the performance of daily activities in healthy participants and determine the envelope of these applied forces.

METHODS

This is a cross-sectional study investigating twenty-five healthy participants (12 female: 22-65 years old and 13 male: 20-53 years old) and participants with osteoarthritis (12 female: 52-79 years old and 9 male: 64-79 years old) examined at one time point. The force sensors were calibrated for each individual using a load cell to provide force output in Newtons. Each participant performed 19 activities of daily living two times. Force was plotted over time for each task, and the maximum force in each finger during that task was evaluated.

RESULTS

The range of applied forces was 1.4 ± 0.6 N to 34.8 ± 1.6 N for healthy participants and 2.3 ± 1.0 N to 30.7 ± 3.7 N for those with osteoarthritis.

DISCUSSION

Sensors allowed for real-time monitoring of finger forces during tasks of daily life. This provides the opportunity to isolate hand grips based on finger recruitment and provide information about the magnitude of forces during the activity.

CONCLUSION

Measurement of individual finger forces can provide more accurate biomechanical models of the hand and determine the effect of disease on hand functions.

Recovery, age, and gender effects on hand dexterity after a distal radius fracture. A 1-year prospective cohort study

STUDY DESIGN

A prospective cohort study.

INTRODUCTION

Physical factors that predict hand dexterity and the recovery of hand dexterity after a distal radius fracture (DRF) have not yet been examined.

PURPOSE OF THE STUDY

The first objective was to evaluate the recovery of hand dexterity comparing the injured and uninjured hands during the year after a DRF. The second objective was to determine the effect of age and sex on hand dexterity of the injured hand.

METHODS

Hand dexterity was examined bilaterally for the manipulation of 3 different sized objects (small, medium, and large) using the NK hand dexterity test. The measurements took place at 3, 6, and 12 months after DRF. Generalized linear modeling was performed, with age and sex as covariates, to assess changes over time, and between sides.

RESULTS

Overall, 242 patients with DRF (45 males and 197 females) with a mean age of 60.2 years with SD of 11.26, participated in the study. Statistical differences in hand dexterity were found between the injured and uninjured hands across all time intervals (P < .001). The effect size for the deficit between the injured and uninjured hands decreased across the time intervals and ranged from 0.19 to 0.38 for large objects, from 0.17 to 0.25 for medium objects, and from 0.11 to 0.32 for small objects. For each 1-year increase in age, hand dexterity scores were 0.3-0.4 seconds slower. Sex had much less effect, with annual increases of 0.1 seconds in hand dexterity scores.

CONCLUSIONS

Scores on the NK dexterity test improved between 3 and 6 months and then worsened between 6 and 12 months; at no point did dexterity equal the uninjured side. Greater attention to measuring and treating dexterity may be needed to provide a complete recovery after DRF. Scores will be affected by age and sex.

LEVEL OF EVIDENCE

Prognosis, 2a.

Construct validity of the Patient-Rated Wrist and Hand Evaluation questionnaire (PRWHE) for nerve repair in the hand

BACKGROUND

Many tools have been described for outcome assessment after nerve repair. The Patient-Rated Wrist and Hand Evaluation (PRWHE) have been shown to be valid for several hand conditions.

OBJECTIVES

To explore the construct validity of the PRWHE in comparison to cold intolerance, pain and dysfunction questionnaires; the Rosén score and its subcomponents; and threshold sensibility, dynamometry and dexterity tests for nerve repair of the hand.

STUDY DESIGN

Clinical measurement.

METHODS

Construct validity was analysed through Pearson's correlation coefficient in a convenience sample of 32 adult patients after long-term median and ulnar nerve repair.

RESULTS

The PRWHE total score was highly to moderately associated with the Disability of Arm, Shoulder and Hand (r = 0.83), Cold Intolerance Symptom Severity (r = -0.60) and McGill's Pain (r = 0.58) questionnaires. In addition, it was correlated to motor (r = -0.55) and sensor subdomains (r = -0.56) of the Rosén score. Substantial to high associations were found for the motor, sensory impairment and dexterity test.

CONCLUSIONS

The PRWHE was shown to be valid, based on construct validity, for patients with nerve repair of the hand.

