Correlation between upper limb functional ability and structural hand impairment in an early rheumatoid population

OBJECTIVE: To explore the relationship in individuals with early rheumatoid arthritis (RA) between self-report upper limb function, therapist-assessed upper limb function and therapist-assessed measures of structural impairment (handgrip, active hand motion and metacarpophalangeal (MCP) joint ulnar deviation). DESIGN: Thirty-six patients with early RA were recruited across seven outpatient occupational therapy departments. OUTCOME MEASURES: Upper limb functional activity and ability was measured using the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the Grip Ability Test (GAT). Upper limb impairment was assessed by bilateral power handgrip using the MIE Digital Grip Analyser, goniometry measures of bilateral metacarpophalangeal (MCP) joint ulnar deviation and bilateral active motion of the wrist. RESULTS: Strong correlations (> 0.7) were seen between the self-report DASH questionnaire and the therapist-rated GAT assessment. Bilateral power handgrips were also strongly correlated with both functional assessments. Dominant ulnar deviation at the MCP joints demonstrated a weak correlation (0.3-0.4) with both self-report and therapist-rated functional ability and a weak to moderate. (0.1-0.5) correlation on the nondominant side. CONCLUSION: In this early RA population handgrip strength is an accurate indicator of upper limb ability. Ulnar deviation at the MCP joints shows only a weak to moderate association with upper limb functional activity and ability. Although the DASH and the GAT were strongly correlated, the DASH was a more discriminating measure than the GAT in assessing upper limb ability in this sample population.     

A simulation of hand impairments: Effects on upper extremity function and implications toward medical impairment rating and disability determination

Objectives: To determine whether simulation of significant impairment of the hand will have a predictable impact on degree of functional loss at the wrist and hand.Design: Single subject repeat measures using before-after trial comparisons and healthy volunteer subjects.Setting: Occupational therapy section of a large academic medical center.Other Participants: Twenty adult volunteer student subjects from an occupational therapy education (OTE) department were included. All were between ages 18 and 43 years, right hand dominant, and in excellent general health. There were 19 women and 1 man, reflecting gender distribution of the OTE student body.Intervention: A simulated fusion of the carpometacarpal (CMC) joint of the thumb was achieved by immobilization in an individually fabricated splint designed to maximally restrict motion at the first CMC joint. Impairment ratings (baseline vs splinted) according to the AMA Guides were obtained by Greenleaf testing, and upper extremity function was quantitatively assessed before and after splinting.Main Outcome Measures: Measures of upper extremity function included grip and pinch strength, wrist torque, and speed of performance on the Valpar Small Tools test, Jebsen Hand Function test, and an exploratory measure, the Functional Life Activity Test (FLAT).Results: Significant impairments were achieved for all subjects after splinting and according to Greenleaf testing. Splinting resulted in significant reductions in grip and pinch strength, wrist torque, and significant slowing of performance on the Valpar, Jebsen, and FLAT tests. Regressions of degree of impairment on degree of functional loss after splinting, and according to each of the above measures, were not significant.Conclusions: Impairment of the hand was simulated to a mild-to-moderate degree as measured according to the AMA Guides. This imposed significant reductions in motion at key joints of the wrist and hand as well as significant reductions in grip and pinch strength and wrist torque. A corresponding and significant slowing of performance on a variety of measures of upper extremity function of an industrial and nonindustrial nature was also seen. However, and for the first time, correlation and regression reveals that it is not possible to predict degree of functional loss attributable to degree of impairment for the hand. It thus appears that, for mild-to-moderate clinical impairments, the associated impairment rating is a poor estimator of functional loss at the hand and should be used cautiously, if at all, as a criterion for disability determination.     

Bilateral Sensory Effects of Unilateral Passive Accessory Mobilization in Patients With Thumb Carpometacarpal Osteoarthritis

