Evaluation of Non Diseased Specified Outcome Measures in Hand Injuries to Assess Activity and Participation Based on ICF Content

The objective of the study is to provide information about non disease specified outcome measures which evaluate disability in patients who have impairments in hand and upper extremity and to find the extent to which they are evaluating “disability” based on ICF hand Core Set (activity limitation and participation restriction). MEDLINE, CINAHL, GOOGLE SCHOLAR , OVID and SCIENCE DIRECT databases were systematically searched for studies on non disease specified outcome measures used to evaluate upper extremity function; only studies written in English were considered. We reviewed titles and abstracts of the identified studies to determine whether the studies met predefined eligibility criteria (eg, non disease specified out come measures used in hand injured patients). All the outcome measures which had eligibility included. After full text review ,7 non disease specified outcome measures in hand were identified. Studies were extracted, and the information retrieved from them. All the outcome measures which had incuded, were linked with ICF hand core set disability part (activity and participation). All of them only linked to 16 (42 %) components of ICF hand Core Set, which were most activity and less participation from ICF. None of the non disease specified out come measures in hand injuries cover all domains of disability from the ICF Hand Core Set.     

The Validity, Reliability, Responsiveness, and Bias of the Manchester-Modified Disability of the Arm, Shoulder, and Hand Score in Hand Injuries

The Manchester-Modified Disability of Arm, Shoulder and Hand questionnaire (M² DASH) was developed by the authors as a modification to the original DASH questionnaire. In this study, we assessed the validity, reliability, responsiveness, and bias of the M² DASH questionnaire for hand injuries using completed M² DASH, Patient Evaluation Measure, and Michigan Hand Outcome questionnaires from 40 patients. The M² DASH scores showed significant positive correlations with the Patient Evaluation Measure and Michigan Hand Outcome scores suggesting validity. There was also no evidence of a statistical difference in the M² DASH scores when the condition had stabilized suggesting good test–retest reproducibility and reliability. The effect size and the standardized response mean for the M² DASH score were greater than those for the Patient Evaluation Measure and Michigan Hand Outcome scores establishing that the M² DASH is highly responsive. There was no gender, hand dominance, or dominant side injured bias for the M² DASH score. There was, however, a relatively weak association between age and the M² DASH score at presentation. We conclude that the M² DASH questionnaire is a robust region-specific outcome measure. It is a valid and responsive questionnaire with test–retest reliability proven for hand injuries in this study. Gender, handedness, and side injured did not cause bias in the responses.     

Self-Reported Symptoms of Cold Intolerance in Workers with Injuries of the Hand

Cold intolerance is a well-recognized complication of crushing injuries and amputations in the hand. These symptoms are usually thought to resolve within 2 years of injury. The objectives of our study were to determine the prevalence and course over time of self-reported symptoms of cold intolerance in workers with hand injuries. Files from a large worker's compensation carrier were randomly selected from index years 2, 4, 6, and 10 after a claim was made. Cohorts comprising cases with diagnostic codes corresponding to traumatic hand injuries and codes referring to non-trauma diagnoses in the hand were assembled for each of the years under consideration. A questionnaire was mailed to a total of 7,088 asking questions related to the symptom of cold intolerance. Twenty-five percent of the surveys were returned. Over 90% of trauma patients from all 4 years reported symptoms of cold intolerance. The rate of cold intolerance in the non-trauma group was between 59% and 69%. Individuals reporting cold intolerance indicated worsening over time in 50% of cases and improvement in only 9%. The severity of injury did not appear to be a factor in the development of cold intolerance. Symptoms of cold intolerance are highly prevalent in workers with significant hand injuries. Workers with non-trauma hand conditions also report a substantial prevalence of this symptom. The development of cold intolerance is not related to injury severity. The symptoms remain either static or deteriorate slightly over time. Improvement is experienced by less than 10% of patients.     

Functional Control of the Hand in Tetraplegics Based on Residual Synergistic EMG Activity

A microprocessor controlled device (MeCFES) was used for the investigation of the possibility of restoring hand function in C5 tetraplegics with paralysis of the hand. To date, 3 tetraplegics have been testing the system. The myoelectric signals from wrist extension were recorded and used as control signals for functional electrical stimulation (FES) of thumb adduction/flexion. The results have shown that the device can improve the hand function of tetraplegics. In this part of the work, a hand function test was designed and used to assess the results.     

Measuring common outcome measures and their concepts using the International Classification of Functioning, Disability and Health (ICF) in adults with burn injury: a systematic review

Purpose

To identify and quantify the health related concepts contained in the most common outcome instruments used in adult burn care, and to compare the content of these instruments based on their linkage to the International Classification of Functioning, Disability and Health (ICF). The ICF has been validated as a reference tool by the World Health Organization and is a framework that incorporates physical, emotional, environmental and social aspects of daily functioning.