Do Impairments Predict Hand Dexterity After Distal Radius Fractures? A 6-Month Prospective Cohort Study

BACKGROUND

The relationship of routinely measured grip and motion measures may be related to hand dexterity. This has not yet been thoroughly examined following a distal radius fracture (DRF). The purpose of this study was to investigate if impairments in range of motion (ROM) and grip strength predict hand dexterity 6 months following a DRF.

METHODS

Patients with DRFs were recruited from a specialized hand clinic. Hand grip was assessed with a J-Tech dynamometer; ROM was measured using standard landmarks and a manual goniometer. Multiple regression analyses were performed to identify whether potential predictors (grip, ROM, age, hand dominance, and sex) were associated with 3-month or 6-month outcomes in large- and small-object subtests of the NK dexterity test in the affected hand.

RESULTS

Age, sex, and arc motion for radial-ulnar deviation were significant predictors of large-object hand dexterity explaining the 23% of the variation. For small-object hand dexterity, age and flexion-extension arc motion were significant predictors explaining 11% of the variation at 3 month after the fracture (n = 391). At 6 months post injury (n = 319), grip strength, arc motion for flexion-extension, and age were found to be significant predictors of large-object dexterity explaining 34% of the variance. For the small objects, age, grip strength, sex, and arc motion of radial-ulnar deviation explained 25% of the variation.

CONCLUSIONS

Although this confirms that the impairments in ROM and grip that occur after a DRF can explain almost one-third of the variation in hand dexterity, it also suggests the need for dexterity testing to provide more accurate assessment.

Physical impairments predict hand dexterity function after distal radius fractures: A 2-year prospective cohort study

Introduction

The overall aim of this study was to determine whether physical impairments – loss of range of motion and grip strength – could be used to predict hand dexterity functions in patients at 1 and 2 years after distal radius fracture.

Methods

This was a prospective cohort study. Hand dexterity was assessed at three different levels using the NK hand dexterity test. We used a manual goniometer to measure the active range of motion in the affected hand for wrist flexion and extension movements, and a J-Tech grip strength device to measure patients’ hand grip strength levels. Assessments were performed at 1- and 2-year follow-ups. Separate multivariable regression analyses were performed to determine if range of motion predicts hand dexterity functions at 1 and 2 years after distal radius fracture.

Results

A total of 160 patients with distal radius fracture were included in this study. Range of motion (flexion and extension) and grip strength were both statistically significant (p < 0.05) independent variables in predicting hand dexterity functions at all three levels among patients after distal radius fracture at 1-year follow-up. Range of motion and strength levels accounted for 31%, 33% and 22% of the variance in patients’ large, medium and small hand dexterity functions, respectively. At 2 years, grip strength remained the only statistically significant (p < 0.001) independent variable in predicting hand dexterity functions at all three levels.

Conclusions

Physical impairments (loss of range of motion and grip strength) have higher predictive values for large and medium hand dexterity functions, than small hand dexterity functions, in patients after distal radius fracture, at both 1- and 2-year follow-up periods.

Validity and responsiveness of the Simple Test for Evaluating Hand Function

Introduction

Despite widespread use of the Simple Test for Evaluating Hand Function, we were unable to find studies to affirm the validity and responsiveness in patients with trauma and inflammatory diseases. The aim of this study was to demonstrate the criterion validity and responsiveness of the Simple Test for Evaluating Hand Function, a tool which is widely used in Japan.

Methods

Thirty patients between the ages of 20 and 82 years with distal radius fracture (n = 10), and cervical spondylosis myelopathy (n = 20) were included in this study. Concurrent validity was tested by examining the correlation between Simple Test for Evaluating Hand Function, the Purdue Pegboard Test, and the Disabilities of the Arm, Shoulder and Hand questionnaire. In addition, standardized response means were calculated to compare the responsiveness of the Simple Test for Evaluating Hand Function with Purdue Pegboard Test and Disabilities of the Arm, Shoulder and Hand.

Results

The correlation coefficient between Simple Test for Evaluating Hand Function and Purdue Pegboard Test was 0.70, and the correlation between Simple Test for Evaluating Hand Function and Disabilities of the Arm, Shoulder and Hand was −0.55 (p < 0.05). Standardized response mean shows that the Simple Test for Evaluating Hand Function (0.69) is more responsive than the Purdue Pegboard Test (0.53), and less responsive than Disabilities of the Arm, Shoulder and Hand (0.97).