ObjectiveThe purpose of this study was to investigate changes in pressure sensitivity and pinch grip force in the nonsymptomatic side in patients with thumb carpometacarpal (CMC) osteoarthritis (OA) after the application of a unilateral passive accessory mobilization to the symptomatic hand.MethodsSecondary analysis of data from a randomized trial with concealed allocation, blinded assessor, and intention-to-treat analysis was performed. Twenty-eight patients (72% females), with unilateral CMC OA and mean age ± SD of 82 ± 6 years, met all the inclusion criteria and agreed to participate. The experimental group received passive accessory mobilization to the CMC OA, and the control group received a nontherapeutic dose of intermittent ultrasound on the affected side for 4 sessions over 2 weeks. Outcome measures including pressure pain thresholds (PPTs) at the lateral epicondyle, thumb CMC joint, tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone and tip and tripod pinch and grip strength of the contralateral/unaffected hand were assessed at baseline as well as 1 and 2 weeks after treatment by an assessor blinded to the group allocation. A repeated measures analysis of variance was used to determine changes in PPT and pinch and grip strength.ResultsNo important baseline differences were observed between groups. At the end of the follow-up period, the experimental group exhibited a significant increase in PPT at the CMC joint as compared with the control group 0.6 kg/cm² (95% confidence interval, 0.3-1.0; F_3.0 = 4.89; P = .009). Although PPT changes in the experimental group were higher than the control group at the remaining sites, differences did not reach statistically significance. Similarly, tip, tripod pinch, and grip strength remained unchanged after the intervention.ConclusionThis secondary analysis found that the application of a unilateral passive accessory mobilization targeted to the symptomatic CMC joint induced an increase of PPT levels 2 weeks after treatment; however, differences were small and likely of limited clinical value. No contralateral motor effects were observed. Future studies including larger sample sizes are needed to examine the effects of joint mobilization on motor and sensory effects.     

Management of the basal joint of the thumb following interposition arthroplasty for pain and instability

Derangement of the carpometacarpal (CMC) joint of the thumb secondary to osteoarthritis (OA) or rheumatoid arthritis (RA) is a source of pain and disability in many postmenopausal women. If surgery becomes necessary, the goals of postsurgical management are directed to relief of pain, joint protection and rest, and restoration of functional activity. This article describes the successful postsurgical rehabilitation of two patients with CMC joint arthritis of differing etiologies, and medical complexity, OA and RA, respectively, and different levels of medical complexity. Basal joint protection, passive range of motion, and gentle active exercise resulted in rapid functional recovery for these two patients.     

Management of the basal joint of the thumb following interposition arthroplasty for pain and instability

Derangement of the carpometacarpal (CMC) joint of the thumb secondary to osteoarthritis (OA) or rheumatoid arthritis (RA) is a source of pain and disability in many postmenopausal women. If surgery becomes necessary, the goals of postsurgical management are directed to relief of pain, joint protection and rest, and restoration of functional activity. This article describes the successful postsurgical rehabilitation of two patients with CMC joint arthritis of differing etiologies, and medical complexity, OA and RA, respectively, and different levels of medical complexity. Basal joint protection, passive range of motion, and gentle active exercise resulted in rapid functional recovery for these two patients.     

Use of Virtual Reality in Burn Rehabilitation: A Systematic Review and Meta-analysis

ObjectivesWe systematically reviewed published clinical trials to evaluate the effectiveness of virtual reality (VR) technology on functional improvement, pain relief, and reduction of mental distress among burn patients undergoing rehabilitation.Data SourcesSystematic searches were conducted in 4 databases, including PubMed, the Cochrane Library, Embase, and Web of Science, from inception to August 2021.Study SelectionRandomized controlled trials (RCTs) evaluating any type of VR for the rehabilitation in burn patients with dysfunction were included.Data ExtractionTwo reviewers evaluated the eligibility, and another 2 reviewers used the Cochrane risk of bias assessment tool to assess the risk of bias. The extracted data included the main results of rehabilitation evaluation (quality of life [QOL], work performance, range of motion [ROM] of joints, hand grip and pinch strength, pain, fun, anxiety), the application performance of VR (realness and presence), adverse effects (fatigue and nausea), and characteristics of the included studies. Heterogeneity was evaluated using the chi-square tests and I² statistics. Random- or fixed-effects models were conducted to pool the effect sizes expressed as standardized mean differences (SMDs).Data SynthesisSixteen RCTs with 535 burn patients were included. VR-based interventions were superior to usual rehabilitation in QOL and work performance of burn patients and produced positive effect on the average gain of ROM (SMD=0.72) as well. VR was not associated with improved hand grip and pinch strength (SMD=0.50, 1.22, respectively) but was associated with reduced intensity, affective, and cognitive components of pain (SMD=−1.26, −0.71, −1.01, respectively) compared with control conditions. Ratings of fun in rehabilitation therapy were higher (SMD=2.38), and anxiety scores were lower (SMD=−0.73) than in control conditions.ConclusionsVR-based burn rehabilitation significantly improves the QOL and work performance of burn patients, increases the ROM gain in the joints, reduces the intensity and unpleasantness of pain and the time spent thinking about pain, increases the fun in the rehabilitation therapy, reduces the anxiety caused by the treatment, and has no obvious adverse effects. However, it did not significantly improve hand grip or pinch strength.     

