Reliability and validity of measurement and associations between disability and behavioural factors in patients with Colles' fracture

The aims of the study were to 1) investigate the test-retest reliability, the internal consistency in instruments that measure behavioural factors and disability as well as to investigate convergent validity between the Disabilities of the Arm, Shoulder, and Hand Outcome Questionnaire (DASH) and the Patient-Rated Wrist Evaluation (PRWE), in patients with Colles' fracture; and 2) assess the relationship between the behavioural measures and the region-specific measures addressing the patient perceptions of impairment, functional loss, and disability. Two samples (sample 1?=?16; sample 2?=?16) of patients with the fracture immobilised in plaster cast were included. The participants answered the Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand Outcome Questionnaire (DASH), Tampa Scale of Kinesophobia (TSK), Catastrophizing Subscale (CAT) of the Coping Strategies Questionnaire (CSQ), and Self-Efficacy Scale (SES) twice. Test-retest reliability was satisfactory for all instruments. The internal consistency examined with Cronbach's alpha was between 0.68 and 0.97. Because acceptable to good test-retest reliability and internal consistency were demonstrated for the PRWE, DASH, TSK, CAT of the CSQ, and SES, they can be used to detect and monitor fear of movement/(re)injury, catastrophic cognitions, and self-efficacy in patients with radius fracture in the acute and subacute phase. Generally low to moderate correlations were found between behavioural and region-specific measures, indicating that there are two distinct concepts that are not interchangeable.     

Pain, functional disability, and psychologic status in tennis elbow

OBJECTIVES: First to compare pain and functional disability in tennis elbow (TE) patients with healthy controls. Second, to evaluate the relationship between the 2 major psychologic factors (anxiety and depression) and TE. METHODS: Sixteen TE patients were recruited from 46 consecutive attendees at an upper limb clinic: inclusion criteria were lateral epicondyle tenderness, pain with resisted wrist and middle finger extension and at least 3 months localized lateral elbow pain. Sixteen healthy controls with no upper limb problem were recruited from students and staff. Participants were given 4 questionnaires, together with instructions for completion: Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, Patient-Rated Wrist Evaluation Questionnaire, and Hospital Anxiety and Depression Scale. The independent t test was used to compare the total and subscale scores between the groups. RESULTS: Significantly higher scores were found in TE for pain and function subscales and also total score for Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Forearm Evaluation Questionnaire, and Patient-Rated Wrist Evaluation Questionnaire. For Hospital Anxiety and Depression Scale, both anxiety and depression subscales (P<0.001) and the total score (P<0.01) were significantly higher in TE. According to the anxiety and depression subscales, 55% and 36% of patients, respectively, were classified as probable cases (score >11). DISCUSSION: TE patients showed markedly increased pain and functional disability. Significantly elevated levels of depression and anxiety pointed out the importance of psychologic assessment in TE patients. In the development of supportive and treatment strategies, we suggest the combination of "upper limb" and "psychologic" assessment tools.     

Validity,reliability and ease of use of the disabilities of arm,shoulder and hand questionnaire in adults following stroke

Purpose: The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire is a patient reported outcome measure for evaluating upper limb function in people with musculoskeletal conditions. While the DASH has good psychometric properties when used with people with musculoskeletal conditions, it has not been tested with adults after stroke.

Methods: Data for n?=?61 adults following stroke (aged 32–93 years, 44% male) were analyzed to test validity and reliability of the DASH for use with a stroke population. Data included demographic and clinical attributes, DASH scores (baseline and four weeks later) and Patient Rated Wrist Evaluation (PRWE) measures.

Results: Internal consistency was good (Cronbach alpha 0.92, SEM 6.65). Factor analysis and Rasch modeling suggested that the questionnaire comprised three subscales: pain, impact and function. Concurrent validity between the DASH and PRWE (Spearman’s Rho r_s?=_?0.41) was moderate. The scale was perceived by clinicians to be useful, quick and simple to administer. The DASH had low four-week test-retest reliability (ICC 0.56 [95% Cl 0.05–0.79]).