Conclusions

The Simple Test for Evaluating Hand Function demonstrates concurrent validity and responsiveness as a performance based assessment of dexterity in patients with distal radius fracture and cervical spondylosis. We conclude that the Simple Test for Evaluating Hand Function could be used as a measure of dexterity or clinical change after therapy intervention. The Purdue Pegboard Test may be used for patients with an occupation that requires integrated fine motor skills and bimanual activity, whereas the Simple Test for Evaluating Hand Function may be more suitable for patients who use a variety of unilateral grips such as pinch and span. The Simple Test for Evaluating Hand Function and Disabilities of the Arm, Shoulder and Hand can complement each other when measuring someone’s activity and participation level.

The Impact of Sensory, Motor and Pain Impairments on Patient- Reported and Performance Based Function in Carpal Tunnel Syndrome

Background:

Research has suggested that persistent sensory and motor impairments predominate the symptoms experienced by patients with carpal tunnel syndrome (CTS); with intermittent pain symptoms, being less predominant.

Objective:

The study aims to determine the relative contribution of sensory, motor and pain impairments as contributors to patient-report or performance-based hand function.

Methods:

Fifty participants with a diagnosis of CTS confirmed by a hand surgeon and electrodiagnosis were evaluated on a single occasion. Impairments were measured for sensibility, pain and motor performance. A staged regression analysis was performed. In the first step, variables with each of the 3 impairment categories were regressed on the Symptom Severity Scale (SSS) to identify the key variables from this domain. Models were created for both self report (Quick Disabilities of arm, shoulder and hand- Quick DASH) and performance based (Dexterity) functional outcomes. Backward regression modelling was performed for SSS and then, to allow comparability of the importance of different impairments across models, the 7 significant variables from the SSS model were forced into the models.

Results:

Variables: age, touch threshold and vibration threshold of the little finger of unaffected hand, median-ulnar vibration threshold ratio of affected hand, mean pain tolerance of unaffected hand, grip strength and pinch strength of affected hand, explained 31%, 36% and 63% of the variance in SSS, Quick DASH and dexterity scores, respectively.

Conclusion:

Hand function in patients with CTS is described by variables that reflect sensory status of the median and ulnar nerves, the persons pain threshold, grip and pinch strength impairments and age.

Recovery of grip strength and hand dexterity after distal radius fracture: A two-year prospective cohort study

Introduction

Clinicians often evaluate deficits after an injury by comparing the injured and uninjured side. It is important to understand what deficits occur in hand function after distal radius fracture, how they change over time and their clinical relevance. The purpose of this study was to evaluate the differences in grip strength and hand dexterity between the injured and uninjured hands of patients two years following distal radius fracture.

Methods

Patients with distal radius fracture were recruited in a specialized hand clinic. Grip strength and hand dexterity were examined bilaterally with a Jamar hand-held dynamometer and with the NK dexterity device at 3, 6, 12 and 24 months’ post-injury respectively. Generalized linear modeling was performed, with age and sex as covariates to assess changes over time, and between sides.

Results

Patients (n = 154) exhibited mean differences of grip strength between injured and uninjured side at 3 months’ (12.09 kg) and 6 months’ (7.47 kg) follow-up. The associated deficit standardized response means (SRM) were 1.30 and 0.73, respectively. At 2-years follow-up the mean deficit on the injured side was 2.30 kg with SRM = 0.22. One hundred and eleven patients who completed dexterity testing demonstrated small to trivial side to side differences across all time points.

Conclusions

There were clinically important differences in grip strength between the injured and uninjured hands in patients with a distal radius fracture at 3 and 6 months’ follow-up. However, at 12 and 24 months, grip strength differences were small and of uncertain clinical importance. Trivial to small differences in hand dexterity can be expected between the injured and uninjured hand by 2 years after distal radius fracture.