Joint Mobilization of the Hands of Patients With Rheumatoid Arthritis: Results From an Assessor-Blinded,Randomized Crossover Trial

ObjectiveThe purpose of this study was to assess the clinical feasibility and effectiveness of manual mobilization of the hands of patients with rheumatoid arthritis (RA).MethodsA total of 320 individual hand joints were evaluated after recruiting an experimental research group of 12 participants with RA and, for clinical comparability, 8 participants with hand osteoarthritis (OA). One hand per participant was randomized to receive weekly low-grade (I-II) Kaltenborn manual mobilization, using passive sustained stretch of the metacarpophalangeal (MCP) joints II to V by licensed manual therapists. After 2 weeks, the randomized treated hand was crossed over to control (untreated) during weeks 3 to 4 and vice versa. Final assessment was at 2 months, which was 1 month after the last treatment at week 4. Primary hand outcomes included pain by visual analog scale, tender or swollen joint count, and presence of Doppler signal or synovial fluid and radiographic joint space by musculoskeletal ultrasound.ResultsIn the RA group, both the initially randomized treated hand and the contralateral hand improved significantly from baseline to crossover to follow-up at 2 months (pain outcomes and Doppler signal, P < .050; synovial fluid and MCP joint space, P ≤ .001). Hand pain and MCP joint space also improved significantly in OA. There were no dropouts or reported adverse events in either the RA or OA group.ConclusionIn this study, manual mobilization of the hands of patients with RA was shown to be feasible, safe, and effective to integrate into specialized healthcare.     

Functional and biomechanical assessment of the normal and rheumatoid hand

OBJECTIVE: To assess hand function in accordance with its accepted definition and to compare the results of three different assessment techniques. DESIGN: A clinical-type assessment was used together with measurement of pinch grip and three-dimensional biomechanical trials. BACKGROUND: Traditional clinical assessment may not relate to a patient's actual hand function. If hand function is defined as "the ability to use the hand in daily activities" then it is more appropriate to measure the forces available for performing everyday tasks using biomechanical tests. METHODS: Eight female patients with rheumatoid arthritis and eight control subjects were recruited for the study. Volunteers underwent a clinical-type assessment using a six-task activity board. Lateral pinch grip of both hands was measured using a custom-built transducer. Biomechanical trials were conducted using a 6 degree-of-freedom transducer and 6-camera motion analysis. RESULTS: Functional differences between the two subject groups were apparent using all three methods of assessment. Pinch strength correlated well with the biomechanical trial data but results from the clinical-type assessment provided only a weak correlation. CONCLUSIONS: Clinical-type assessments do not give an accurate measure of hand function. Pinch strength measurements can provide a cost-effective alternative to full biomechanical analysis. RELEVANCE: Traditional functional assessment uses measurements of grip or pinch strength and range of motion together with a subjective assessment of activities of daily living. This study demonstrates that pinch strength measurements can provide an accurate measure of hand function. The results from activity-board trials do not reflect hand ability and are of limited use for hand evaluation.     

Upper limb sensorimotor function and functional performance in patients with rheumatoid arthritis

PURPOSE: Although sensorimotor deficits have been identified in isolated upper limb joints of patients with rheumatoid arthritis (RA), relatively little is known about the presence or consequences of sensorimotor deficits in the upper limb as a whole. To address this, we compared sensorimotor and functional performance in multiple upper limb joints of patients with RA and healthy subjects. METHODS: Global upper limb strength, proprioception (joint position sense) and the time taken to perform 2 common functional daily activities (dressing and eating) were estimated in 31 RA patients and 18 healthy subjects. Disability, pain and clinical disease activity were also assessed in the RA patients. RESULTS: The RA patients were weaker (mean difference 280N, 95% Confidence Interval 172 to 389; P < 0.001), had poorer functional performance (6 sec, CI 8.1 - 23.9; P < 0.001), hand grip strength (117 mmHg, CI 61 - 173; P < 0.001) and proprioceptive acuity (2 degrees , CI 0.4 - 3.5; P < 0.05) than the healthy subjects. Upper limb functional performance and disability in the RA patients were inversely associated with global upper limb (r = -0.54 to -0.36) and hand grip strength (r = -0.51 to -0.32) but not proprioception (r = 0.55 - 0.11). CONCLUSIONS: Compared to healthy subjects, patients with RA had global upper limb sensorimotor deficits. Weakness contributes to poor upper limb function and disability in patients with RA, although the clinical importance of proprioception is unclear.     