Conclusions: The DASH is considered to have acceptable validity when used with adults following stroke. Test–retest reliability was low but further research is needed to establish whether this is a result of condition-related change or the stability of the measure.

• Implications for Rehabilitation

• The DASH questionnaire examines upper limb function in task performance and appears to be a useful tool, which is simple to administer in the clinical setting with adults following stroke.

• Upper limb function post stroke can be meaningfully assessed using the DASH as it has good internal consistency and moderate concurrent validity.

• Rasch analysis and factor analysis suggests that the tool appears to consist of three subscales: pain, impact and function. The total score of the DASH may be less meaningful than the totals of these subscales.

• The test–retest reliability of the DASH requires further research; over a four-week period DASH stability was poor in a group of people with moderate to severe upper limb impairment.

     

Psychometric properties of the performing arts module of the Disabilities of the Arm,Shoulder, and Hand questionnaire

Abstract

Background: The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) offers an optional performing arts module. The goal was to examine the psychometric properties of this module in musicians.

Methods: This study is a secondary analysis of a randomized controlled trial on the effectiveness of a biopsychosocial intervention to prevent or reduce playing-related disability in conservatory students. Baseline data were used to examine internal consistency and discriminative validity of the performing arts module of the DASH questionnaire. Construct validity was analyzed by hypotheses testing. The performing arts module outcomes were compared to scores from the general DASH questionnaire, pain disability index, Short-Form 36, playing-related musculoskeletal disorder (PRMD) intensity, and pain intensity.

Results: Questionnaires completed by 130 conservatory students were analyzed, 55% of the population was female. Median age was 20 years (IQR 4). The performing arts module showed good internal consistency (Cronbach’s alpha 0.893). Discriminative validity between students with and without PRMDs was good. Three out of six hypotheses were accepted, indicating moderate construct validity.

Conclusions: The performing arts module showed good internal consistency, good discriminative validity and moderate construct validity in a population of conservatory students.

• Implications for Rehabilitation

• Musicians suffer frequently from musculoskeletal disorders, mostly in the upper extremity.

• The Disabilities of the Arm, Shoulder, and Hand questionnaire is a well-known outcome measure, which also includes a performing arts module.

• This study is the first to explore psychometric properties of the performing arts module.

• The performing arts module of the Disabilities of the Arm, Shoulder, and Hand questionnaire showed good internal consistency, good discriminative validity, and moderate construct validity.

     

Performance of the disabilities of the arm, shoulder and hand outcome questionnaire and the Moberg picking up test in patients with finger joint arthroplasty

OBJECTIVE: To compare the performance of the Disabilities of the Arm, Shoulder and Hand Outcome (DASH) Questionnaire and the Moberg Picking Up Test (MPUT) with other outcome measurement tools in assessing both hand function and aspects of general health in finger joint arthroplasty in patients with rheumatoid arthritis (RA). DESIGN: Case series, with an average follow-up duration of 104.9 months. SETTING: Orthopedic outpatient clinic at a university hospital. PARTICIPANTS: Of 64 consecutive patients (21 dead, 6 lost to follow-up), 37 patients with 140 spacers in 107 metacarpophalangeal and 33 proximal interphalangeal joints of 51 hands were evaluated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Hand function tests and general health measures. RESULTS: The DASH correlated with both hand function (Health Assessment Questionnaire: r=.72, P<.01; MPUT: r=0.6, P<.01) and general health (Medical Outcomes Study 36-Item Short-Form Health Survey subscales: r range, -.73 to -.31; P range, <.001 to <.05). The MPUT was a suitable tool for precision grip testing. CONCLUSIONS: The DASH has the advantage of being self-administered and assesses both functional and health aspects. It can be recommended as an instrument for a routine clinical follow-up for patients with hand surgery and RA. Additional tests should be applied when detailed information is needed.     

Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure

OBJECTIVE: To translate and validate the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure (Persian DASH). DESIGN: Cultural translation and psychometric testing. SETTING: Outpatient departments of orthopaedics surgery, primary care settings, rehabilitation medicine and physical therapy. SUBJECTS: Two hundred and seventy-one consecutive Persian-speaking patients with upper extremity disorders including subacromial impingement syndrome, rotator cuff disease, epicondylitis, ulnar nerve entrapment, bursitis, instability, carpal tunnel syndrome, tenosynovitis and adhesive capsulitis. METHODS: The translation and cultural adaptation of the original questionnaire was carried out in accordance with published guidelines. The participants were asked to complete a questionnaire booklet including the Persian DASH, the Short Form General Health Survey (SF-36) and a visual analogue scale (VAS) of pain. In addition, 31 randomly selected patients were asked to complete the questionnaire 48 hours later for the second time. RESULTS: Cronbach's alpha coefficient for the Persian DASH was 0.96. The Persian DASH showed excellent test-retest reliability with intraclass correlation coefficient equal to 0.82 (P<0.01). The correlation between the Persian DASH and the functional scales of the Iranian SF-36 showed desirable results indicating a good convergent validity (Pearson's coefficients ranged from -0.25 to -0.72; P<0.001). The correlation between the Persian DASH and the visual analogue scale was 0.52 (P<0.01). CONCLUSIONS: The Persian DASH is a reliable and valid instrument to measure functional status in Persian-speaking patients with upper extremity disorders in Iran. It is simple and easy to use and now can be applied in clinical settings and future outcome studies in Iran and other Persian-speaking communities.     

英文版腕关节功能患者自评量表的汉化及其信度研究

目的 研究中文版腕关节患者自行评估量表(PRWE)在桡骨远端骨折患者功能评定中的重测信度和内部的一致性。方法 运用中文版和英文版的PRWE分别对5l例桡骨远端骨折患者进行量表的重测信度和内在一致性对比观察。用Intra-class Correlation Coefficient(ICC)来表示量表的重测可信度；用Cron-bach Alpha来表示量表的内部一致性。结果 中文版的PRWE信度良好，ICC范围为0．88～0．92；内部一致性也较高，Cronbach Alpha值介于0．87-0．97之间，均大于0．70。结论 中文版PRWE具有良好的重测信度和内部一致性．可以作为桡骨远端骨折华人患者的主观功能评定量表。     

The validity of prospective and retrospective global change criterion measures

OBJECTIVE: To assess the validity of retrospective versus prospective criterions of change. DESIGN: Single cohort pretest-posttest design. SETTING: Physical or occupational therapy outpatient clinics. PARTICIPANTS: Volunteer sample of 211 patients with upper-extremity musculoskeletal problems. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Disabilities of the Arm, Shoulder, and Hand questionnaire, the Shoulder Pain and Disability Index, the Patient-Rated Wrist Evaluation, the Medical Outcomes Study 12-Item Short-Form Health Survey; global disability rating (GDR), retrospective global rating of change (GRC), and patient satisfaction. RESULTS: Correlations were calculated among the baseline, 3-month follow-up, and change scores for each outcome measure with the change criterion instruments. Retrospective GRC and patient satisfaction ratings showed moderate correlations with the 3-month follow-up scores, but nonsignificant correlations with baseline scores. By contrast, the prospective GDR criterion showed significant correlations with both baseline and 3-month follow-up scores ranging between 0.3 and 0.4 (absolute value). CONCLUSIONS: Retrospective self-report measures of change do not accurately reflect true change over time. The retrospective GRC and patient satisfaction were heavily influenced by current (posttreatment) status whereas the prospective global change measure reflected both baseline and posttreatment status equally and thus appeared to be a more valid measure of change over time. This study demonstrates the need for an alternative criterion for establishing true individual change.     

Scapular kinematics and muscle performance in a single case of Parsonage–Turner

This study characterized the impairments of range of motion, three-dimensional scapulo-thoracic kinematics, isokinetic muscle performance and disability in a patient with Parsonage–Turner Syndrome. The patient had a history of 2.5-years of shoulder pain, and electroneurodiagnostic testing indicative of suprascapular neuropathy. The patient-rated Disabilities of the Arm, Shoulder and Hand (DASH) score was 33.3% (0 = no symptoms/disability), and reduced shoulder internal rotation, external rotation, and flexion as compared bilaterally. There were deficits in isokinetic muscle performance at slow and fast speeds during abduction, lateral and medial rotations as compared to the uninvolved side. Alterations in scapular kinematics were decreased posterior tilt, increased internal rotation, and increased upward rotation during arm elevation and lowering. This information can be used to assist clinicians in developing treatment programs to address the alterations caused by this neuralgic amyotrophy.     