The Effect of Physical Factors on Grip Strength and Dexterity

This study evaluated the relationship between physical factors (age, sex, hand size and dominance, height and weight) and both grip strength and dexterity. Ninety healthy subjects without current upper extremity pathology or injuries were recruited. Anthropometric measures of the hand were taken using the NK Micrometer, grip strength using the NK Digit-Grip, and dexterity (small, medium and large subsets) was tested using the NK Dexterity Board. Univariate correlations between grip strength and subject height, hand span, width and length were significant (r=0.38-0.82). Sex (p 0.001) and hand dominance (p 0.05) were also significant predictors of grip strength. Increased age resulted in increased time in all dexterity subtests (r=0.30-0.51). Multivariate stepwise regression revealed that sex explained the majority of variance in grip strength scores (r2=0.46-0.76), with additional contribution of age and height. Dexterity was less predictable, but most related to age (r2=0.13-0.26), with sex and dominance providing some additional information. While it is relatively easy to establish that a patient has an impaired grip, caution should be taken when ascribing that label to an individual patient's performance on a dexterity test.

The construct validity and responsiveness of sensory tests in patients with carpal tunnel syndrome

Background and Purpose :

Sensory evaluation is fundamental to evaluation of patients with Carpal Tunnel Syndrome (CTS). The purpose of this study was to determine the construct validity and responsiveness for sensory threshold tests in patients with CTS.

Methods :

Sixty-three patients diagnosed with CTS were evaluated prior to orthotic intervention and again at follow up at 6 and 12 weeks. Sensory tests included touch threshold PSSD (Pressure Specified Sensory Device) and vibration threshold (Vibrometer). Construct validity was assessed by comparing sensory tests to hand function, and dexterity testing using Spearman rho (r_s). Patients were classified as either responders or non-responders to orthotic intervention based on the change score of the Symptom Severity Scale (SSS) of 0.5. Responsiveness of the sensory tools was measured using ROC (receiver operating characteristic) curves, SRM (Standardized Response Mean), and ES (Effect Sizes).

Results :

The PSSD had low to moderate correlations (r_s ≤ 0.32) while Vibrometer scores had moderate correlations (r_s = 0.36 - 0.41) with dexterity scores. The Clinically Important Difference (CID) for the PSSD was estimated at 0.15 g/mm² but was not discriminative. The Vibrometer demonstrated moderate responsiveness, with a SRM = 0.61 and an ES = 0.46 among responders. The PSSD had a SRM = 0.09 and an ES = 0.08 and showed low responsiveness for patients with a clinically important improvement in symptoms.

Conclusion :

Measurement properties suggest that the Vibrometer was preferable to the PSSD because it was more correlated to hand function, and was more responsive. Clinicians may choose use the Vibrometer opposed to the PSSD for determining important change in sensation after orthotic intervention.

A study to compare two goniometric methods for measuring active pronation and supination range of motion

Introduction

Movement of the forearm allows positioning the hand during several functional activities of daily living. Assessing range of motion of supination and pronation is essential for clinical identification of functional limitations, although many methods can be used. Confounding values can be found due to different techniques used by therapists. The purpose of this study was to compare two standard goniometric methods for measuring active range of motion of forearm pronation and supination, aiming to define its reliability and ease of use.

Methods

The study included 33 individuals, 13 injured and 20 non-injured volunteers. We analyzed two standard goniometric methods for measuring pronation and supination. For the first method, the volunteers had to hold a pencil as a guide for the movable arm of the goniometer and for the second method the movable arm was in contact with the distal dorsal surface of the wrist near the ulna head, and the hand was free. Two trained examiners performed the evaluations. Intraclass correlation coefficient and limits of agreement of Bland and Altman were used to analyze the data.

Results

Intraclass correlation coefficient values were excellent for both groups and movements at inter-rater and inter-methods comparison. Bland and Altman plots showed that, although excellent reliability, some data dispersion was present.

Conclusion

These data suggest that both methods could be used in clinical practice with excellent reliability. The goniometric method with the movable arm placed in contact with the distal dorsal surface of the wrist near the ulna head might be easier to perform and useful in cases where finger prehension is absent or weak, which would prevent the use of a pencil as reference.