Effects of Virtual Reality and Task-Oriented Training on Hand Function and Activity Performance in Pediatric Hand Burns: A Randomized Controlled Trial

ObjectiveTo assess the efficacy of a motion-sensing, hands-free gaming device and task-oriented training (TOT) programs on improving hand function, activity performance, and satisfaction in pediatric hand burns.DesignA randomized controlled trial.SettingOutpatient rehabilitation center.ParticipantsFifty children with deep partial-thickness or full-thickness hand burns. (N=50; mean age, 10.70±1.64y; range, 7-14y)InterventionsChildren were randomized into 1 of the following 3 groups: the motion-sensing, hands-free gaming device group that used interactive video games plus traditional rehabilitation (TR); the TOT group that used real materials plus TR; and the control group that only received TR, all groups received the interventions 3 days per week for 8 weeks.Main Outcome MeasuresWe assessed the children at the baseline and after 8 weeks of intervention. The primary outcome measures were the Jebsen-Taylor Hand Function Test, Duruoz Hand Index (DHI), and Canadian Occupational Performance Measure (COPM). The secondary outcome measures were range of motion (ROM) of the digits, grip strength, and pinch strengths (tip, palmer, and lateral pinch).ResultsThere was a significant increase in all measurements of the motion-sensing, hands-free gaming device and TOT groups compared with that of the control group postintervention (P<.05). There was no significant change in Jebsen-Taylor Hand Function Test, COPM performance, ROM, grip strength, and tip and lateral pinch strengths between the motion-sensing, hands-free gaming device group and TOT group (P>.05), whereas there was a significant increase in DHI, COPM satisfaction, and palmer pinch strength (P<.05) in the motion-sensing, hands-free gaming device group compared with the TOT group postintervention.ConclusionsThe motion-sensing, hands-free gaming device and TOT programs resulted in significant improvement in hand function, activity performance and satisfaction, ROM of the digits, grip strength, and pinch strengths in pediatric hand burns compared with the traditional hand rehabilitation.     

Factors which contribute to fatigue associated with rheumatoid arthritis

The purpose of this research was to identify the factors which people with rheumatoid arthritis (RA) believed contributed to their fatigue. A second purpose was to examine the relationships among identified factors and the sensation of fatigue. One hundred people with RA were asked to identify verbally factors which they believed contributed to their fatigue. The three most frequently identified factors included RA disease activity, disturbed sleep and increased physical effort. These factors were operationalized and measured as joint pain using the Modified McGill Pain Inventory, fragmented sleep through overnight electroencephalographic (EEG) sleep studies, and reduced physical ability using walking time and grip strength measures. Fifteen of the original subjects with RA and 12 age and gender matched control subjects completed the second phase of the research. Five of the RA subjects were experiencing a disease flare while the remaining 10 were either in remission or their disease was midly active. Those subjects in flare had significantly (P less than 0.01) more joint pain, significantly (P less than 0.05) more fragmented sleep, and significantly reduced functional capacity as measured through walking time (P less than 0.05) and grip strength (P less than 0.05) when compared to non-flare and control subjects. Fatigue levels of the subjects in flare were positively correlated with joint pain (r = 0.62), fragmented sleep (r = 0.42) and grip strength of the right hand (r = 0.52) and left hand (r = 0.88). Fatigue levels of non-flare and control subjects were negatively correlated with the majority of measured variables.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome

[Purpose] The aim of the present study was to investigate and compare the effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. [Subjects and Methods] Sixty outpatients (30 per group) with complex regional pain syndrome participated. They received 15 treatment 5 days per week for 3 weeks. The outcome measures were the visual analogue scale for pain, edema, range of motion of the wrist (flexion and extension), fingertip-to-distal palmar crease distance, hand grip strength, and pinch strength. All parameters were measured at baseline (week 0) and at the trial end (week 3). [Results] There were significant improvements in all parameters after therapy in both groups. The whirlpool bath group showed significantly better improvements in the visual analogue score, hand edema, hand grip strength, wrist range of motion (both flexion and extension), fingertip-to-distal palmar crease distance, and the three-point and fingertip pinch strengths than the neuromuscular electrical stimulation group; however, the lateral pinch strengths were similar. [Conclusion] Both whirlpool bath and neuromuscular electrical stimulation are effective in the treatment of complex regional pain syndrome, but the efficacy of the whirlpool bath treatment was better.Key words: Complex regional pain syndrome, Whirlpool bath, Neuromuscular electrical stimulation     

Physical Therapy (95)

Relationship between functional evaluation measures and self‐assessment in nonacute low back pain. (Concordia University, Montréal, Québec, Canada) Spine 2000;25:1817–1826. In this study, two hypotheses were examined: range of motion and velocity are controllable and inherently correlated with self‐assessment; complex spinal coordination patterns such as range of lordosis cannot be controlled and are independent of self‐assessment. Self‐assessment questionnaires were administered, and indexes of spinal motion and coordination were measured through skin marker kinematics. The correlation between self‐assessments and biomechanical measures was determined. Self‐assessments of function were significantly correlated with parameters prone to regulation: range of motion, velocity, and load lifted. In contrast, little correlation was found with measures of complex spinal coordination less susceptible to conscious or affective regulation, namely, range of lordosis, and estimated segmental mobility. This effect was magnified with increased load. Self‐assessment scores were significantly poorer among insurance referrals, regardless of functional status. Conclude that simple parameters of the functional examination, such as range of motion and velocity, are strongly correlated with cognitive state, and thus the information they supply is less than ideal. Complex spinal coordination is a better indicator of the degree of spinal dysfunction and enhances the process of differentiating between pain, disability, and functional impairment. Comment by Phillip S. Sizer Jr., MEd, PT. Numerous approaches to the evaluation of lumbar spine disorders have been proposed. Self‐reported disability scales are frequently implemented, but outcomes can be influenced by patient psychological factors. ROM tests have been frequently used for disability rating, but difficulty is encountered in detecting submaximal patient effort. These investigators evaluated the relationships between the Quebec Back Pain Disability Questionnaire and other self‐assessment measures, simple functional measures, and coordination patterns using the Spinoscope. From these measures the investigators attempted to elucidate a more accurate objective measure of biomechanical impairment independent from affective or self‐assessment influences. The outcomes illustrated that, while simple ROM and velocity measures were strongly correlated with subjective index scores, complex spinal coordination measures were not correlated with the same self‐assessment outcomes. Additionally, the authors suggested that simple ROM does not ensure biomechanical normalcy in movement. Furthermore, they suggested that complex coordination measures that include Range of Lordosis (ROL) and Estimate of Inter‐segmental Mobility (EISM) may serve as a better compliment to the clinical examination findings associated with lumbar conditions. Finally, they suggested that loading the spine during coordination testing further distances the outcomes from the subjective influence of pain and other factors. These measures may be superior to traditional measures for accurate diagnosis and return‐to‐work decisions with patients suffering from seemingly vague conditions, such as nonspecific low back pain.     