Effectiveness of extracorporeal shock wave therapy and kinesio taping in calcific tendinopathy of the shoulder: a randomized controlled trial北大核心CSCD

BACKGROUND AND OBJECTIVE Extracorporeal Shock Wave Therapy (ESWT) is effective in the treatment of calcific tendinopathy of the rotator cuff, eliciting an analgesic/anti-inflammatory action and promoting tissue regeneration. Kinesio taping (KT), another recently-introduced rehabilitative tool, exerts an analgesic and biomechanical action on joints and muscles. ESWT and KT may have a synergic effect when used in combination, but the effectiveness of the association has not been established. METHODS In the experimental group, patients underwent three sessions (once a week for 3 weeks) of ESWT with KT applied at the end of each session. Controls underwent three sessions of ESWT only. All patients were assessed before treatment (T0) and at 1 (T1), 4 (T2) and 12 weeks (T3) after the end of treatment with the following outcome measures: a visual analogue scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Subjective Shoulder Rating Questionnaire (SSRQ), and Oxford Shoulder Score (OSS). RESULTS Both groups showed significant improvement in all outcome measures, but the time course differed between the two groups. At T1 vs. T0, the improvement was significantly better in ESWT+KT than ESWT on VAS (P=0.007), DASH (P<0.0001) and SSRQ (P=0.0001). Successive improvements at T2 vs. T1 and T3 vs. T2 did not differ significantly between the groups. At the end of follow-up, ESWT+KT still showed significantly greater improvement than ESWT on VAS (P=0.02) and SSRQ (P=0.038). CONCLUSION KT associated with ESWT seems to improve the recovery in rotator cuff calcific tendinopathy with a faster therapeutic response compared to ESWT only.     

Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain

The transition from acute to chronic low back pain (LBP) is influenced by many interacting factors. Pain-related fear, as measured by the Tampa Scale for Kinesiophobia (TSK) and the Fear-Avoidance Beliefs Questionnaire (FABQ), is one of these factors. The objectives of this study were to investigate, in a population with acute LBP, the reliability of TSK and FABQ through evaluation of the internal consistency, the test-retest reliability, and the concurrent validity between TSK and FABQ. One hundred and Seventy-Six patients suffering LBP for no longer than 4 weeks completed a Visual Analogue Scale for pain (VAS), the TSK, the FABQ, and a socio-demographic questionnaire. Each patient completed the VAS, TSK, and FABQ twice within 24 h. Internal consistency of TSK and FABQ scores range from alpha=0.70 to 0.83. Test-retest reliability ranges from r(s)=0.64 to 0.80 (P<0.01). Concurrent validity is moderate, ranging from r(s) =0.33 to 0.59 (P<0.01). It may be concluded that in a population with acute LBP, both the TSK and the FABQ are reliable measures of pain-related fear. In the clinical setting they may provide the practitioner a means of identifying pain-related fear in a patient with acute LBP.     

Clinical assessment of upper extremity injury outcomes

PATIENT SCENARIO: The patient presented is a high school baseball pitcher who was unable to throw because of shoulder pain. He subsequently failed nonoperative management but was able to return to pitching after surgery and successful rehabilitation. CLINICAL OUTCOMES ASSESSMENT: The Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PENN) were selected as clinical outcome assessment tools to quantify the patient's perceived ability to perform common daily tasks and sport tasks and current symptoms such as pain and patient satisfaction. CLINICAL DECISION MAKING: The DASH and PENN provide important information that can be used to target specific interventions, set appropriate patient goals, assess between-sessions changes in patient status, and quantify patients' functional loss. CLINICAL BOTTOM LINE: Best clinical practice involves the use of clinical outcome assessment tools to garner an objective measure of the impact of a patient's disease process on functional expectations. This process should facilitate a patient-centered approach by clinicians while they select the optimal intervention strategies and establish prognostic timelines.     