Sensory nerve action potentials and sensory perception in women with arthritis of the hand

Background

Arthritis of the hand can limit a person’s ability to perform daily activities. Whether or not sensory deficits contribute to the disability in this population remains unknown. The primary purpose of this study was to determine if women with osteoarthritis (OA) or rheumatoid arthritis (RA) of the hand have sensory impairments.

Methods

Sensory function in the dominant hand of women with hand OA or RA and healthy women was evaluated by measuring sensory nerve action potentials (SNAPs) from the median, ulnar and radial nerves, sensory mapping (SM), and vibratory and current perception thresholds (VPT and CPT, respectively) of the second and fifth digits.

Results

All SNAP amplitudes were significantly lower for the hand OA and hand RA groups compared with the healthy group (p < 0.05). No group differences were found for SNAP conduction velocities, SM, VPT, and CPT.

Discussion

We propose, based on these findings, that women with hand OA or RA may have axonal loss of sensory fibers in the median, ulnar and radial nerves. Less apparent were losses in conduction speed or sensory perception.

A blinded placebo-controlled randomized trial on the use of astaxanthin as an adjunct to splinting in the treatment of carpal tunnel syndrome

BACKGROUND

Nutritional supplementation is a potential adjunct in the conservative management of carpal tunnel syndrome (CTS). This study investigated whether astaxanthin (a beta-carotenoid) increased the effectiveness of splinting in managing CTS.

METHODS

This is a triple-blinded randomized controlled trial where 63 patients with electrodiagnostically confirmed CTS were randomly allocated into either the experimental group (n = 32) (astaxanthin-4-mg capsules + splinting) or the control group (n = 31) (placebo + splinting). Medications were taken for 9 weeks followed by a 3-week washout. The primary outcome measure was the Symptom Severity Scale (SSS). Secondary outcome measures in the study included physical impairments, disability, and health status measures. Electrodiagnostic testing was performed before entry into the study and again at 12 weeks. All other outcomes were measured at baseline, 6, and 12 weeks.

RESULTS

There was a reduction in symptoms as measured by the SSS over the course of treatment in both groups (p = 0.002), but no differences between the groups (p = 0.18). The Disability of Arm, Shoulder and Hand questionnaire and the Short Form 36-item Health Survey showed no effects over time or between treatment groups. The baseline difference between the groups in the level of total cholesterol and low-density lipoproteins remained constant over the course of the study. Impairment measures demonstrated no significant changes in grip, dexterity, or sensation.

CONCLUSION

At present, the role for astaxanthin as an adjunct in conservative management of CTS has not been established.

Muscle activation during hand dexterity tasks in women with hand osteoarthritis and control subjects

STUDY DESIGN

Descriptive cross-sectional study.

INTRODUCTION

Hand osteoarthritis (OA) is a condition that results in hand pain and disability. It is important to understand how muscle function impairments contribute to impaired dexterity.

PURPOSE OF THE STUDY

To compare muscle activation in women with and without hand OA and determine if the activation relates to measures of impairment and disability.

METHODS

Electromyography (EMG) was recorded from four muscles of the hand/forearm while subjects threaded (assembly) and unthreaded (disassembly) a small bolt. The groups were compared on the integrated EMG (IEMG) of four muscles using two-way repeated-measures analyses of covariance for the assembly and disassembly tasks.

RESULTS

No differences were found in muscle activation between groups when IEMG values were normalized by time (p>0.05).

CONCLUSIONS

Patients with OA have some indicators of altered muscle function. It is unclear whether these are adaptive or predisposing changes. When controlling for the time to perform a task, there were no significant IEMG differences between women with hand OA and control subjects.

LEVEL OF EVIDENCE

2b.

Assessment of strength of individual digits in persons with osteoarthritis of the hand

Introduction

The purpose of this study was to determine the extent to which individual digit strength measures correlate with overall hand strength, pain and function in persons with osteoarthritis (OA) of the hand, and thereby judge whether individual digit strength measures are relevant to the clinical assessment of hand disability in this population.

Methods

One hundred and four community-dwelling persons with OA of the dominant hand (84 women) participated in this cross-sectional study. Correlations between measures of hand strength (grip: digit and total; pinch: tripod, wide key and narrow key), dexterity and self-reported pain and function (subscales of the Patient-Rated Wrist and Hand Evaluation) were investigated.