Continuous low-level heat wrap therapy is effective for treating wrist pain

OBJECTIVE: To evaluate the efficacy of continuous low-level heat wrap therapy for the treatment of various sources of wrist pain including strain and sprain (SS), tendinosis (T), osteoarthritis (OA), and carpal tunnel syndrome (CTS). DESIGN: Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial. SETTING: Two community-based research facilities. PARTICIPANTS: Ninety-three patients (age range, 18-65 y) with wrist pain. INTERVENTION: Subjects with moderate or greater wrist pain were randomized and stratified to 1 of the following treatments: efficacy evaluation (heat wrap, n=39; oral placebo, n=42) or blinding (oral acetaminophen, n=6; unheated wrap, n=6). Data were recorded over 3 days of treatment and 2 days of follow-up. MAIN OUTCOME MEASURES: The primary comparison was between the heat wrap and the oral placebo group among SS/T/OA subjects for pain relief. Outcome measures included pain relief (0-5 scale), joint stiffness (101-point numeric rating scale), grip strength measured by dynamometry, and perceived pain and disability (Patient Rated Wrist Evaluation [PRWE]); subjects with CTS also completed the Symptom Severity Scale and Functional Status Scale. RESULTS: Heat wrap therapy showed significant benefits in day 1 to 3 mean pain relief (P=.045) and increased day 3 grip strength (P=.02) versus oral placebo for the SS/T/OA group. However, joint stiffness and PRWE results were comparable between the 2 treatments. For the CTS group, heat wraps provided greater day 1 to 3/hour 0 to 8 mean pain relief (P=.001), day 1 to 3 mean joint stiffness reduction (P=.004), increased day 3 grip strength (P=.003), reduced PRWE scores (P=.0015), reduced symptom severity (P=.001), and improved functional status (P=.04). In addition, the heat wrap showed significant extended benefits through follow-up (day 5) in the CTS group. CONCLUSIONS: Continuous low-level heat wrap therapy was efficacious for the treatment of common conditions causing wrist pain and impairment.     

A comparison of two methods of assessing disease activity in the joints

BACKGROUND: Considerable debate has occurred concerning the utility of different methods of obtaining joint counts and their usefulness in predicting outcomes in persons with rheumatoid arthritis. OBJECTIVE: The purpose of this study was to compare two methods of assessing disease activity in the joints (clinician joint count, self-reported joint count), and to compare their relative utility in predicting two methods of assessing outcomes (self-reported ratings of impairment and pain, objective performance index) with and without controlling for negative affectivity. METHOD: Data for this study were obtained during home visits from 185 persons diagnosed with rheumatoid arthritis. Individuals completed a series of self-report measures including the joint count. Trained research assistants completed a 28-joint count and timed participants on a series of measured performance activities (e.g., grip strength, pinch strength, walk time). RESULTS: The self-report joint count was highly correlated with the clinician joint count and also accounted for as much, if not more, variance in the subjective outcome measures than did clinician assessments. Both types of indicators predicted unique variance in the objective performance index. CONCLUSIONS: For most research purposes, measures such as self-report joint counts have sufficient validity to be used in place of more costly clinician assessment of joint counts.     

Exercise training and postural correction improve upper extremity symptoms among touchscreen smartphone users

BackgroundRepetitive movements and poor posture are associated with over-use of smartphones when texting or playing games and significantly contribute to the symptoms of pain and discomfort in the upper extremities.ObjectiveThis study investigated the effect of exercise training and postural correction on disabilities of the arm, shoulder, and hand (DASH), hand grip and key pinch strength among smartphone users.MethodsOne hundred university students were randomly divided into two groups; the experimental group participated in a 12-week programme of exercise training and postural corrections. The control group were instructed to follow their usual routine for smartphone utilization. Measurements of DASH scores, hand grip strength, and key pinch grip strength were conducted before and after 12 weeks for both groups.ResultsThere were no significant differences between the start values of both groups for DASH scores, hand grip strength, and key pinch strength (p > 0.05). However, there was a significant improvement in all outcomes measured in the experimental group (p < 0.05), with significant changes in the outcomes of the control group.ConclusionPostural correction combined with a selected exercise training programme improved the hand grip, key pinch grip strength, and upper extremity disability and symptoms associated with smartphone use among university students.     

Upper limb sensorimotor function and functional performance in patients with rheumatoid arthritis

Purpose. Although sensorimotor deficits have been identified in isolated upper limb joints of patients with rheumatoid arthritis (RA), relatively little is known about the presence or consequences of sensorimotor deficits in the upper limb as a whole. To address this, we compared sensorimotor and functional performance in multiple upper limb joints of patients with RA and healthy subjects.

Methods. Global upper limb strength, proprioception (joint position sense) and the time taken to perform 2 common functional daily activities (dressing and eating) were estimated in 31 RA patients and 18 healthy subjects. Disability, pain and clinical disease activity were also assessed in the RA patients.

Results. The RA patients were weaker (mean difference 280N, 95% Confidence Interval 172 to 389; P < 0.001), had poorer functional performance (6 sec, CI 8.1 – 23.9; P < 0.001), hand grip strength (117 mmHg, CI 61 – 173; P < 0.001) and proprioceptive acuity (2°, CI 0.4 – 3.5; P < 0.05) than the healthy subjects. Upper limb functional performance and disability in the RA patients were inversely associated with global upper limb (r = ?0.54 to ?0.36) and hand grip strength (r = ?0.51 to ?0.32) but not proprioception (r = 0.55 – 0.11).