Effects of strengthening and stretching exercises applied during working hours on pain and physical impairment in workers with subacromial impingement syndrome

This study evaluated the effectiveness of a rehabilitation program performed during working hours on function and pain in workers with subacromial impingement syndrome. Fourteen male workers (31.93 ± 5.86 years) in the school supply industry were assessed. The duration of their shoulder pain was 28.50 ± 33.64 months, and their amount of time in this industry was 9.07 ± 3.68 years. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire evaluated function of the upper limbs. The Mc Gill Pain Questionnaire quantified the pain by the number of words chosen and the pain rating index (PRI). Subjects completed an 8-week rehabilitation program, twice a week, consisting of cryotherapy, strengthening, and stretching exercises. Subjects’ outcome data were collected pre- and post-intervention. The results showed that DASH scores improved (p<0.05) and the number of words chosen and PRI decreased (p<0.05) on the McGill Pain Questionnaire at post-intervention. Results should be interpreted cautiously, considering the lack of a control group in the investigation. In conclusion, it is suggested that an intervention program consisting of cryotherapy, strengthening, and stretching applied during working hours and twice a week may be effective to decrease pain and physical impairment in male workers with subacromial impingement syndrome.     

Suggestions for Refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): A Factor Analysis and Rasch Validation Study

Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): a factor analysis and Rasch validation study.

Objective

To perform a comprehensive psychometric analysis of Disabilities of the Arm, Shoulder and Hand (DASH) to examine its properties and provide insights for an improved version.

Design

Methodologic research on cross-sectional data from a convenience sample.

Setting

A free-standing rehabilitation center.

Participants

Outpatients and inpatients (N=238; 56% men; mean age, 52.2y) with upper-extremity musculoskeletal disorders.

Main Outcome Measure

The official Italian version of DASH was analyzed by factor (both explorative and confirmatory) and Rasch analysis for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices.

Interventions

Not applicable.

Results

Factor analysis established the presence of 3 underlying constructs related to manual functioning (items 1-5, 7-11, 16-18, 20, 21), shoulder range of motion (items 6, 12-15, 19), and symptoms and consequences (items 22-30). Rating scale diagnostics showed category malfunctioning. The fit to the Rasch model was good for all items except 4 (items 20, 21, 25, 26). Ten item pairs had high residual correlations after subtraction of the Rasch dimension (local dependency). A test model based on the 3 subscales suggested by factor analysis and corrected categories still showed misfitting in items 21 (“Sexual Activities”) and 26 (“Tingling”) and the presence of some dependent items.

Conclusions

Unidimensionality and the key domains identified by the original developers as the theoretic framework of DASH were not confirmed by our analyses. The response categories showed misfunctioning. “Sexual Activities” and “Tingling” misfit the Rasch model. Further detailed investigations of DASH are warranted, both to confirm these results in different health conditions and cultures, and to reanalyze in-depth content validity issues regarding the questionnaire.     

Assessing physical function in adult acquired major upper-limb amputees by combining the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire and clinical examination

Østlie K, Franklin RJ, Skjeldal OH, Skrondal A, Magnus P. Assessing physical function in adult acquired major upper-limb amputees by combining the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire and clinical examination.

Objectives

To describe physical function in adult acquired major upper-limb amputees (ULAs) by combining self-assessed arm function and physical measures obtained by clinical examinations; to estimate associations between background factors and self-assessed arm function in ULAs; and to assess whether clinical examination findings may be used to detect reduced arm function in unilateral ULAs.

Design

Survey: postal questionnaires and clinical examinations.

Setting

Norwegian ULA population. Clinical examinations performed at 3 clinics.

Participants

Questionnaires: population-based sample (n=224; 57.4% response rate). Clinical examinations: combined referred sample and convenience sample of questionnaire responders (n=70; 83.3% of those invited). Survey inclusion criteria: adult acquired major upper-limb amputation, resident in Norway, mastering of spoken and written Norwegian.