Results

Although OA involved radial digits more than ulnar digits, radial digit strength contributes more to total grip (59% versus 41%). Correlations between total grip and digit strength varied from excellent (digits 3 and 4: r = 0.93 and 0.88, respectively) to moderate (digits 2 and 5: r = 0.75 and 0.74, respectively). Correlations between pinch and individual digit strength (digits 2 and 3) were moderate ( r = 0.66–0.74). Correlations between measures of different constructs (strength, pain and physical function) did not exceed 0.41.

Conclusions

Individual digit strength is not linked with OA involvement of that digit. At most, strength of individual digits explains just over half of the variance in total grip strength and pinch strength. Assessment of individual digit grip strength appears to provide unique information regarding hand disability in persons with OA.

Reproducibility of controlled force exertion measurements computed by a quasi-random target-pursuit system

The reproducibility of measurements and measurement error of controlled force exertion was examined based on target-pursuit of quasi-random waveforms. 30 college students were required to match their grip strength to a changing demand value appearing on the display of a personal computer using visual images in the form of four different quasi-random waveforms. The variable was the sum of the differences over time between the demand value and produced grip strength. Intraclass correlation coefficients (ICCs) for measurements one day apart were low or moderate for quasi-random waveform displays, with mean frequencies of 0.01, 0.05, 0.07, and 0.09 Hz (ICCs= .37, .73, .57, and .57, respectively). Measurements at a 1-wk. interval showed statistically significant improvements in performance at all quasi-random waveform frequencies. The total error between test and retest, and the systematic error between tests, remained relatively small as mean frequency increased. Tests that use the quasi-random waveform displays of 0.05 Hz and over can be useful in documenting controlled force exertion.

Clinimetric evaluation of measurement tools used in hand therapy to assess activity and participation

STUDY DESIGN

Systematic review.

INTRODUCTION

A number of measurement tools with strong clinimetric properties address activities and participation in hand-injured persons.

PURPOSE OF THE STUDY

To evaluate clinimetric quality of measurement tools assessing activities and participation in patients with hand injuries.

METHODS

The electronic databases Medline, Cochrane library, EMBASE, PEDro, Cumulative Index to Nursing and Allied Health Literature (ClNAHL), and Allied and Complementary Medicine Database (AMED) were searched for appropriate literature. Descriptive data of included tools were given, and their clinimetric quality was scored with specific criteria.

RESULTS

The literature search identified 696 publications, referring to 15 measurement tools that met the inclusion criteria. For most of the included tests, applicability was good, whereas information on clinimetric properties was often lacking, especially for the performance tests. Overall, the Disabilities of the Arm, Shoulder, and Hand (DASH) was the most extensively studied tool with positive ratings for all criteria, closely followed by the Michigan Hand Outcomes Questionnaire (MHQ). Of the performance tests, the Functional Dexterity Test (FDT) received the best ratings.

CONCLUSIONS

Optimal measurement tool selection depends highly on the purpose of measurement and the type of hand injury.

LEVEL OF EVIDENCE

2a-.

Validation of a new test that assesses functional performance of the upper extremity and neck (FIT-HaNSA) in patients with shoulder pathology

Background

There is a lack of standardized tests that assess functional performance for sustained upper extremity activity. This study describes development of a new test for measuring functional performance of the upper extremity and neck and assesses reliability and concurrent validity in patients with shoulder pathology.

Methods

A series of developmental tests were conducted to develop a protocol for assessing upper extremity tasks that required multi-level movement and sustained elevation. Kinematics of movement were investigated to inform subtask structure. Tasks and test composition were refined to fit clinical applicability criteria and pilot tested on 5 patients awaiting surgery for shoulder impingement and age-sex matched controls. Test-retest reliability was assessed on 10 subjects. Then a cohort of patients with mild to moderate (n = 17) shoulder pathology and 19 controls (17 were age-sex matched to patients) were tested to further validate the Functional Impairment Test-Hand, and Neck/Shoulder/Arm (FIT-HaNSA) by comparing it to self-reported function and measured strength. The FIT-HaNSA, DASH and SPADI were tested on a single occasion. Impairments in isometric strength were measured using hand-held dynamometry. Discriminative validity was determined by comparing scores to those of age-sex matched controls (n = 34), using ANOVA. Pearson correlations between outcome measures (n = 41) were examined to establish criterion and convergent validity.