Methods

Electronic searches of MEDLINE, EMBASE CINAHL, PsychINFO and the Cochrane Library from 2003 onwards were carried out using a predetermined search strategy. Specific characteristics of the included studies and data pertaining to the outcome instruments were extracted. Two reviewers independently categorised the underlying concepts contained in the most commonly used outcome measures and linked them to ICF categories using standardised linkage rules.

Results

Out of a total 132 included studies, 151 outcome instruments were identified. Of these, 14 frequently used generic and burn-specific instruments were selected for linkage to the ICF. From the 381 items contained in the 14 instruments, 356 concepts were extracted and subsequently linked to 99 ICF categories. Nearly 46% of the concepts were linked to body function and 20% to activities and participation, whereas only a few concepts were formally linked to health condition, body structures and personal or environmental factors.

Conclusion

The ICF proved highly useful for the content comparison of frequently used generic and burn-specific instruments. The results may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies in those with burn injury.     

Exploring the relationships between International Classification of Functioning, Disability and Health (ICF) constructs of Impairment, Activity Limitation and Participation Restriction in people with osteoarthritis prior to joint replacement

Background

Hip arthroscopies are often used in the treatment of intra-articular hip injuries. Patient-reported outcomes (PRO) are an important parameter in evaluating treatment. It is unclear which PRO questionnaires are specifically available for hip arthroscopy patients. The aim of this systematic review was to investigate which PRO questionnaires are valid and reliable in the evaluation of patients undergoing hip arthroscopy.

Methods

A search was conducted in Pubmed, Medline, CINAHL, the Cochrane Library, Pedro, EMBASE and Web of Science from 1931 to October 2010. Studies assessing the quality of PRO questionnaires in the evaluation of patients undergoing hip arthroscopy were included. The quality of the questionnaires was evaluated by the psychometric properties of the outcome measures. The quality of the articles investigating the questionnaires was assessed by the COSMIN list.

Results

Five articles identified three questionnaires; the Modified Harris Hip Score (MHHS), the Nonarthritic Hip Score (NAHS) and the Hip Outcome Score (HOS). The NAHS scored best on the content validity, whereas the HOS scored best on agreement, internal consistency, reliability and responsiveness. The quality of the articles describing the HOS scored highest. The NAHS is the best quality questionnaire. The articles describing the HOS are the best quality articles.

Conclusions

This systematic review shows that there is no conclusive evidence for the use of a single patient-reported outcome questionnaire in the evaluation of patients undergoing hip arthroscopy. Based on available psychometric evidence we recommend using a combination of the NAHS and the HOS for patients undergoing hip arthroscopy.     

真皮下血管网皮瓣原位再植治疗手背皮肤逆行撕脱伤

目的探讨真皮下血管网皮瓣原位再植治疗手背皮肤逆行撕脱伤的临床效果.方法 1996年1月至2001年6月,应用真皮下血管网皮瓣原位再植治疗手背皮肤逆行撕脱伤56例.撕脱皮瓣面积为7 cm × 10 cm ～ 10 cm × 13 cm. 结果 56例移植皮瓣全部成活.术后随访3个月～ 5年,10例失访;46例的手背外形满意,再植皮瓣恢复了保护性痛觉,拇指对掌对指功能正常.2 ～ 5指的伸屈活动范围按 TAM评定标准评定,功能恢复优良者40例,占87.0%. 结论将无挫伤或轻度挫伤的手背逆行撕脱皮肤修成真皮下血管网皮瓣原位再植,是治疗手背皮肤逆行撕脱伤的有效方法之一.     

The Effect of Rotational Fixation Error of the Tibial Cutting Guide and the Distance Between the Guide and the Bone on the Tibial Osteotomy in Total Knee Arthroplasty

Computed tomography based computer simulation studies were made on fifty consecutive patients with osteoarthritis scheduled for TKA. Proximal tibial cutting was simulated with the cutting guide placed at different rotational errors (− 10°, 0°, 10° and 20° of internal rotation) and different distances (4 cm and 8 cm) between the alignment rod and the bone. Only ten degrees of rotation error with 8 cm of distance resulted in over 3° of varus or valgus tibial cut. Our study demonstrated that rotational mismatch between the proximal and distal part of the tibia should be avoided and the distance between the alignment rod and the bone should be as short as possible to achieve proper tibial alignment.     

