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

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.

Effect of silver ring splints on hand dexterity and grip strength in patients with rheumatoid arthritis: an observational pilot study

Background

Deformities of the proximal interphalangeal joints (PIPJ) of the hand are common in patients with rheumatoid arthritis. Three-point ring splints are one of several conservative options for treating such deformities.

Methods

This observational pilot study assessed the impact of PIPJ silver ring splints (SRS) on dexterity and handgrip strength in individuals with rheumatoid arthritis. Dexterity and handgrip were measured using two standardized outcome tools, the Nine Hole Peg Test and the MIE digital grip analyser. Eight individuals who routinely wore individually tailored SRS from one rheumatology occupational therapy department were recruited into the study. Hand dexterity and grip strength was tested with and without the SRS in situ.

Results

Although differences in bilateral dexterity and handgrip strength results did not reach statistical significance ( P > 0.05) in this sample, there was a trend for dexterity and grip strength to slightly improve when SRS were worn.

Conclusions

Further research is needed to evaluate the effect of SRS on hand function especially its long-term effect on deformities.

Effectiveness of a MP-blocking splint and therapy in rheumatoid arthritis: a descriptive pilot study

The purpose was to evaluate the effect of a metacarpal phalangeal joint blocking splint combined with exercises, aimed at regaining strength, manipulative skills, and a normal pattern of movement of the hands in patients with rheumatoid arthritis (RA). All patients were measured three times: before the start of the therapy, after finishing the therapy, and at three months follow-up. Outcome measures were grip strength, pinch strength (Jamar dynamometer and pinchmeter), active range of motion (goniometer), dexterity (Sequential Occupational Dexterity Assessment [SODA]), and experienced functioning in daily life (Michigan Hand Outcome Questionnaire and Disability of Arm, Shoulder, and Hand questionnaire). The hands treated improved significantly on both total SODA score and on the pain score of the SODA. This means that the dexterity improved over time. No significant changes were found on the other outcome measures. This study indicates that intervention on the function of the hands in patients with RA who present an intrinsic-plus posture and movement pattern, improve significantly on dexterity and pain, measured by the SODA.

The 'M2 DASH'-Manchester-modified Disabilities of Arm Shoulder and Hand score

The Disability of the Arm, Shoulder, and Hand (DASH) questionnaire was originally designed as a measure of disability in patients with disorders of the upper limb, but the DASH score is also affected by disability because of lower limb disorders. The aim of this study was to investigate the construct validity of the DASH questionnaire and to create a revised DASH questionnaire, the Manchester-modified or M2 DASH, with fewer questions that is more specific to the upper limb. Patients were asked to fill in the DASH questionnaire in a fracture clinic after ethical approval. This included 79 patients with upper limb injuries, 61 patients with lower limb injuries, and 52 control subjects. The mean DASH scores for the three groups varied significantly, and the lower limb group had a mean score of 16. The M2 DASH questionnaire was developed using questions more specific to the upper limb and included questions 1-4, 6, 13-17, 21-23, and 26-30 from the original questionnaire. The mean M2 DASH score for the lower limb group was 9 and, unlike the original DASH score, was not statistically different from the control group. The M2 DASH scores were then calculated for the upper limb group and a correlation study showed highly significant correlation between the original DASH scores and the M(2) DASH scores. Our study shows that the original DASH questionnaire is not specific for the upper limb. The M2 DASH questionnaire has the advantage of being more specific for the upper limb than the DASH questionnaire, and it correlates well with the original DASH questionnaire when looking at isolated upper limb injuries.

Hand span influences optimal grip span in boys and girls aged 6 to 12 years

PURPOSE

The first aim was to determine whether there is an optimal grip span for determining the maximum hand grip strength in boys and girls aged 6 to 12 years and whether the optimal grip span was related to hand span. If so, the second aim was to derive a mathematical equation relating hand span and optimal grip span.

METHODS

A total of 123 boys (9 y +/- 2) and 70 girls (8 y +/- 2) were evaluated. Each hand was randomly tested on 10 occasions using 5 different grip spans, allowing a 1-minute rest between attempts. The hand span was measured from the tip of the thumb to the tip of the little finger with the hand opened widely.

RESULTS

An optimal grip span to determine maximum hand grip strength was identified for both genders. Hand span and optimal grip span showed a significant linear association in the studied children. The equation relating grip span as a function of hand span in boys is formulated as y = x/4 + 0.44 and in girls as y = 0.3x - 0.52, where x is the hand span (maximal width between first and fifth fingers) and y is the optimal grip span.

CONCLUSIONS

The results suggest that there is an optimal grip span to which the dynamometer should be adjusted when measuring hand grip strength in children. The optimal grip span was influenced by hand span in both genders.

Can pinch grip strength be used as a valid indicator of manual dexterity?