Results

A test protocol based on three five-minute subtasks, each either comprised of moving objects to waist-height shelves, eye-level shelves, or sustained manipulation of overhead nuts/bolts, was developed. Test scores for the latter 2 subtasks (or total scores) were different between controls as compared to either surgical-list patients with shoulder impingement or a variety of milder shoulder pathologies (p < 0.01). Test 1 correlated the highest with the DASH (r = -0.83), whereas Test 2 correlated highest with the SPADI (r = -0.76).

Conclusion

Initial data suggest the FIT-HaNSA provides valid assessment of impaired functional performance in patients with shoulder pathology. It discriminates between patients and controls, is related to self-reported function, and yet provides distinct information. Longitudinal testing is warranted.

Validity of self-report measures of pain and disability for persons who have undergone arthroplasty for osteoarthritis of the carpometacarpal joint of the hand

OBJECTIVE

To establish the validity of three self-report scales used to measure function following arthroplasty for osteoarthritis (OA) of the carpometacarpal joint.

METHOD

Persons with OA of the carpometacarpal joint (n=122) were assessed on one occasion 9-117 months following tendon interposition arthroplasty. They completed three self-report measures of hand/upper limb disability: the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist Hand Evaluation (PRWHE), and the Disabilities of Arm, Shoulder and Hand (DASH). They also completed the Short Form 36 (SF-36) and performed tests of strength, range of motion (ROM), and dexterity. Factor analysis and correlations were used to determine the association among the scales and subscales considered to measure similar constructs (e.g., pain and physical disability). Correlations between the scales and measures of impairment were also conducted to examine construct validity of the disability measures. t-Tests evaluated the hypotheses that subjects with isolated hand OA would have lower scores than those with additional joint involvement.

RESULTS

All three scales or their subscales loaded on one factor. Convergent validity of the disability measures was demonstrated by high correlations between similar subscales (r>0.75), and divergent validity by a lack of correlation between the measures and self-report hand appearance. As expected, correlations between disability and strength, dexterity, or a global measure of ROM were higher than with ROM of individual joints. The AUSCAN and the DASH were better able to discriminate those with localized hand OA from those with involvement of other joints.

CONCLUSIONS

The AUSCAN, PRWHE, and DASH are valid assessments of pain and/or disability of hand OA, and provide information distinct from impairment measures.

Assessment of thumb metacarpophalangeal joint arthrodesis using a single longitudinal K-wire

PURPOSE

To evaluate retrospectively the functional and radiographic outcome of patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire.

METHODS

We performed a retrospective review of 27 patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire. Outcomes were assessed using self-reported measures (Patient-Rated Wrist/Hand Evaluation; AUSCAN Osteoarthritis Hand Index; Disabilities of the Arm, Shoulder and Hand questionnaire; Short Form-36 General Health questionnaire), measured physical impairments (range of motion, strength, manual dexterity), and radiographic review.

RESULTS

Patient-rated outcome scores indicated mild pain, difficulty with specific and usual tasks, and minimal concern with hand appearance. Most physical impairment measures were not significantly different from the side not surgically treated, and patient satisfaction was high. There was a slight decrease in tripod pinch strength, manual dexterity, interphalangeal joint flexion, handspan, and thumb opposition compared with the contralateral side. The overall complication rate was 11% (3 complications). Twenty-five patients (89%) were able to return to their previous occupations. There were no radiographic malunions or nonunions. Radiographic evidence of degenerative changes was present in 20% of patients at the carpometacarpal joint and 30% of patients at the interphalangeal joint.