颈髓损伤外周血淋巴细胞的表达及临床意义

目的　探讨颈髓损伤 (cervicalcordinjuries ,CCI)外周血淋巴细胞表达的相互作用及临床意义。方法　用免疫荧光标记流式细胞仪检测了 2 0例急性颈髓损伤患者外周血淋巴细胞CD19、CD3、CD4 、CD8、CD69、CD54 、CD56表达的变化 ,并与正常人群进行比较。结果　T细胞CD3、CD4 和CD4 /CD8比值显著降低 (P <0 0 1) ,而早期活化标志CD69则显著升高 (P <0 0 1)。B细胞CD19表达明显增加 ,粘附分子CD56和CD54 表达也明显增加 (P <0 0 1)。结论　以上结果提示急性颈髓损伤后机体细胞免疫功能发生明显变化 ,主要表现为T细胞的减少 ,B细胞的增加以及淋巴细胞活化抗原和粘附分子的表达增加。CCI对细胞功能造成严重损伤 ,机体免疫系统对CCI的刺激则表现为产生能力的增强和活化及粘附功能的反应性增强     

护士锐器伤与职业紧张及心理卫生关系探讨

目的了解护士锐器伤的发生与其职业紧张及心理卫生状况是否存在相关性.方法采用一般情况问卷、Mclean‘s工作紧张问卷及普通健康问卷对2868名临床护士调查过去1个月内发生锐器伤情况及工作紧张程度和心理状况,并进行相关性分析.结果1084人发生过锐器伤(受伤组),占37.8%,受伤组各职业紧张因子得分及心理卫生状况总体得分高于对照组(未发生锐器伤者,1784人),但除主动性与创造性1项因子评分两组差异有显著性意义(P＜0.05)外,其它各因子评分差异均无显著性意义.结论护士锐器伤的发生与其个性中具有较多主动性与创造性有关,与心理卫生状况及其它职业紧张因子无关.     

Exploring the facilitators and barriers to shopping mall use by persons with disabilities and strategies for improvements: Perspectives from persons with disabilities,rehabilitation professionals and shopkeepers

Persons with disabilities face challenges which impact on their ability to accomplish daily activities such as moving around, communicating and fulfilling social roles. Social participation assumes individuals with disabilities live within their community and interact with others. Shopping malls are public spaces used by individuals for various reasons. Here, all components of the social and physical environment interact and have an impact on social participation. This exploratory and qualitative study provides a multi-perspective assessment of the usability, as well as of the environmental facilitators and obstacles to social participation in shopping malls. The results also suggest necessary improvements. We interviewed 15 persons with disabilities, 15 rehabilitation professionals and 9 shopkeepers. Participants viewed the mall as a multifunctional place for everyday use, but at times, also as a limiting place. Multiple facilitators and obstacles were identified; the most important were interaction with shopkeepers and the mall's design for mobility or wayfinding. All participants agreed shopkeeper training and an improved awareness of the needs of persons with disabilities would be beneficial. Multiple stakeholders’ perceptions provide a basis for further investigation about needed changes and their potential for making malls more welcoming and inclusive to all.     

腹部带血管蒂皮瓣修复术用于手部外伤患者皮肤缺损治疗的效果及影响分析

目的 分析腹部带血管蒂皮瓣修复术用于手部外伤患者皮肤缺损治疗的效果。方法 选取2019年1月-2023年1月我院收治的100例手部外伤患者作为研究对象,对所有患者均实施腹部带血管蒂皮瓣修复术方案,根据治疗效果进行分组,分析影响疗效的相关危险因素。结果 100例手部外伤患者皮肤缺损治疗中,治疗效果理想占比89.00%,高于治疗效果较差的11.00%（P＜0.05）;治疗效果理想与治疗效果较差患者手部外伤受损原因、年龄比较,差异无统计学意义（P＞0.05）;治疗效果理想与治疗效果较差患者外伤患肢、存在并发症、手部外伤受损面积、受伤到就诊时间比较,差异有统计学意义（P＜0.05）;手部外伤患肢、存在并发症、手部外伤受损面积、受伤到就诊时间是影响手部外伤患者皮肤缺损治疗效果主要危险因素（P＜0.05）。结论 手部外伤临床较为常见,选择腹部带血管蒂皮瓣修复术对皮肤缺损治疗效果较为理想,但外伤患肢为右侧、术后存在并发症、手部外伤受损面积过大、受伤到就诊时间过长可降低治疗效果,需提高重视度,做好相关干预策略进而达到提升疗效目的。     