Conclusions. Compared to healthy subjects, patients with RA had global upper limb sensorimotor deficits. Weakness contributes to poor upper limb function and disability in patients with RA, although the clinical importance of proprioception is unclear.     

Osteoarthritic knee pain: a behavioral analysis

This study used behavioral assessment techniques to analyze pain in osteoarthritis (OA) patients. Eighty-seven OA patients having chronic knee pain served as subjects. Pain behavior was evaluated using a standard observation method and functional impairment was assessed using the Arthritis Impact Measurement Scales. Data analysis revealed that pain and limitations in physical activities were the most common functional impairments and that the most frequently observed pain behavior was guarded movement. Predictive analyses indicated that disability support status and scores on a Pain Control and Rational Thinking factor of the Coping Strategies Questionnaire (CSQ) were predictive of functional impairment. Patients receiving disability support payments were much more functionally limited than those not receiving this financial support. Patients scoring high on the Pain Control and Rational Thinking factor of the CSQ were much less functionally impaired, walked a 5 m course more rapidly and moved from a standing to a sitting or reclining position more quickly than patients scoring low on this factor. The implications of these results for behavioral treatment of OA knee pain are discussed.     

Limitations in activities in patients with osteoarthritis of the hip or knee: The relationship with body functions,comorbidity and cognitive functioning

Purpose. To determine the relationship between body functions, comorbidity and cognitive functioning on the one side and limitations in activities on the other, in elderly patients with osteoarthritis (OA) of the hip or knee.

Method. A cross-sectional cohort study was conducted in which 288 patients with hip or knee OA were included. Patients were recruited from rehabilitation centres and hospitals (Departments of Orthopedics, Rheumatology or Rehabilitation). Apart from demographic and clinical data, information about limitations in activities, body functions (pain, muscle strength, range of joint motion), comorbidity and cognitive functioning was collected by questionnaires and tests. Statistical analyses included univariate and stepwise multivariate regression analysis.

Results. Self-reported limitations in activities (Western Ontario and McMaster Universities Osteoarthritis Index) were significantly associated with pain, muscle strength knee extension, range of motion (ROM) hip flexion and morbidity count. Performance-based limitations in activities (timed walking test) were significantly associated with ROM (knee flexion, hip flexion and knee extension), muscle strength hip abduction, pain, cognitive functioning and age.

Conclusions. Self-reported limitations in activities in hip or knee OA are largely dependent on pain and to a lesser extent on range of joint motion, muscle strength and comorbidity. Performance-based limitations in activities are largely dependent on range of joint motion and muscle strength, and to a lesser extent on pain, cognitive functioning and other factors. These findings point to the role of body functions in limitations in activities in OA of the hip or knee. Although less important, comorbidity and cognitive functioning play a role as well.     

Decreased strength and mobility in patients after anterior cervical diskectomy compared with healthy subjects

OBJECTIVE: To evaluate whether patients acquired normal physical function after cervical disk prolapse and surgery compared with healthy matched controls. DESIGN: Cross-sectional study. SETTING: Hospital in central Finland. PARTICIPANTS: Fifty-three patients with cervical diskectomy and 53 healthy matched controls. INTERVENTIONS: Not applicable.Main Outcome Measures: Postoperative physical function was studied by measuring muscle strength and range of motion (ROM) values of the neck and grip strength. Disability was assessed by the neck and shoulder pain index and by the Oswestry index, mood by the Short Depression Inventory; and pain on a visual analog scale (VAS). RESULTS: Most patients recovered well after the operation. Forty-three percent of the patients still experienced moderate or high pain (VAS score, >30mm). Subjective pain and disability were associated with decreased neck movement and strength. Both ROM and cervical muscle strength values were significantly lower (P<.001) in all the measured directions in cervical disk surgery patients compared with healthy controls. ROM was mostly confined in extension (25%). Muscle strength of the neck was mostly confined in both rotation directions (38%). No statistically significant difference in grip strength was found between the groups. CONCLUSION: The loss of muscle strength and ROM is clearly visible postoperatively and thus the effectiveness of the early identification and rehabilitation of these deficits merits further studies.