CONCLUSIONS

Our technique of performing a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire is effective, with high overall patient satisfaction and a relatively low complication rate, despite small losses of strength, manual dexterity, and motion.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Reliability of a computerized target-pursuit system for measuring coordinated exertion of force

The purpose was to examine trial-to-trial and day-to-day reliability and sensitivity for measurements of the ability to coordinate exertion of force based on target-pursuit. 30 college students were required to match their grip strength to a changing demand value appearing on the display of a personal computer, using two visual images in the form of a bar chart and waveform. The variable was the sum of the differences between demanded and produced grip strength over time. Analysis indicated high intraclass correlation coefficients (ICC) for bar chart and waveform displays (ICC = .87, ICC = .95, respectively). The limits of agreement, designating the interval comprising 95% of the differences between three measurements in a stable individual, were -14.8 to 99.3% for the bar chart and -3.5 to 113.6% for the waveform displays. One-tailed, paired t tests of the day-to-day measurements showed significant (p < .05) improvement in both the bar chart and waveform displays. ICCs for day-to-day measurements were low-to-moderate for bar chart and waveform displays (ICC = .33 to .71, ICC = .48 to .76, respectively). The limits of agreement between measurements of two trials for day-to-day measurements were -112.2 to 218.6% for the bar chart and -139.2 to 352.8% for the waveform displays. The repeatability coefficients of trial-to-trial and day-to-day measurements for bar chart and waveform displays were 141 and 173%, and 152 and 176%, respectively. The limits of agreement between each test were relatively wide. We believe that these tests, on which the force response is visually guided, can be useful in objectively documenting the ability to coordinate exertion of force.

Development of an apparatus to estimate coordinated exertion of force

The purpose of this study was to develop a practical apparatus for estimation of the coordinated exertion of force and to develop methods for display, test duration, and sampling interval. A total of 84 healthy male college students were required to match their grip strength to a changing demand value appearing on the display of a personal computer (using two descriptions in the form of a bar chart and wave form). The variables were the maximal difference and the total sum of the differences between demanded and produced grip strength over time. In estimating coordinated exertion of force, an actual force (kgf) scale was more effective than a relative force (%) scale. Reliability tests indicated that a 30-sec. test was effective. Both bar chart and wave form displays were effective.

Concurrent validity of the NK hand dexterity test

BACKGROUND AND PURPOSE

The present study evaluated the concurrent validity of the NK hand dexterity test (NKHDT) by use of three separate analyses: (1) the correlation between the NKHDT and a criterion comparator (Jebson's Hand Function Test (JHFT)); (2) the correlation between both dexterity tests and a patient-rated function questionnaire; and (3) the ability of subscales to differentiate between subjects with and without upper extremity pathology.

METHOD

The study population included 40 individuals with a variety of musculoskeletal problems affecting the upper extremity and 10 individuals without any history of upper extremity problems. Both dexterity tests were administered on a single occasion according to a standard protocol. Subjects also completed a rating scale which evaluated self-care, household work, work and recreation on an 0-10-point scale.

RESULTS

The validity of the NKHDT was supported in all three analyses because: (1) the correlation between the NKHDT and JHFT subtests was moderate to strong (Pearson's r = 0.47-0.87) and stronger when the objects were more similar in size; (2) both scales correlated to a similar extent with patient-rated function (Pearson's r = 0.34-0.67); and (3) all subscales were statistically different between subjects with and without upper extremity pathology (p < 0.01).

CONCLUSIONS

The present study supports the use of the NKHDT as a measure of hand dexterity.

Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture

We evaluated the responsiveness of patient questionnaires and physical testing in the assessment of recovery after distal radius fracture. Patients (n = 59) were assessed at their baseline clinic visit and again 3 and 6 months after injury. At each visit patients completed a short form-36, Disability of the Arm, Shoulder, and Hand questionnaire, and patient-rated wrist evaluation (PRWE). At 3 and 6 months grip strength, range of motion, and dexterity were analyzed. Standardized response means (SRM) and effects sizes were calculated to indicate responsiveness. The PRWE was the most responsive. Both the PRWE (SRM = 2.27) and the Disability of the Arm, Shoulder, and Hand (SRM = 2.01) questionnaire were more responsive than the short form-36 (SRM = 0.92). The physical component summary score of the short form-36 was similar to that of the physical component subscales. Questionnaires were highly responsive during the 0- to 3-month time period when physical testing could not be performed. Of the physical tests, grip strength was most responsive, followed by range of motion. Responsive patient-rating scales and physical performance evaluations can assist with outcome evaluation of patients with distal radius fracture.