Interventions

Not applicable.

Main Outcome Measures

The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire, and clinical examination of joint motion and muscle strength with and without prostheses.

Results

Mean DASH score was 22.7 (95% confidence interval [CI], 20.3–25.0); in bilateral amputees, 35.7 (95% CI, 23.0–48.4); and in unilateral amputees, 22.1 (95% CI, 19.8–24.5). A lower unilateral DASH score (better function) was associated with paid employment (vs not in paid employment: adjusted regression coefficient [aB]=−5.40, P=.033; vs students: aB=−13.88, P=.022), increasing postamputation time (aB=−.27, P=.001), and Norwegian ethnicity (aB=−14.45, P<.001). At clinical examination, we found a high frequency of impaired neck mobility and varying frequencies of impaired joint motion and strength at the shoulder, elbow, and forearm level. Prosthesis wear was associated with impaired joint motion in all upper-limb joints (P<.006) and with reduced shoulder abduction strength (P=.002). Impaired without-prosthesis joint motion in shoulder flexion (ipsilateral: aB=12.19, P=.001) and shoulder abduction (ipsilateral: aB=12.01, P=.005; contralateral: aB=28.82, P=.004) was associated with increased DASH scores.

Conclusions

Upper-limb loss clearly affects physical function. DASH score limitation profiles may be useful in individual clinical assessments. Targeted clinical examination may indicate patients with extra rehabilitational needs. Such examinations may be of special importance in relation to prosthesis function.     

Upper extremity strength and range of motion and their relationship to function in breast cancer survivors

The impact upper extremity impairments (UE) have on UE function in breast cancer survivors (BCS) is unclear. The purpose of this study was to evaluate the associations between upper extremity active range of motion (AROM), passive range of motion (PROM), and strength with self-reported function in BCS. BCS (n = 24) completed the Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PSS). AROM and PROM of shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction were measured using a digital inclinometer. Strength was measured using a hand-held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, IR, ER, scaption, and horizontal adduction. All constructs of AROM, PROM, and strength were correlated with the DASH and PSS. DASH was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 6 of 7 shoulder strength measures. PSS was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 4 of 7 shoulder strength measures. Regression analysis showed that AROM explained 40% of the DASH scores and strength explained 20% of scores on the PSS. This study characterizes the impact that shoulder motion, flexibility, and strength losses have on shoulder function in BCS. Deficits in AROM and shoulder strength explained the greatest proportion of shoulder disability. Future clinical trials should consider incorporating AROM and strengthening techniques to improve shoulder use after breast cancer treatments.     

Hand function and Disability of the Arm,Shoulder and Hand in Charcot-Marie-Tooth disease

Purpose. The aim of the present study was to examine hand function and disability in persons with Charcot-Marie-Tooth disease (CMT) and to evaluate the possible correlations between hand function and disability.

Methods. Nine male, 11 female (24–73 yrs) persons with CMT in northern Sweden and a matched control group of 18 men, 22 women (21–73 yrs) participated in the study. Measurements applied were tests of dexterity (Box and Block Test; Nine-Hole Peg test), grip strength (Grippit®), tactile gnosis (Shape Texture Identification test) and upper-limb disability (Disabilities of the Arm Shoulder and Hand questionnaire, DASH).

Results. Hand function in CMT was reduced (p < 0.001) to about 60% of normal, as indicated by each of the separate outcome measures as well as by a constructed summary index of hand function. DASH score median was 38.8 (range 0–66.7) and was clearly related to hand function (r = 0.64–0.83).

Conclusion. Reduced hand function in CMT was found at different dimensions according to the International Classification of Functioning, Disability and Health (ICF). We suggest that DASH can be used in persons with CMT, though clinicians should be aware that patients might score lower than expected, possibly because of a long process of adaptation when learning to live with a slowly progressive disease.     

Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with neck pain

OBJECTIVE: To examine selected psychometric properties of these instruments in a cohort of patients with mechanical neck pain. DESIGN: Cohort design of 78 subjects completing self-report measures of pain, disability, and the Fear-Avoidance Beliefs Questionnaire Work (FABQW) and Physical Activity (FABQPA) subscales, as well as the Tampa Scale of Kinesiophobia (TSK) at baseline and a 2-day follow-up. Intraclass correlation coefficients were used to calculate test-retest reliability, and Cronbach's alpha was used to calculate internal consistency. Concurrent validity was analyzed between the FABQPA, FABQW, TSK, pain, and disability using Pearson correlation coefficients and hierarchical linear regression modeling. RESULTS: The FABQPA and FABQW subscales exhibited substantial test-retest reliability, whereas the TSK exhibited moderate reliability. Internal consistency was high for all measures. The FABQW subscale was the only measure that significantly contributed to the regression model for both pain and disability in this group of patients with neck pain. CONCLUSIONS: Whereas the reliability and internal consistency of all measures ranged between moderate and substantial, the results of this study suggest weaker relationships between measures of fear and avoidance beliefs and pain/disability among patients with mechanical neck pain than has been reported among patients with low-back pain.     

Effectiveness of a Telerehabilitation Evidence-Based Tablet App for Rehabilitation in Traumatic Bone and Soft Tissue Injuries of the Hand,Wrist, and Fingers

ObjectiveTo assess whether feedback-guided exercises performed on a tablet touchscreen improve clinical recovery and reduce health care usage more than the conventional home exercise program prescribed on paper in patients with bone and soft tissue injuries of the wrist, hand, and/or fingers treated by public health services.DesignA multicenter assessor-blinded, parallel, 2-group controlled trial.SettingTrauma and rehabilitation services of 4 hospitals.ParticipantsSix hundred sixty-three patients with limited functional ability due to bone and soft tissue injuries of the wrist, hand, and/or fingers (N=663).InterventionsThe experimental group received a home exercise program using a tablet-based application with feedback, monitoring, and progression; the control group received an evidence-based home exercise program on paper.Main Outcome MeasuresThe primary outcome was functional ability through Patient Rated Wrist Evaluation for wrist conditions and the short version of Disabilities of the Arm, Shoulder and Hand for all other hand pathologies. Secondary outcomes included dexterity, pain intensity, grip strength, and health care usage (number of patients referred to rehabilitation service and number of clinical appointments).ResultsThe experimental group showed a significant improvement on the Patient Rated Wrist Evaluation (P=.001) and the short version of Disabilities of the Arm, Shoulder and Hand (P=.001) with medium effect sizes (η²=0.066-0.067) when compared with the control group. Regarding health care usage, the experimental group presented a reduction of 41% in the rate of referrals to face-to-face rehabilitation service consultations, a reduction of rehabilitation consultations (mean difference=−1.64; 95% confidence interval, −2.64 to −0.65) and physiotherapy sessions (mean difference=−8.52, 95% confidence interval, −16.92 to −0.65) compared to the control group.ConclusionsIn patients with bone and soft tissue injuries of the wrist, hand, and/or fingers, prescribing feedback-guided exercises performed on a tablet touchscreen was more effective for improving patients’ functional ability and reduced the number of patients referred to rehabilitation consultation and number of clinical appointments.     

体外冲击波对肘关节半脱位保守治疗后患者上肢功能的临床效果观察

目的:观察体外冲击波疗法(ESWT)对肘关节脱位保守治疗后患者上肢功能的临床效果。方法:将30例肘关节脱位经手法复位及石膏绷带外固定的患者随机分为ESWT组和对照组各15例,2组每天进行相同的肘关节及上肢功能康复治疗,ESWT组在此基础上增加体外冲击波治疗。治疗前后分别对2组患者进行疼痛视觉模拟评分(VAS),肘关节主动活动度(AROM),上肢及手功能DASH问卷(DASH)评价。结果:治疗后,2组的肘关节AROM均较训练前明显提高(均P0.05),且ESWT组更高于对照组(P0.05);2组VAS评分及DASH评分均较训练前明显降低,且ESWT组更低于对照组(均P0.05)。结论:体外冲击波结合上肢功能康复治疗可有效提高肘关节脱位保守治疗后患者的肘关节活动度及上肢功能,同时有效减轻疼痛。