数字化导板引导的口腔种植修复术对牙列缺损患者牙周健康及修复美学效果的影响

的 探讨数字化导板引导的口腔种植修复术对牙列缺损患者牙周健康及修复美学效果的影 响。方法 选取2021年1月-2022年12月贵州省人民医院收治的66例牙列缺损患者为研究对象,采取随机数 字表法分为对照组和观察组,各33例。对照组予以常规修复术,观察组予以数字化导板引导的口腔种植 修复术,比较两组牙周健康指数、修复美学效果、种植成功率及术后并发症情况。结果 观察组种植后 1周龈沟出血指数、牙龈指数及菌斑指数评分均低于对照组（P＜0.05）;观察组种植后1周、6个月红色美 学评分及白色美学评分均高于对照组（P＜0.05）;观察组术后3、6、12个月的种植成功率均高于对照组 （P＜0.05）;观察组术后并发症发生率为3.03%,低于对照组的21.21%（P＜0.05）。结论 针对牙列缺损患 者,数字化导板引导的口腔种植修复术可改善其牙周健康,提高修复美学效果,且种植成功率高。     

重睑就医者社会心理因素与术后满意度相关性研究

目的:探究重睑就医者社会心理因素与术后满意度的相关性。方法:以重庆医科大学附属第一医院整形外科149例重睑就医者为研究对象。术前采用自制问卷,术后采用满意度调查问卷,术前临床访谈和术后追踪回访相结合。研究重睑就医者社会心理因素特征及其与术后满意度的相关性。结果:预期效果与手术满意程度呈现正相关,对手术效果的期待与手术满意程度呈负相关(P<0.05);手术信任度与手术满意程度呈现正相关,肿胀消退情况与手术满意程度呈现正相关,术后效果评价、术前预期效果、家人朋友对该手术满意度与术后手术者满意度呈正相关(P<0.01)。社会因素中就医者年龄、性别、职业、收入、婚姻状况、术式等与术后满意度无明显相关性。结论:重睑术后满意度评价存在较大的主观性,术前对就医者做好预期效果、手术信任度调查,针对不同调查结果做好心理护理及专业指导,同时术中、术后的肿胀预防及处理可提高术后满意度。     

Compensatory Movement Patterns Are Based on Abnormal Activity of the Biceps Brachii and Posterior Deltoid Muscles in Patients with Symptomatic Rotator Cuff Tears

BackgroundAbnormal movement patterns due to compensatory mechanisms have been reported in patients with rotator cuff tears. The long head of the biceps tendon may especially be overactive and a source of pain and could induce abnormal muscle activation in these patients. It is still unknown why some patients with a rotator cuff tear develop complaints and others do not.Questions/purposes(1) Which shoulder muscles show a different activation pattern on electromyography (EMG) while performing the Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) in patients with a symptomatic rotator cuff tear compared with age-matched controls with an intact rotator cuff? (2) Which shoulder muscles are coactivated on EMG while performing the FIT-HaNSA?MethodsThis comparative study included two groups of people aged 50 years and older: a group of patients with chronic symptomatic rotator cuff tears (confirmed by MRI or ultrasound with the exclusion of Patte stage 3 and massive rotator cuff tears) and a control group of volunteers without shoulder conditions. Starting January 2019, 12 patients with a chronic rotator cuff tear were consecutively recruited at the outpatient orthopaedic clinic. Eleven age-matched controls (randomly recruited by posters in the hospital) were included after assuring the absence of shoulder complaints and an intact rotator cuff on ultrasound imaging. The upper limb was examined using the FIT-HaNSA (score: 0 [worst] to 300 seconds [best]), shoulder-specific instruments, health-related quality of life, and EMG recordings of 10 shoulder girdle muscles while performing a tailored FIT-HaNSA.ResultsEMG (normalized root mean square amplitudes) revealed hyperactivity of the posterior deltoid and biceps brachii muscles during the upward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 111% ± 6% versus 102% ± 10%, mean difference -9 [95% confidence interval -17 to -1]; p = 0.03; biceps brachii: 118% ± 7% versus 111% ± 6%, mean difference -7 [95% CI -13 to 0]; p = 0.04), and there was decreased activity during the downward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 89% ± 6% versus 98% ± 10%, mean difference 9 [95% CI 1 to 17]; p = 0.03; biceps brachii: 82% ± 7% versus 89% ± 6%, mean difference 7 [95% CI 0 to 14]; p = 0.03). The posterior deltoid functioned less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than in the control group.ConclusionPatients with a symptomatic rotator cuff tear show compensatory movement patterns based on abnormal activity of the biceps brachii and posterior deltoid muscles when compared with age-matched controls. The posterior deltoid functions less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than the control group.Clinical RelevanceThis study supports the potential benefit of addressing the long head biceps tendon in the treatment of patients with a symptomatic rotator cuff tear. Moreover, clinicians might use these findings for conservative treatment; the posterior deltoid can be specifically trained to help compensate for the deficient rotator cuff.