Outcome measurement is important in clinical practice. Manual dexterity is a relevant component of hand function and improvement in dexterity can often be a treatment aim following hand injury. However, standardized dexterity tests can be costly and time consuming to complete in busy clinical practice. Valid, quick and practical clinical indicators of broader functional performance can be a useful adjunct to outcome measurement. This study examined whether tripod pinch grip strength was a valid indicator of manual dexterity.

Thirty healthy volunteers were recruited and their tripod pinch strength was measured using the B+L pinch gauge (B and L Engineering). Manual dexterity was assessed using the Purdue Pegboard.

There were strong, statistically signifi cant correlations between pinch strength and manual dexterity for males but not for females in this healthy sample. Tripod pinch grip could be used as a valid indicator for manual dexterity for males but the relationship between dexterity and pinch grip differs between sexes.

Direct, quantitative clinical assessment of hand function: usefulness and reproducibility

Methods of assessing functional impairment in arthritic hands include pain assessments and disability scoring scales which are subjective, variable over time and fail to take account of the patients' need to adapt to deformities. The aim of this study was to evaluate measures of functional strength and joint motion in the assessment of the rheumatoid (RA) and osteoarthritic (OA) hand. Ten control subjects, ten RA and ten OA patients were recruited for the study. All underwent pain and disability scoring and functional assessment of the hand using measures of pinch/grip strength and range of joint motion (ROM). Functional assessments including ROM analyses at interphalangeal (IP), metacarpophalangeal (MCP) and wrist joints along with pinch/grip strength clearly discriminated between patient groups (RA vs. OA MCP ROM P<0.0001), pain and disability scales were unable to. In the RA there were demonstrable relationships between ROM measurements and disability (R2=0.31) as well as disease duration (R2=0.37). Intra-patient measures of strength were robust whereas inter-patient comparisons showed variability. In conclusion, pinch/grip strength and ROM are clinically reproducible assessments that may more accurately reflect functional impairment associated with arthritis.

Hand disability and related variables in patients with rheumatoid arthritis

OBJECTIVE

To carry out a cross-sectional study of patients with rheumatoid arthritis (RA) for hand disability, articular damage and to define their relation with demographic, laboratory and clinical parameters.

METHODS

The study included 105 RA patients with a mean age of 49.4 years. Demographic parameters of the patients were recorded. Clinical parameters including disease duration, duration of morning stiffness, pain assessed by visual analog scale, Ritchie Articular Index, grip strength, lateral, tip and three-fingered pinch, and laboratory parameters comprising C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor were evaluated in all patients. The Rheumatoid Arthritis Articular Damage (RAAD) score was used to assess the irreversible articular damage and deformities of the hand. Hand disability was assessed by the special hand disability index of Standford Health Assessment Questionnaire (HAQ).

RESULTS

Hand disabilities of various levels were detected in 81% of the patients. Disease duration, grip strength, pinch measurements, clinical and laboratory activity parameters were strongly correlated with hand disability (p<0.01). Hand disability was more related to disease activity parameters than articular damage (p<0.01 and p<0.05, respectively). Grip strength and pinch measurements were the most related parameters with hand disability. The disability scores were significantly higher in female patients (p<0.01). The RAAD score was correlated with disease duration and grip strength (p<0.01). The clinical and laboratory parameters and seropositivity were not correlated with articular damage assessed by RAAD score (p>0.05).

CONCLUSION

Our data suggest that grip strength and pinch measurements seem to be the most related variables with hand disability and articular damage. Therefore, grip strength and pinch measurement should be included in the evaluation and follow-up of the patients with RA in hand rehabilitation units.

Static orthoses in the prevention of hand dysfunction in rheumatoid arthritis: a review of the literature

Static orthoses are recommended for individuals who have early rheumatoid arthritis (Scottish Intercollegiate Guidelines Network, 2002; College of Occupational Therapists, 2003). These orthoses aim to rest and immobilize weakened joint structures and decrease local inflammation (Janssen et al., 1990; Nicholas et al., 1982); correctly position joints (Nordenskiöld, 1990; Ouellette, 1991); minimize joint contractures (McClure et al., 1994); increase joint stability (Kjeken et al., 1995); relieve pain (Feinberg, 1992; Callinan and Mathiowetz, 1996; Kjeken et al., 1995) and improve function (Janssen et al., 1990; Pagnotta et al., 1998; Nordenskiöld, 1990). Wrist and hand orthoses have been routinely prescribed for individuals with rheumatoid arthritis (RA) for the last 30 years with limited evidence that they are effective in achieving their purported aims. This article reviews the possible deterioration in hand structure that can occur in RA and discusses the theoretical basis for the application of static orthoses in RA. The evidence for the effectiveness of four commonly used static orthoses is then examined.